Early alcohol use leads to abuse

For six years, John Donovan's "hobby" was to dig up hard-to-find data on children's use of alcohol. With so much attention paid to binge drinking by high-schoolers and college students, he wanted to shine a light on what was happening with kids even before junior high.

"The younger that people are when they start to drink," says Mr. Donovan, an associate professor of psychiatry and epidemiology at the University of Pittsburgh Medical Center, "the more likely they are to have problems with alcohol in adolescence and in later life, and the more likely they are to be involved in a whole variety of other problematic behaviors," like absence from school, delinquency, use of illicit drugs, drunken driving, and risky sexual activity.

By eighth grade, about 40 percent of American students say they've had some alcohol, but Donovan looked at an even younger set in a report just published in the September issue of Prevention Science. He found that between fourth and sixth grades, the prevalence of alcohol use increases significantly. In one national survey, for instance, about 10 percent of fourth-graders and 29 percent of sixth-graders said they'd had more than a sip of alcohol. In a survey in New York State, 21 percent of fifth- and sixth-graders reported having had a drink of alcohol at some point, including 7 percent who had drunk liquor, as distinct from beer or wine.

Broad conclusions can't yet be drawn, because the data are scattered in various substance-use and behavior surveys that span more than a decade, but Donovan's hope is to impel people to examine an age group that's been largely overlooked in alcohol studies. The data suggest that prevention might best be timed around fifth-grade, he says. Such efforts would be most effective, he and others say, if they involve not just schools, but families and whole communities as well.

"Parents should know that even when they give children alcohol in family contexts, there is still a risk that their children would be more likely to be involved in problematic use later on," Donovan says.

But much more research is needed to reveal the context in which children have alcohol and the amount they drink, he and other researchers agree.

"If a kid reports that they had wine with communion ... that's a very different thing than that they one day sat down and drank a whole beer with their father," says Vivian Faden, a deputy director at the National Institute on Alcohol Abuse and Alcoholism in Bethesda, Md. "Drinking with the family isn't the same in every family," she says.

From a public policy perspective, however, Ms. Faden says it would be appropriate to send a general message that it's not a good idea for young children to drink.

In a statement last March to announce a "National Call to Action to Prevent and Reduce Underage Drinking," Acting Surgeon General Kenneth Moritsugu said that those who start drinking before age 15 "are five times more likely to have alcohol-related problems later in life. New research also indicates that alcohol may harm the developing adolescent brain." He urged parents, schools, students, and governments to work together on the issue.

That communitywide approach is what Hope Taft, former first lady of Ohio, promotes as executive director of the Leadership to Keep Children Alcohol Free. The group works with the spouses of governors and former governors to encourage 9- to 15-year-olds to steer clear of alcohol. The group has also called for more national surveys to be conducted to better gauge children's alcohol consumption.

In Ohio, Mrs. Taft started the Smart and Sober campaign for middle-schoolers, "because that's when you begin to see the real jump in the use [of alcohol] or the desire to drink," she says. Through videos, town hall meetings, coalitions, and statewide celebrations, the program educates adults and helps students realize "they can say 'no' and be respected, and that their future is much brighter if they do stay alcohol-free," she says.

Sending positive messages and rewarding students for choosing not to have alcohol is one step endorsed in the Surgeon General's Call to Action.

"Parents invest a lot in their children – in education, in classes, in sports ... and yet they have no idea that getting them started on alcohol use can wipe all those efforts out pretty quickly," Taft says.

A number of prevention projects that focus on developing family skills have been found to reduce students' future use or abuse of alcohol. For example, one component of the Strengthening Families Program works with 6- to 12-year-olds and their families to stave off academic, emotional, and substance-abuse problems. It has been cited as a science-based model by groups such as the National Institute on Drug Abuse.

Donovan's report suggests that such prevention efforts may have started to pay off. Various surveys show a decline in children's experience with alcohol since the early 1990s. Nonetheless, one national study in 2001 found that among 11-year-olds, a small subset drank alcohol regularly – 3.9 percent of boys and 3.2 percent of girls said they had alcohol weekly.

"There have been some improvements in certain of the measures [of underage drinking]," Faden says. "But it still leaves quite substantial portions of kids who are drinking.... We need to do a lot better."