• Defining "young people"
• Social considerations
• Health considerations
• Implications for policy and prevention
• Conclusions
• Policy options
• References

Drinking among young people is an issue of public health and policy concern in countries around the world. Not all young people drink and, among those who do, not all do so in a harmful way. However, certain drinking patterns and general risk-taking behavior among youths may place them at considerable risk for harm. Efforts to ensure that this risk is minimized are a key objective of prevention approaches aimed at this population group.

Defining “young people”

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When it comes to the consumption of beverage alcohol, there is currently no consensus regarding the age threshold at which an individual ceases to be a “young person” and becomes an adult. A World Health Organization (WHO) Study Group has defined a young person as someone between the ages of 10 and 24 years (World Health Organization, 1986, pp. 11-12). For the purposes of alcohol consumption, a number of countries have a legally mandated threshold around drinking, which may or may not coincide with the age of majority for other activities (International Center for Alcohol Policies, 1998/2002; World Health Organization, 2004; see also MODULE 12: Legal Age Limits; a regularly updated table listing minimum age limits in different countries is available from the Policy Issues: Young People's Drinking section of the ICAP website).

In developing policy and prevention approaches, it is important to differentiate between young people who are above the legal drinking age and those below it. The legal implications of drinking are different for the two groups, as well as for those who sell and serve them alcohol.

Social considerations

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Internationally, experiences with alcohol are relatively common among young people. Drinking before adulthood, however, is generally discouraged in most countries, although young people may be introduced to alcohol at an earlier age in some societies, typically within the family and in the context of meals or celebrations. Such integrative and relatively permissive approach to drinking is commonly found in cultures with a “Mediterranean” drinking style (e.g., Araoz, 2004; Heath, 1995, 2000).

In general, studies have shown that young males are more likely to drink and do so in higher quantities than young females. However, recent data suggest that in some countries the gender gap among young people is narrowing, with girls and young women “catching up” with their male peers (Hibell et al., 2000, 2004; Higuchi, Suzuki, Matsushita, & Osaki, 2004; McPherson, Casswell, & Pledger, 2004; Office for National Statistics, 2004; M. A. Plant, 2004; M. L. Plant, 1997; M. L. Plant & M. A. Plant, 2001; M. L. Plant, M. A. Plant, & Mason, 2002; Wilsnack & Wilsnack, 1997). These findings include not only the quantity of alcohol consumption but also frequency and drinking patterns.

Comparative studies across countries suggest that overall drinking culture is an important determinant of how young people drink. Within Mediterranean cultures, for example, young people are more likely to drink and drink more often than their counterparts in other regions (Currie et al., 2004; Hibell et al., 2000, 2004; Norström, 2002). At the same time, they are also less likely to engage in excessive and extreme drinking patterns, to get drunk, or to display otherwise problematic drinking behaviors. By contrast, their counterparts in Scandinavia are more likely to drink in a problematic and risky way. These results, coupled with other findings (Araoz, 2004; Choquet, 2004; Heath, 2000), suggest that culture plays a prominent role in setting norms and expectancies around drinking, including young people’s drinking.

In addition to culture, other key factors help shape young people’s attitudes toward alcohol consumption. For example:

• Parental influence and drinking habits play a strong role in shaping drinking behavior in young people (e.g., Donovan et al., 2004; Hellandsjo Bu, Watten, Foxcroft, Ingebrigtsen, & Relling, 2002; Milgram, 2001; Wood, Read, Mitchell, & Brand, 2004).
• Family structure can be a protective or a risk factor in the development of drinking patterns. Young people who have a close relationship with their parents and are surrounded by strong family support are less likely to experience problems than those whose families are not intact or who lack adult support and supervision (Bjarnason et al., 2003; Hellandsjo Bu et al., 2002; Milgram, 2001; Sanchez-Sosa & Poldrugo, 2001; Turrisi, Wiersma, & Hughes, 2000; Vakalahi, 2001; Wood et al., 2004).
• Peers and friends also play an important role in young people’s decisions on whether and how to drink (Andrews, Tildesley, Hops, & Li, 2002; Arata, Stafford, & Tims, 2003; Borsari & Carey, 2001; Geckova & van Dijk, 2001; Hellandsjo Bu et al., 2002; Milgram, 2001; Miller & M. A. Plant, 2003; Wood et al., 2004).
• Religiosity and active religious involvement appear to have a protective effect on young people’s drinking (Borynski, 2003; Kerestes, Youniss, & Metz, 2004; Mason & Windle, 2002).
• In general, young people involved in extracurricular activities are less likely to have problems with alcohol (Eccles & Barber, 1999), although some evidence exists that youths participating in sports may be more prone to risky drinking practices (Leichliter, Meilman, Presley, & Cashin, 1998; Nelson & Wechsler, 2001).

Drinking during adolescence may be a predictor of future alcohol abuse and other risky behaviors (Grant & Dawson, 1997; Grant, Stinson, & Harford, 2001; Gruber, DiClemente, Anderson, & Lodico, 1996; Hawkins et al., 1997). However, there is a debate as to whether beginning to drink at an earlier age itself increases the likelihood of harmful tendencies in adulthood (e.g., Hawkins et al., 1997; McGue, Iacono, Legrand, Malone, & Elkins, 2001; Prescott & Kendler, 1999). It may be that early drinking is not the cause but an indicator of other problems and may be coupled with a number of factors and behaviors, such as family troubles or mental illness (McGue et al., 2001; Prescott & Kendler, 1999).

While alcohol consumption among young people is an area of concern for a variety of social and health reasons, there is also evidence that the majority of youths grow out of their harmful and reckless drinking patterns over time (Chassin, Pitts, & Prost, 2002; Johnston, O'Malley, Bachman, & Schulenberg, 2004; O'Neill, Parra, & Sher, 2001; Schulenberg, O'Malley, Bachman, Wadsworth, & Johnston, 1996). In general, as responsibilities associated with employment, marriage, and children take on a larger role, drinking tends to decrease, as do problems in most people (Bachman, Safron, Sy, & Schulenberg, 2003; Bachman, Wadsworth, O'Malley, Johnston, & Schulenberg, 1997; O'Malley, Bachman, Johnston, & Schulenberg, 2004).

Much attention has been given to research on heavy episodic (or “binge”) and related drinking patterns among young people. These behaviors have been studied particularly well among student populations (e.g., Hibell et al., 2000, 2004; Johnston et al., 2004; Substance Abuse and Mental Health Services Administration, 2004; Wechsler et al., 2002). Social consequences of such consumption include negative effects on studies and academic achievement, family conflict, and risky sexual behavior (see MODULE 6: Binge Drinking; see also Brown & Tapert, 2004; Grunbaum et al., 2002; Hingson & Kenkel, 2004; Jennison, 2004; Perkins, 2002).

Health considerations

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As for adults, heavy and abusive drinking patterns by young people are related to a number of negative health outcomes (e.g., Brown & Tapert, 2004; Jennison, 2004). In comparison to adults, however, youths have a greater sensitivity to the effects of alcohol due to developmental changes that occur during childhood and adolescence, potentially resulting in greater risk of physiological damage (e.g., Brown & Tapert, 2004; Spear, 2004).

Several areas have been identified where risk for harm may be increased for young people. The developing brain appears to be more sensitive to disruption by chronic drinking than the mature adult brain (Spear, 2004). As a result, heavy consumption during adolescence may affect the development of certain brain regions (Brown, Tapert, Granholm, & Delis, 2000; Tapert et al., 2001), including the hippocampus, involved in learning and memory (De Bellis et al., 2000). In addition, animal and human studies suggest that early heavy alcohol use may have a number of deleterious effects on bone (Klein, 1997; Sampson, Gallager, Lange, Chondra, & Hogan, 1999), growth and endocrine development (Dees, Dissen, Hiney, Lara, & Ojeda, 2000; Frias, Rodriguez, Torres, Ruiz, & Ortega, 2000).

In addition, alcohol abuse and harmful drinking patterns among young people are correlated with injuries, for example as a result of acute intoxication, traffic crashes, or assault (Hingson, Heeren, Winter, & Wechsler, 2005; Smith, Branas, & Miller, 1999; Turner & Shu, 2004). Alcohol-impaired driving among youths accounts for a large proportion of those hurt or killed in road traffic crashes (see MODULE 15: Drinking and Driving; Hingson, Heeren, Zakocs, Kopstein, & Wechsler, 2002; National Highway Traffic Safety Administration, 2004). In addition, for some young people, risky sexual behavior may accompany drinking: unwanted pregnancy, sexually transmitted diseases, and sexual assault and date rape have all been reported for this population (Grunbaum et al., 2002; Harrington & Leitenberg, 1994; Mohler-Kuo, Dowdall, Koss, & Wechsler, 2004).

Another area for concern is prenatal exposure to high levels of alcohol due to maternal drinking patterns. Such exposure has been associated with a range of developmental problems in children and adolescents that may persist into adulthood. These include fetal alcohol syndrome (FAS) and other conditions (see MODULE 10: Drinking and Pregnancy; Florey, 1992; Institute of Medicine, 1996; M. L. Plant, Abel, & Guerri, 1999; Werler, Lammer, Rosenberg, & Mitchell, 1991).

A number of risk factors for alcohol abuse among young people may be identified. Genetic predisposition may play a role in the development of alcohol dependence (e.g., Begleiter & Porjesz, 1999; Schuckit, 1999) and in relative insensitivity to the effects of alcohol (Heath et al., 1999; Schuckit, 1994). Alcohol problems in some youths may be related to heavy maternal drinking during pregnancy (Baer, Sampson, Barr, Connor, & Streissguth, 2003; Yates, Cadoret, Troughton, Stewart, & Giunta, 1998). Various other stressors and environmental factors, like living with a parent who is an alcohol abuser (Chassin, Curran, Hussong, & Colder, 1996) or heavy drinking within the immediate peer group (Arata et al., 2003; Borsari & Carey, 2001; Kypri & Langley, 2003; Wood et al., 2004), may also contribute to alcohol problems in young people. However, youths are generally responsive to treatment and intervention and targeted approaches have been developed to specifically meet their needs (see MODULE 17: Alcohol Dependence and Treatment and MODULE 18: Early Identification and Brief Intervention).

Implications for policy and prevention

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A variety of measures has been implemented around the world to limit drinking among young people. Yet how best to reduce risks among this population remains, at best, uncertain. No single strategy has been shown to be successful in all settings, and combined initiatives targeting particular behaviors or aspects of drinking may be a more useful approach.

Prevention and intervention measures range from limiting young people’s access to alcohol (e.g., through drinking age laws) to educating them about drinking patterns, outcomes, and coping skills. Approaches also differ with regard to the desired end goal—from, in some cases, complete abstinence to encouraging responsible consumption and minimizing risk (for review, see International Center for Alcohol Policies, 2004). Both approaches have strengths and weaknesses, but recent years have seen a gradual shift in alcohol policy from measures that address entire populations to those that target specific drinking behaviors and minimize harm for groups at risk.

Minimum age limits

Many countries where alcohol consumption is legal mandate a threshold age at which buying or drinking alcohol becomes permitted (International Center for Alcohol Policies, 2002/1998; World Health Organization, 2004). There is no universal agreement, however, on the exact age when alcohol consumption is considered appropriate. Legislation tends to reflect the prevailing cultural attitudes toward alcohol and drinking by young people. As a policy measure, the implementation of a minimum drinking age is only effective if it is enforced and if other measures, such as education, accompany it (see MODULE 12: Legal Age Limits and MODULE 15: Drinking and Driving).

Alcohol education

Further controversy surrounds explanations of how young people learn to drink and what influences their drinking (Houghton & Roche, 2001). A variety of factors may contribute to an adolescent’s first contact with alcohol and to the development of a subsequent drinking pattern: family, peers, cultural and religious norms, media, and government policies. Strong evidence points to family and peers as the primary forces in the early formation of drinking behavior (e.g., Milgram, 2001; Sanchez-Sosa & Poldrugo, 2001), but there is considerable debate around the effect of advertising on perception and behavior of children and youths (Grube, 2004).

There is evidence that alcohol education can raise awareness among young people and, in some cases, change their behavior around drinking (International Center for Alcohol Policies, 2004). Several approaches have shown particular promise. The social norms approach relies on changing perceptions among young people about how much their peers actually do—and do not—drink (see MODULE 3: Social Norms Marketing; see also Mattern & Neighbors, 2004; Perkins, 2003; Perkins & Craig, 2002). Integrative education that also includes family and the community has been found to be particularly effective (Ashery, Robertson, & Kumpfer, 1998; Foxcroft, Ireland, Lister-Sharp, Lowe, & Breen, 2003; Holder et al., 2000; Kumpfer, Alvarado, & Whiteside, 2003; Spoth, Redmond, & Lepper, 1999; Wagenaar, Murray, & Toomey, 2000). There is also evidence that life skills, when incorporated into a general approach to teaching about health and lifestyle issues, can be useful in changing behavior (see MODULE 2: Life Skills; Botvin, Baker, Dusenbury, Botvin, & Diaz, 1995; Botvin, Griffin, Paul, & Macaulay, 2003; International Center for Alcohol Policies, 2000, 2004).

Marketing and advertising

The relationship between beverage alcohol marketing and young people’s drinking is the focus of considerable attention in research, prevention, and policy (Babor et al., 2003; Grube, 2004; International Center for Alcohol Policies, 2002). While there is strong evidence that advertising and marketing are effective in changing brand choices, there is little evidence that they increase consumption (Calfee & Scheraga, 1994; Fisher, 1993; Nelson, 1997, 2001; Saffer, 2002). The influence of media on attitudes and lifestyle choices among young people is still under considerable debate, although family and peers remain the most influential factors in a young person’s life (Houghton & Roche, 2001).

Most producers of beverage alcohol and related organizations, such as trade associations, have strict rules of conduct around marketing. Internal company guidelines and industry-wide codes exist in which special attention is paid to young people and safeguards around them (see Grant & O'Connor, 2005; International Center for Alcohol Policies, 2001, 2002).

Other targeted interventions 

Other targeted interventions have been developed to ensure that risk for harm is minimized for young people who drink. Drink-drive laws in a number of countries set a more stringent standard for permissible blood alcohol content (BAC) for individuals under the legal drinking age (see MODULE 16: Blood Alcohol Concentration Limits). Similarly, in some countries young people are issued graduated drivers’ licenses that may restrict the hours during which they are permitted to drive (see MODULE 15: Drinking and Driving).

In some jurisdictions, proof of age cards or other identification is required and determines whether individuals below the legal drinking age are permitted in certain establishments or can be served beverage alcohol (see MODULE 12: Legal Age Limits).

Where beverage alcohol is served or sold, training staff to deal with young people can also help reduce the risk for harm. Severs and retailers may be trained to request age identification, and such IDs may also be mandated by law (see MODULE 4: Responsible Hospitality). Servers can be trained to deal with patrons under the legal drinking age who are refused service or access.

As with other measures aimed at minimizing harm through the imposition of legislated means, the effectiveness of these approaches hinges heavily upon enforcement.

Conclusions

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Most young people have some experience with alcohol before reaching adulthood and before they are legally able to drink. The cultural acceptability of drinking plays a role in setting legally mandated drinking ages in different countries. It also influences attitudes around drinking and how young people are introduced to alcohol. There is an imperative to ensure that the laws in a given country are observed and that young people are kept out of harm’s way.

Among young people who drink, those who abuse alcohol face considerable risks for health, injury, and social problems. Developmental changes during childhood and adolescence may make young people more susceptible to harm—particularly neurological harm—from alcohol abuse. Dangerous patterns of drinking and risk-taking behaviors place many young people at heightened risk, including from drinking and driving.

A variety of legal, economic, and social measures aimed at preventing underage drinking and at reducing risks are undertaken around the globe. Family, peers, media, government regulation, and culture blend together in creating the environment in which the young begin drinking. Much progress has been made in understanding the mechanisms shaping young people’s consumption. Much more, however, remains to be learned in order to enhance the effectiveness of prevention and intervention programs for this group.

References

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Andrews, J. A., Tildesley, E., Hops, H., & Li, F. (2002). The influence of peers on young adult substance use. Health Psychology, 21, 349–357.

Araoz, G. (2004). Cultural considerations. In What drives underage drinking? An international analysis. Washington, DC: International Center for Alcohol Policies.

Arata, C. M., Stafford, J., & Tims, M. S. (2003). High school drinking and its consequences. Adolescence, 38, 567–579.

Ashery, R. S., Robertson, E. B., & Kumpfer, K. L. (Eds.). (1998). Drug abuse prevention through family interventions. Rockville, MD: National Institute of Drug Abuse.

Babor, T. F., Caetano, R., Caswell, S., Edwards, G., Giesbrecht, N., Graham, K., et al. (2003). Alcohol: No ordinary commodity. Research and public policy. Oxford, UK: Oxford University Press.

Bachman, J. G., Safron, D. J., Sy, S. R., & Schulenberg, J. E. (2003). Wishing to work: New perspectives on how adolescents' part-time work intensity is linked to educational disengagement, substance use, and other problem behaviours. International Journal of Behavioral Development, 27, 301–315.

Bachman, J. G., Wadsworth, K. N., O'Malley, P. M., Johnston, L. D., & Schulenberg, J. E. (1997). Smoking, drinking, and drug use in young adulthood: The impacts of new freedoms and new responsibilities. Mahwah, NJ: Lawrence Erlbaum Associates.

Baer, J. S., Sampson, P. D., Barr, H. M., Connor, P. D., & Streissguth, A. P. (2003). A 21-year longitudinal analysis of the effects of prenatal alcohol exposure on young adult drinking. Archives of General Psychiatry, 60, 377–385.

Begleiter, H., & Porjesz, B. (1999). What is inherited in the predisposition toward alcoholism? A proposed model. Alcoholism, Clinical and Experimental Research, 23, 1125–1135.

Bjarnason, T., Andersson, B., Choquet, M., Elekes, Z., Morgan, M., & Rapinett, G. (2003). Alcohol culture, family structure and adolescent alcohol use: Multilevel modeling of frequency of heavy drinking among 15-16 year old students in 11 European countries. Journal of Studies on Alcohol, 64, 200–208.

Borsari, B., & Carey, K. B. (2001). Peer influences on college drinking: A review of the research. Journal of Substance Abuse, 13, 391–424.

Borynski, M. L. (2003). Factors related to reductions in alcohol consumption among college students: The role of religious involvement. Current Psychology, 22, 138–148.

Botvin, G. J., Baker, E., Dusenbury, L., Botvin, E. M., & Diaz, T. (1995). Long-term follow-up results of a randomized drug abuse prevention trial in a white middle-class population. Journal of American Medical Association, 273, 1106–1112.

Botvin, G. J., Griffin, K. W., Paul, E., & Macaulay, A. P. (2003). Preventing tobacco and alcohol use among elementary school students through life skills training. Journal of Child and Adolescent Substance Abuse, 12, 1–17.

Brown, S. A., & Tapert, S. F. (2004). Health consequences of adolescent alcohol use. In National Research Council and Institute of Medicine, Reducing underage drinking: A collective responsibility, background papers. [CD-ROM]. Committee on Developing a Strategy to Reduce and Prevent Underage Drinking, Division of Behavioral and Social Sciences and Education. Washington, DC: National Academies Press.

Brown, S. A., Tapert, S. F., Granholm, E., & Delis, D. C. (2000). Neurocognitive functioning of adolescents: Effects of protracted alcohol use. Alcoholism: Clinical and Experimental Research, 24, 164–171.

Calfee, J., & Scheraga, C. (1994). The influence of advertising on alcohol consumption: A literature review and an econometric analysis of four European nations. International Journal of Advertising, 13, 287–310.

Chassin, L., Curran, P. J., Hussong, A. M., & Colder, C. R. (1996). The relation of parent alcoholism to adolescent substance use: A longitudinal follow-up study. Journal of Abnormal Psychology, 105, 70–80.

Chassin, L., Pitts, S. C., & Prost, J. (2002). Binge drinking trajectories from adolescence to emerging adulthood in a high-risk sample: Predictors and substance abuse outcomes. Journal of Consulting and Clinical Psychology, 70, 67–78.

Choquet, M. (2004). Underage drinking: The epidemiological data. In What drives underage drinking? An international analysis (pp. 14–24). Washington, DC: International Center for Alcohol Policies.

Currie, C., Roberts, C., Morgan, A., Smith, R., Settertobutle, W., Samdal, O., et al. (Eds.). (2004). Young people’s health in context. Health Behaviour in School-aged Children (HBSC) study: International report from the 2001/2002 survey. Copenhagen, Denmark: WHO Regional Office for Europe.

De Bellis, M. D., Clark, D. B., Beers, S. R., Soloff, P. H., Boring, A. M., Hall, J., et al. (2000). Hippocampal volume in adolescent-onset alcohol use disorders. American Journal of Psychiatry, 157, 737–744.

Dees, W. L., Dissen, G. A., Hiney, J. K., Lara, F., & Ojeda, S. R. (2000). Alcohol ingestion inhibits the increased secretion of puberty-related hormones in the developing female rhesus monkey. Endocrinology, 141, 1325–1331.

Donovan, J. E., Leech, S. L., Zucker, R. A., Loveland-Cherry, C. J., Jester, J. M., Fitzgerald, H. E., et al. (2004). Really underage drinkers: Alcohol use among elementary students. Alcoholism: Clinical and Experimental Research, 28, 341–349.

Eccles, J. S., & Barber, B. L. (1999). Student council, volunteering, basketball, or marching band: What kind of extracurricular involvement matters? Journal of Youth and Adolescence, 6, 281–294.

Fisher, J. C. (1993). Advertising, alcohol consumption, and abuse: A worldwide survey. Wesport, CT: Greenwood Press.

Florey, C. D. (1992). EUROMAC. A European concerted action: maternal alcohol consumption and its relation to the outcome of pregnancy and child development at 18 months. Methods. International Journal of Epidemiology, 21(Suppl. 1), S38–S39.

Foxcroft, D. R., Ireland, D., Lister-Sharp, D. J., Lowe, G., & Breen, R. (2003). Longer-term primary prevention for alcohol misuse in young people: A systematic review. Addiction, 98, 397–411.

Frias, J., Rodriguez, R., Torres, J. M., Ruiz, E., & Ortega, E. (2000). Effects of acute alcohol intoxication on pituitary-gonadal axis hormones, pituitary-adrenal axis hormones, beta-endorphin and prolactin in human adolescents of both sexes. Life Sciences, 67, 1081–1086.

Geckova, A., & van Dijk, J. P. (2001). Peer impact on smoking, alcohol consumption, drug use and sports activities in adolescents. Studia Psychologica, 43, 113–123.

Granfield, R. (2002). Believe it or not: Examining to the emergence of new drinking norms in college. Journal of Alcohol and Drug Education, 47, 18–31.

Grant, B. F., & Dawson, D. A. (1997). Alcohol and drug use, abuse and dependence among welfare recipients. American Journal of Public Health, 86, 1450–1454.

Grant, B. F., Stinson, F. S., & Harford, T. C. (2001). Age at onset of alcohol use and DSM-IV alcohol abuse and dependence: A 12-year follow-up. Journal of Substance Abuse, 13, 493–504.

Grant, M., & O'Connor, J. (Eds.). (2005). Corporate social responsibility and alcohol: The need and potential for partnership. New York: Brunner-Routledge.

Grube, J. W. (2004). Alcohol in the media: Drinking portrayals, alcohol advertising, and alcohol consumption among youth. In National Research Council and Institute of Medicine, Reducing underage drinking: A collective responsibility, background papers. [CD-ROM]. Committee on Developing a Strategy to Reduce and Prevent Underage Drinking, Division of Behavioral and Social Sciences and Education. Washington, DC: National Academies Press.

Gruber, E., DiClemente, R. J., Anderson, M. M., & Lodico, M. (1996). Early drinking onset and its association with alcohol use and problem behavior in late adolescence. Preventative Medicine, 25, 293–300.

Grunbaum, J. A., Kann, L., Kinchen, S. A., Williams, B., Ross, J. G., Lowry, R., et al. (2002). Youth risk behavior surveillance–United States, 2001. MMWR Surveillance Summaries, 51, 1–62.

Harrington, N. T., & Leitenberg, H. (1994). Relationship between alcohol consumption and victim behaviors immediately preceding sexual aggression by an acquaintance. Violence and Victims, 9, 315–324.

Hawkins, J. D., Graham, J. W., Maguin, E., Abbott, R., Hill, K. G., & Catalano, R. F. (1997). Exploring the effects of age of alcohol use initiation and psychosocial risk factors on subsequent alcohol misuse. Journal of Studies on Alcohol, 58, 280–290.

Heath, A. C., Madden, P. A., Bucholz, K. K., Dinwiddie, S. H., Slutske, W. S., Bierut, L. J., et al. (1999). Genetic differences in alcohol sensitivity and the inheritance of alcoholism risk. Psycholical Medicine, 29, 1069–1081.

Heath, D. B. (2000). Drinking occasions: Comparative perspectives on alcohol and culture. Philadelphia, PA: Brunner/Mazel.

Heath, D. B. (Ed.). (1995). International handbook on alcohol and culture. Westport, CT: Greenwood Press.

Hellandsjo Bu, E. T., Watten, R. G., Foxcroft, D. R., Ingebrigtsen, J. E., & Relling, G. (2002). Teenage alcohol and intoxication debut: The impact of family socialization factors, living area and participation in organized sports. Alcohol and Alcoholism, 37, 74–80.

Hibell, B., Andersson, B., Ahlström, S., Balakireva, O., Bjarnason, T., Kokkevi, A., et al. (2000). The 1999 ESPAD report: Alcohol and other drug use among students in 30 European countries. Stockholm, Sweden: Swedish Council for Information on Alcohol and Other Drugs (CAN).

Hibell, B., Andersson, B., Ahlström, S., Balakireva, O., Bjarnason, T., Kokkevi, A., et al. (2004). The ESPAD report 2003: Alcohol and other drug use among students in 35 European countries. Stockholm, Sweden: Swedish Council for Information on Alcohol and Other Drugs (CAN).

Higuchi, S., Suzuki, K., Matsushita, S., & Osaki, Y. (2004, October). Young people’s drinking behavior in Japan. Paper presented at the Symposium 40, “Young people’s drinking – international perspective,” XVIII World Congress of the World Association for Social Psychiatry, Kobe, Japan.

Hingson, R., Heeren, T., Winter, M., & Wechsler, H. (2005). Magnitude of alcohol-related mortality and morbidity among U.S. college students ages 18–24: Changes from 1998 to 2001. Annual Review of Public Health, 26, 259–279.

Hingson, R., & Kenkel, D. (2004). Social, health, and economic consequences of underage drinking. In National Research Council and Institute of Medicine, Reducing underage drinking: A collective responsibility, background papers. [CD-ROM]. Committee on Developing a Strategy to Reduce and Prevent Underage Drinking, Division of Behavioral and Social Sciences and Education. Washington, DC: National Academies Press.

Hingson, R. W., Heeren, T., Zakocs, R. C., Kopstein, A., & Wechsler, H. (2002). Magnitude of alcohol-related mortality and morbidity among U.S. college students ages 18–24. Journal of Studies on Alcohol, 63, 136–144.

Holder, H. D., Gruenewald, P. J., Ponicki, W. R., Treno, A. J., Grube, J. W., Saltz, R. F., et al. (2000). Effect of community-based interventions on high-risk drinking and alcohol-related injuries. Journal of American Medical Association, 284, 2341–2347.

Houghton, E., & Roche, A. M. (Eds.). (2001). Learning about drinking. New York: Brunner-Routledge.

Institute of Medicine. (1996). Fetal alcohol syndrome: Diagnosis, epidemiology, prevention, and treatment. Washington, DC: The National Academy Press.

International Center for Alcohol Policies. (2000). Life skills education in South Africa and Botswana. Washington, DC: Author.

International Center for Alcohol Policies (ICAP). (2001). Self-regulation of beverage alcohol advertising. ICAP Report 9. Washington, DC: Author.

International Center for Alcohol Policies (ICAP). (2002). Industry views on beverage alcohol advertising and marketing, with special reference to young people. Report prepared for the World Health Organization. Washington, DC: Author.

International Center for Alcohol Policies (ICAP). (2004). Alcohol education and its effectiveness. ICAP Report 16. Washington, DC: Author.

International Center for Alcohol Policies (ICAP). (1998, updated 2002). Drinking age limits. ICAP Report 4. Washington, DC: Author.

Jennison, K. M. (2004). The short-term effects and unintended long-term consequences of binge drinking in college: A 10-year follow-up study. American Journal of Drug and Alcohol Abuse, 30, 659–684.

Johnston, L. D., O'Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2004). Monitoring the Future national survey results on drug use, 1975-2003: Volume II, College students and adults ages 19–45. Bethesda, MD: National Institute of Drug Abuse.

Kerestes, M., Youniss, J., & Metz, E. (2004). Longitudinal patterns of religious perspective and civic integration. Applied Developmental Science, 8, 39–46.

Klein, R. F. (1997). Alcohol-induced bone disease: Impact of ethanol on osteoblast proliferation. Alcoholism, Clinical and Experimental Research, 21, 392–399.

Kumpfer, K. L., Alvarado, R., & Whiteside, H. O. (2003). Family-based interventions for substance use and misuse prevention. Substance Use and Misuse, 38, 1759–1787.

Kypri, K., & Langley, J. D. (2003). Perceived social norms and their relation to university student drinking Journal of Studies on Alcohol, 64(6), 829-834.

Leichliter, J. S., Meilman, P. W., Presley, C. A., & Cashin, J. R. (1998). Alcohol use and related consequences among students with varying levels of involvement in college athletics Journal of American College Health, 46, 257–262.

Mason, W., & Windle, M. (2002). Longitudinal study of the effects of religiosity on adolescent alcohol use and alcohol-related problems. Journal of Adolescent Research, 17, 346–363.

Mattern, J. L., & Neighbors, C. (2004). Social norms campaigns: Examining the relationship between changes in perceived norms and changes in drinking levels. Journal of Studies on Alcohol, 65, 489–493.

McGue, M., Iacono, W. G., Legrand, L. N., Malone, S., & Elkins, I. (2001). Origins and consequences of age at first drink. I. Associations with substance-use disorders, disinhibitory behavior and psychopathology, and P3 amplitude. Alcoholism: Clinical and Experimental Research, 25, 1156–1165.

McPherson, M., Casswell, S., & Pledger, M. (2004). Gender convergence in alcohol consumption and related problems: Issues and outcomes from comparisons of New Zealand survey data. Addiction, 99, 738–748.

Milgram, G. G. (2001). Alcohol influences: The role of family and peers. In E. Houghton & A. M. Roche (Eds.), Learning about drinking (pp. 85–101). Philadelphia, PA: Brunner-Routledge.

Miller, P., & Plant, M. (2003). Family, peer influences and substance use: Findings from a study of UK teenagers. Journal of Substance Use, 8, 19–26.

Mohler-Kuo, M., Dowdall, G. W., Koss, M. P., & Wechsler, H. (2004). Correlates of rape while intoxicated in a national sample of college women. Journal of Studies on Alcohol, 65, 37–45.

National Highway Traffic Safety Administration. (2004). Traffic safety facts 2003. Washington, DC: Author.

Nelson, J. P. (1997). Broadcast advertising and U.S. demand for alcoholic beverages: System-wide estimates with quarterly data. Washington, DC: U.S. Federal Trade Commission.

Nelson, J. P. (2001). Alcohol advertising bans: A survey of research methods, results, and policy implications. In M. R. Baye & J. P. Nelson (Eds.), Advances in applied microeconomics. Volume 10: Advertising and differentiated products (pp. 239–295). Amsterdam, the Netherlands: JAI Press & Elsevier Press.

Nelson, T. F., & Wechsler, H. (2001). Alcohol and college athletes. Medicine and Science in Sports and Exercise, 33, 43–47.

Norström, T. (2002). Alcohol in postwar Europe: Consumption, drinking patterns, consequences and policy responses in 15 European countries. Retrieved April 8, 2005, from http://www.fhi.se/templates/Page2cols____616.aspx .

O'Malley, P. M., Bachman, J. G., Johnston, L. D., & Schulenberg, J. E. (2004). Studying the transition from youth to adulthood: Impacts on substance use and abuse. In J. S. House, F. T. Juster, R. L. Kahn, H. Schuman & E. Single (Eds.), A telescope on society: Survey research and social science at the University of Michigan and beyond (pp. 305–329). Ann Arbor, MI: University of Michigan Press.

O'Neill, S. E., Parra, G. R., & Sher, K. J. (2001). Clinical relevance of heavy drinking during the college years: Cross-sectional and prospective perspectives. Psychology of Addictive Behaviors, 15, 350–359.

Office for National Statistics. (2004). Living in Britain: Results from the General Household Survey. London: The Stationery Office.

Perkins, H. W. (2002). Surveying the damage: a review of research on consequences of alcohol misuse in college populations. Journal of Studies on Alcohol Supplement (14), 91-100.

Perkins, H. W. (Ed.). (2003). Social norms approach to preventing school and college age substance abuse: A handbook for educators, counselors, and clinicians. San Francisco, CA: Jossey-Bass.

Perkins, H. W., & Craig, D. W. (2002). A multifaceted social norms approach to reduce high-risk drinking: Lessons from Hobart and William Smith Colleges. Newton, MA: The Higher Education Center for Alcohol and Other Drug Prevention.

Plant, M. A. (2004). The alcohol harm reduction strategy for England. British Medical Journal, 328, 905–906.

Plant, M. L. (1997). Women and alcohol: Contemporary and historical perspectives. London: Free Association Books.

Plant, M. L., Abel, E. L., & Guerri, C. (1999). Alcohol and pregnancy. In I. Macdonald (Ed.), Health issues related to alcohol consumption. 2^nd ed. (pp. 182–213). Oxford, UK: Blackwell Science.

Plant, M. L., & Plant, M. A. (2001). Heavy drinking by young British women gives cause for concern. British Medical Journal, 323, 1183.

Plant, M. L., Plant, M. A., & Mason, W. (2002). Drinking, smoking and illicit drug use among British adults: Gender differences explored. Journal of Substance Use, 7, 24–33.

Prescott, C. A., & Kendler, K. S. (1999). Age at first drink and risk for alcoholism: A noncausal association. Alcoholism: Clinical and Experimental Research, 23, 101–107.

Saffer, H. (2002). Alcohol advertising and youth. Journal of Studies on Alcohol, (Suppl.14), 173–181.

Sampson, H. W., Gallager, S., Lange, J., Chondra, W., & Hogan, H. A. (1999). Binge drinking and bone metabolism in a young actively growing rat model. Alcoholism: Clinical and Experimental Research, 23, 1228–1231.

Sanchez-Sosa, J. J., & Poldrugo, F. (2001). Family and cultural influences on alcohol and young people. In E. Houghton & A. M. Roche (Eds.), Learning about drinking (pp. 57–83). Philadelphia, PA: Brunner-Routledge.

Schuckit, M. A. (1994). Low level of response to alcohol as a predictor of future alcoholism. American Journal of Psychiatry, 151, 184–189.

Schuckit, M. A. (1999). New findings in the genetics of alcoholism. Journal of American Medical Association, 281, 1875–1876.

Schulenberg, J., O'Malley, P. M., Bachman, J. G., Wadsworth, K. N., & Johnston, L. D. (1996). Getting drunk and growing up: Trajectories of frequent binge drinking during the transition to young adulthood. Journal of Studies on Alcohol, 57, 289–304.

Smith, G. S., Branas, C. C., & Miller, T. R. (1999). Fatal nontraffic injuries involving alcohol: A metaanalysis. Annals of Emergency Medicine, 33, 659–668.

Spear, L. P. (2004). Biomedical aspects of underage drinking. In What drives underage drinking? An international analysis (pp. 25–38). Washington, DC: International Center for Alcohol Polices.

Spoth, R., Redmond, C., & Lepper, H. (1999). Alcohol initiation outcomes of universal family-focused preventive interventions: One- and two-year follow-ups of a controlled study. Journal of Studies on Alcohol Supplement, 13, 103–111.

Substance Abuse and Mental Health Services Administration (SAMHSA). (2004). Overview of findings from the 2003 National Survey on Drug Use and Health. Rockville, MD: Author.

Tapert, S. F., Brown, G. G., Kindermann, S. S., Cheung, E. H., Frank, L. R., & Brown, S. A. (2001). fMRI measurement of brain dysfunction in alcohol-dependent young women. Alcoholism: Clinical and Experimental Research, 25, 236–245.

Turner, J. C., & Shu, J. (2004). Serious health consequences associated with alcohol use among college students: Demographic and clinical characteristics of patients seen in an emergency department. Journal of Studies on Alcohol, 65, 179–183.

Turrisi, R., Wiersma, K. A., & Hughes, K. K. (2000). Binge-drinking-related consequences in college students: role of drinking beliefs and mother-teen communications. Psychology of Addictive Behaviors, 14, 342–355.

Vakalahi, H. F. (2001). Adolescent substance use and family-based risk and protective factors: Literature review. Journal of Drug Education, 31, 1–28.

Wagenaar, A. C., Murray, D. M., & Toomey, T. L. (2000). Communities mobilizing for change on alcohol (CMCA): Effects of a randomized trial on arrests and traffic crashes. Addiction, 95, 209–217.

Wechsler, H., Lee, J. E., Kuo, M., Seibring, M., Nelson, T. F., & Lee, H. (2002). Trends in college binge drinking during a period of increased prevention efforts. Findings from 4 Harvard School of Public Health College Alcohol Study surveys: 1993-2001. Journal of American College Health, 50, 203–217.

Wechsler, H., Nelson, T. E., Lee, J. E., Seibring, M., Lewis, C., & Keeling, R. P. (2003). Perception and reality: A national evaluation of social norms marketing interventions to reduce college students' heavy alcohol use. Journal of Studies on Alcohol, 64, 484–494.

Werler, M. M., Lammer, E. J., Rosenberg, L., & Mitchell, A. A. (1991). Maternal alcohol use in relation to selected birth defects. American Journal of Epidemiology, 134, 691–698.

Wilsnack, R. W., & Wilsnack, S. C. (Eds.). (1997). Gender and alcohol: Individual and social perspectives. New Brunswick, NJ: Rutgers Center of Alcohol Studies.

Wood, M. D., Read, J. P., Mitchell, R. E., & Brand, N. H. (2004). Do parents still matter? Parent and peer influences on alcohol involvement among recent high school graduates. Psychology of Addictive Behavior, 18, 19–30.

World Health Organization (WHO). (1986). Young people’s health: A challenge for society. Report of a WHO Study Group on Young People and “Health for All by Year 2000.” WHO Technical Report Series No.731. Geneva, Switzerland: Author.

World Health Organization (WHO). (2004). Global status report: Alcohol policy. Geneva, Switzerland: Author.

Yates, W. R., Cadoret, R. J., Troughton, E. P., Stewart, M., & Giunta, T. S. (1998). Effect of fetal alcohol exposure on adult symptoms of nicotine, alcohol, and drug dependence. Alcoholism: Clinical and Experimental Research, 22, 914–920.