HOW DOES ALCOHOL AFFECT
THE WORLD OF A CHILD

Note: You may order the hard copy of How Does Alcohol Affect the World of the Child? on the Leadership's publication page.

Because we are constantly updating our web pages to incorporate the most recent statistics, there may be some differences between the statistics in our published documents and those on the Web site. Please note that the Web site statistics are always our most current.

FAMILY

"I've seen alcohol at work in my family and that's enough for a lifetime. I'm not drinking." -Matthew, Michigan

• Approximately one in four children is exposed to family alcoholism or addiction, or alcohol abuse, some time before the age of 18.¹
• Current research suggests children are less likely to drink when their parents are involved with them and when they and their parents report feeling close to each other.^{2, 3}
• Adolescents drink less and have fewer alcohol-related problems when their parents discipline them consistently and set clear expectations.²
• Children of alcoholics are significantly more likely to initiate drinking during adolescence and to develop alcohol use disorders.⁴
• Parents' drinking behaviors and favorable attitudes about drinking have been associated with adolescents' initiating and continuing drinking.^2,5,6
• Any drinking during pregnancy, even "social drinking," can put offspring at risk for learning and behavioral problems during adolescence.⁷

1 Grant BF. 2000. Estimates of US children exposed to alcohol abuse and dependence in the family. American Journal of Public Health 90(1):112-115.
2 Hawkins JD, Graham JW, Maguin E, et al. 1997. Exploring the effects of age of alcohol use initiation and psychosocial risk factors on subsequent alcohol misuse. Journal of Studies on Alcohol 58(3):280-290.
3 Resnick MD, Bearman PS, Blum RW, et al. 1997. Protecting adolescents from harm: Findings from the National Longitudinal Study on Adolescent Health. Journal of the American Medical Association 278(10):823-832.
4 National Institute on Alcohol Abuse and Alcoholism. 1997. Youth Drinking: Risk Factors and Consequences. Alcohol Alert No. 37.
5 Andrews JA, Hops H, Ary D. 1993. Parental influence on early adolescent substance use: Specific and nonspecific effects. Journal of Early Adolescence 13(3):285-310.
6 Ary DV, Tildesley E, Hops H. 1993. The influence of parent, sibling, and peer modeling and attitudes on adolescent use of alcohol. International Journal of the Addictions 28(9):853-880.
7 Olson HC, Streissguth AP, Sampson PD, et al. 1997. Association of prenatal alcohol exposure with behavioral and learning problems in early adolescence. Journal of the AmericanAcademy of Child and Adolescent Psychiatry 36(9):1187-1194.

THE CHILD

"Parents must understand that they are the first line of defense in raising healthy children." -Peggy Sapp, President, National Family Partnership

• Sixty-eight percent of eighth graders and 85 percent of tenth graders believe that alcohol is readily available to them for consumption.¹
• Forty percent of ninth-grade students reported having consumed alcohol before they were age 13. In contrast, only 26.2 percent of ninth graders reported having smoked cigarettes, and 11.6 percent reported having used marijuana before they were age 13.²
• Forty-one percent of ninth-grade students reported drinking in the past month, while only 24 percent reported smoking in the past month.²
• More than one-fifth of eighth graders and 44 percent of tenth graders have been drunk at least once.¹
• Almost one-fourth of ninth graders reported binge drinking (having had five or more drinks on one occasion) in the past month.²
• Rates of drinking differ among racial and ethnic minority groups. Among students in grades 9 to 12, binge drinking was reported by 34 percent of non-Hispanic white students, 11 percent of African American students, and 30 percent of Hispanic students.²
• The gap between alcohol use by boys and girls has closed. Among ninth graders, girls consume alcohol and binge drink at rates almost equal to boys.
• More than 40 percent of individuals who start drinking before the age of 13 will develop alcohol abuse or alcohol dependence at some point in their lives.³
• If drinking is delayed until age 21, a child's risk of serious alcohol problems is decreased by 70 percent.⁴

1 Johnston LD, O'Malley PM, Bachman JG. 2003. Monitoring the Future national results on adolescent drug use: Overview of key findings, 2002. Bethesda, MD: National Institute on Drug Abuse.
2 Centers for Disease Control and Prevention. 2002. Youth Risk Behavior Surveillance United States, 2001. Morbidity and Mortality Weekly Report: CDC Surveillance Summaries 51(SS-4):1-64.
3 Grant BF, Dawson DA. 1997. Age at onset of alcohol use and its association with DSM-IV alcohol abuse and dependence. Results from the National Longitudinal Alcohol Epidemiologic Survey. Journal of Substance Abuse 9:103-110.
4 Calculated from information contained in: Grant BF, Dawson DA. 1997. Age at onset of alcohol use and its association with DSM-IV alcohol abuse and dependence. Results from the National Longitudinal Alcohol Epidemiologic Survey. Journal of Substance Abuse 9:103-110.

COMMUNITY

"Alcohol is the number one drug of choice among our Nation's youth. Yet the seriousness of this issue does not register with the general public or policymakers." -Enoch Gordis, M.D., Director, National Institute on Alcohol Abuse and Alcoholism

• An overwhelming number of Americans (96 percent) are concerned about underage drinking, and a majority support measures that would help reduce teen drinking, such as stricter controls on alcohol sales, advertising, and promotion.¹
• Recent advertising expenditures in the United States for beer, wine, and liquor combined ($1.4 billion) totaled about 20 times the amount spent on milk ads ($70.5 million). A total of $910.4 million was spent on beer ads, $135.2 million on wine ads, and $377 million on liquor ads.^{2, 3}
• A study of fifth- and sixth-grade students found that those who demonstrated an awareness of beer ads also held more favorable beliefs about drinking and intended to drink more frequently when they grew up.⁴
• One study of midwestern States found that 46 percent of ninth graders who reported drinking alcohol in the previous month said they obtained the alcohol from a person aged 21 or older.⁵
• In a study conducted in 38 States and the District of Columbia, areas with greater numbers of drinking establishments had higher rates of alcoholism.⁶
• The National Highway Traffic Safety Administration estimates that the 21-year-old minimum drinking age laws have saved 20,043 lives since the mid-1970s.⁷
• Among drivers aged 15 to 20, fatal crashes involving a single vehicle at night are three times more likely than other fatal crashes to be alcohol-related.⁸

1 Wagenaar AC, Harwood E, Bernat D. 2002. The Robert Wood Johnson Foundation 2001 Youth Access to Alcohol Survey: Summary Report. Minneapolis: University of Minnesota, Alcohol Epidemiology Program.
2 Adams Business Research. Adams Liquor Handbook 2001. Adams Wine Handbook 2001. Adams Beer Handbook 2001. New York: Adams Business Media.
3 Blisard N, Balyney D, Chandran R, et al. 1999. Analyses of Generic Dairy Advertising, 1984-97. Technical Bulletin No. 1873. Washington, DC: US Department of Agriculture, Food and Rural Economics Division, Economic Research Service.
4 Grube JW, Wallack L. 1994. Television beer advertising and drinking knowledge, beliefs, and intentions among schoolchildren. American Journal of Public Health 84(2):254-259.
5 Wagenaar AC, Toomey TL, Murray DM. 1996. Sources of alcohol for underage drinkers. Journal of Studies on Alcohol 57(3):325-333.
6 Harford TC, Parker D, Paulter C, et al. 1979. Relationship between the number of on-premise outlets and alcoholism. Journal of Studies on Alcohol 40(11):1053-1057.
7 National Highway Traffic Safety Administration. 2001. Traffic Safety Facts 2000 - Alcohol. Washington, DC: US Department of Transportation.
8 Hingson R, Heeren T, Winter M. 1994. Lower legal blood alcohol limits for young drivers. Public Health Reports 109(6):738-744.

SCHOOL

"Alcohol almost destroyed my life. I started out drinking with my friends, trying to be cool. I drank to get drunk . . . and I did some stupid things while I was drunk. Now I'm trying to get my life back, and it's not easy with a baby." -Amy, Colorado

• Evidence suggests that alcohol use by peers is a strong predictor of adolescent use of alcohol.¹
• According to a 1995 National survey of fourth through sixth graders who read the Weekly Reader, 30 percent of students reported that they received "a lot" of pressure from their classmates to drink beer.²
• According to this same 1995 Weekly Reader survey, more than half (54 percent) of fourth through sixth graders reported learning about the dangers of illicit drugs at school, but fewer than a third (30 percent) learned about the dangers of drinking and smoking at school.²
• Among eighth graders, students with higher grade point averages reported less alcohol use in the past month.³
• Research indicates that adolescents who abuse alcohol may remember 10 percent less of what they have learned than those who don't drink.⁴
• Among eighth graders, higher truancy rates were associated with greater rates of alcohol use in the past month.³
• One National study found that students are less likely to use alcohol if they are socially accepted by people at school, and feel that teachers treat students fairly.⁵
• In a survey of seventh- through twelfth-grade teachers, 76 percent felt that underage student drinking was a serious or somewhat serious problem.⁶

1 Hawkins JD, Graham JW, Maguin E, et al. 1997. Exploring the effects of age of alcohol use initiation and psychosocial risk factors on subsequent alcohol misuse. Journal of Studies on Alcohol 58(3):280-290.
2 The Weekly Reader. 1995. National Survey on Drugs and Alcohol. Middletown, CT: Field Publications.
3 O'Malley PM, Johnston LD, Bachman JG. 1998. Alcohol use among adolescents. Alcohol Health & Research World 22(2):85-93.
4 Brown SA, Tapert SF, Granholm E, et al. 2000. Neurocognitive functioning of adolescents: Effects of protracted alcohol use. Alcoholism: Clinical and Experimental Research 24(2):164-171.
5 Resnick MD, Bearman PS, Blum RW, et al. 1997. Protecting adolescents from harm: Findings from the National Longitudinal Study on Adolescent Health. Journal of the American Medical Association 278(10):823-832.
6 Metropolitan Life/Louis Harris Associates, Inc. 1996. The Metropolitan Life Survey of the American Teacher, 1984-1995. Cited in Department of Education. Digest of Education Statistics, 1996. Washington, DC: National Center for Education Statistics.

IMPACT ON CHILDREN'S
HEALTH AND SAFETY

"Underage alcohol use is a significant threat to the health and safety of our children. It is time for us to come to grips with this widespread, devastating public health problem." -Steven A. Schroeder, M.D., President/CEO, The Robert Wood Johnson Foundation

• In a 2001 survey, 30 percent of ninth graders reported having ridden in a car driven by someone who had been drinking alcohol. Nearly 7 percent of ninth graders reported driving one or more times while drinking.1
• Of all children under age 15 killed in vehicle crashes in 2000, 20 percent were killed in alcohol-related crashes.²
• Among 12- to 17-year-old current drinkers, 31 percent had extreme levels of psychological distress, and 39 percent exhibited serious behavioral problems.³
• Twenty-eight percent of the suicides by children ages 9 to 15 could be attributed to alcohol.⁴
• Current drinkers among a nationally representative sample of youth aged 12 to 16 had higher levels of diastolic blood pressure than did their nondrinking counterparts.⁵
• Twelve- to sixteen-year-old girls who are current drinkers are four times more likely than their nondrinking peers to suffer from depression.⁶
• Adolescent females who drink exhibit higher levels of estradiol (an estrogen) and testosterone than nondrinking girls. High levels of estrogen may contribute to increased risk for specific diseases, including breast cancer; high levels of testosterone are associated with an increased risk of substance use.⁷

1 Centers for Disease Control and Prevention. 2002. Youth Risk Behavior Surveillance United States, 2001. Morbidity and Mortality Weekly Report: CDC Surveillance Summaries 51(SS-4):1-64.
2 National Highway Traffic Safety Administration. 2001. Traffic Safety Facts 2000 - Children. Washington, DC: US Department of Transportation.
3 Substance Abuse and Mental Health Services Administration. 1999. The Relationship Between Mental Health and Substance Abuse Among Adolescents. Rockville, MD: Substance Abuse and Mental Health Services Administration.
4 Unpublished data extrapolated by National Institute on Alcohol Abuse and Alcoholism from State Trends in Alcohol Mortality, 1979-1992. 1996. US Alcohol Epidemiolgic Data Reference Manual, Volume 5; Rockville, MD: NIAAA.
5 Hanna EZ, Dufour MC, Yi H, et al. Drinking, smoking, and blood pressure: Do their relationships among youth foreshadow what we know among adults? Paper presented at the American Public Health Association Annual Meeting, November 1999, Chicago, IL.
6 Hanna EZ, Hsaio-Ye Y, Dufour M. The relationship of drinking alone and other substance use alone and in combination to health and behavior problems among youth aged 12-16: Findings from the Third National Health and Nutrition Survey (NHANES III). Paper presented at the 23rd Annual Scientific Meeting of the Research Society on Alcoholism, June 24-29, 2000, Denver, CO.
7 Martin CA, Mainous AG, Curry T. 1999. Alcohol use in adolescent females: Correlates of estradiol and testosterone. American Journal on Addiction 8(1):9-14.

IMPACT ON SOCIETY

• Approximately 14 million Americans-about 7.4 percent of the adult population-meet the diagnostic criteria for alcohol abuse or alcoholism.¹
• More than one-half of American adults have a close family member who has or has had alcoholism.²
• Research was conducted in 1998 to determine the total cost attributable to the consequences of underage drinking. The cost was more than $58 billion per year, based on year 2000 dollars.³
• In 1992, the estimated productivity loss for employees with past or current alcoholism was $66.7 billion. Productivity losses were greatest for male employees who initiated drinking before age 15.⁴
• In a survey of 18- to 24-year-old current drinkers who failed to complete high school, nearly 60 percent had begun to drink before age 16.⁵
• In 1999, the average American drank 32 gallons of beer compared with 51 gallons of soft drinks, 24 gallons of milk, and 26 gallons of coffee.⁶
• Men who consume more than two alcoholic drinks per day are at increased risk for cancer, cerebrovascular disease, accidents, and violence.⁷
• Long-term heavy alcohol use is the leading cause of illness and death from liver disease in the U.S.⁷
• Alcohol is implicated in more than 100,000 deaths annually.⁸
• In 1996, about 2 million (38 percent) of the estimated 5.3 million convicted offenders under the jurisdiction of corrections agencies were drinking at the time of the offense.⁹

1 Grant BF, Harford TC, Dawson DA, et al. 1994. Prevalence of DSM-IV alcohol abuse and dependence: United States, 1992. Alcohol Health & Research World 18(3):243-248.
2 Dawson DA, Grant BF. 1998. Family history of alcoholism and gender: Their combined effects on DSM-IV alcohol dependence and major depression. Journal of Studies on Alcohol 59(1):97-106.
3 Pacific Institute for Research and Evaluation. Costs of Underage Drinking, prepared September 5, 2002.
4 Harwood H, Fountain D, Livermore G. 1998. The Economic Costs of Alcohol and Drug Abuse in the United States, 1992. Rockville, MD: National Institute on Drug Abuse.
5 National Institute on Alcohol Abuse and Alcoholism. 1998. Drinking in the United States: Main Findings from the 1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES). US Alcohol Epidemiologic Data Reference Manual, Volume 6. Rockville, MD: NIAAA.
6 US Census Bureau. 2002. Statistical Abstract of the United States, 2001 (121st ed.). Washington, DC: US Census Bureau.
7 National Institute on Alcohol Abuse and Alcoholism. 2000. 10th Special Report to the US Congress on Alcohol and Health. Rockville, MD: NIAAA.
8 McGinnis JM, Foege WH. 1993. Actual causes of death in the United States. Journal of the American Medical Association 270(18):2207-2212.
9 US Department of Justice, Bureau of Justice Statistics. 1998. Alcohol and Crime: An Analysis of National Data on the Prevalence of Alcohol Involvement in Crime.
(NCJ-168632). Washington, DC: Department of Justice.

ASK YOURSELF

As Parents

• Do you know how to discuss alcohol use with your child and where to get information to help you?
• Do you know your child's friends, and do you feel that they provide positive influences on your child's activities?
• Do you know the extent of drinking by children in your neighborhood and how to find local organizations that are working on the issue?
• Do you know the legal consequences if your child is caught drinking alcohol?
• Do you know your State's laws about providing alcohol to anyone under 21?

As Teachers, Administrators, and School Counselors

• Has your school or community assessed student drinking to determine the extent of the problem?
• Do you know what factors may be contributing to student drinking in your school or community (e.g., easy access to alcohol, peer pressure, adults' failure to address the issue)?
• Do you know what steps, if any, are being taken within your school system to help kids resist the pressure to drink?
• Is your school currently working to educate parents about alcohol use among children?
• Does your school have an active partnership with the families of its students?

As Concerned Citizens

• Do you know how easily children in your community can obtain alcohol and what communities can do to prevent access to alcohol by young people?
• Does your community have educational programs and policies to prevent children from drinking?
• Does your community have "alcohol-free" events? If not, do you know how to initiate them?
• Is there collaboration among public and private schools, community businesses, local government, and the police force to develop and enforce policies related to youth alcohol use?

Founders: National Institute on Alcohol Abuse and Alcoholism and The Robert Wood Johnson Foundation
Additional Funding Agencies: Office of Research on Women's Health/National Center on Minority Health and Health Disparities/Office of Juvenile Justice and Delinquency Prevention/Substance Abuse and Mental Health Services Administration/National Highway Traffic Safety Administration

For more information contact: leadership@alcoholfreechildren.org

NIH Publication No. 99-4670 Updated January 2003