Underage drinking: frequency, consequences, and interventions

OBJECTIVES: To examine the frequency of underage drinking, driving after drinking and alcohol-related crashes, trends in these behaviors, and promising interventions. METHODS: We examined drinking and drinking- and-driving behaviors reported in the United States in the 2001 U.S. National Household Survey of Drug Abuse, the Centers for Disease Control and Prevention 2001 Youth Risk Behavior Survey, the 1992 National Longitudinal Alcohol Epidemiologic Study, and the 1999 National Survey of Drinking and Driving conducted for the National Highway Traffic Administration. We also examined the 1999 European School Survey Project on Alcohol and Other Drugs. Alcohol-related fatal crashes were examined from the U.S. Fatality Analysis Reporting System. Evaluation of interventions to reduce teenage drinking and driving after drinking were reviewed. RESULTS: In the United States, 19% of youth ages 12-20 consumed five or more drinks on an occasion in the past 30 days. Although European nations have lower legal drinking ages (16-18) than in the United States (21), similar proportions engage in underage drinking. In two-thirds of European countries, a greater percentage of 15-16 year-olds drank five or more drinks on an occasion in the past month than in the United States. In both the United States and Europe, the earlier people begin to drink, the greater the likelihood of developing alcohol dependence and other alcohol-related problems, including alcohol-related crash involvement, during adolescence and adult years. During the past 20 years alcohol-related traffic deaths among people younger than 21 have been cut in half in the United States, but progress has halted since 1995 and the problem is still large. Interventions shown by research to reduce alcohol-related crashes among youth include raising the legal drinking age to 21, zero tolerance laws, and some interventions that are family, school, or community based. CONCLUSIONS: Despite research showing that a variety of interventions can reduce underage drinking and alcohol-related crash fatalities, the frequency of these behaviors remains high and the average age of drinking initiation is declining in the United States. Efforts are needed to enhance publicized enforcement of underage drinking laws. Comprehensive community interventions that include enforcement of these laws also are needed.     

The prevention of young driver's DWI (driving while intoxicated) and RWDI (riding with a driver under influence) in Europe: a social-sequential model

Inspired by the "critical incident technique" of McKnight et al. (1995) who analyzed 12,000 drivers' decisions leading to (or not to) DWI, and identified the influence of social, motivational, and economic factors, we have developed a social-sequential model of young drivers' DWI (driving while intoxicated) and RWDI (riding with a driver under influence) prevention. DWI or RWDI may be analyzed as a four-stage process: (1) the decision to drink and to associate leisure activities with drinking; (2) the management of alcohol consumption during the evening; (3) the decision to drive after drinking; and (4) the behavioral adaptation, once the decision to drive is taken (disinhibition of risk-taking or risk compensation). At each of these four stages, preventive action can reflect the intervention of two types of actors: (1) formal social control of behavior is influenced by professionals involved in accident prevention, and (2) informal social control of behavior is influenced by the proximal environment of the subject.