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Reducing Underage Drinking: A Collective Responsibility 4 Understanding Youth Drinking Adolescents in the United States grow up in a world filled with messages about alcohol (see Box 4-1 for select vignettes). Most of the messages present drinking in a positive light, and most of them show alcohol as a normal part of adult and teen social life. Warnings against underage drinking from parents or in health class may well be drowned out by the barrage of daily messages about alcohol in daily life. Given this backdrop, it is not surprising that experimental or occasional use of alcohol is reported by the majority of adolescents in the United States, making it a normative behavior during the second decade of life. As noted in Chapter 2, about 50 percent of 20-year-olds report having recently drunk alcohol and the majority of twelfth graders (78 percent) report having drunk alcohol in their lifetimes. In this chapter we examine factors—primarily developmental and environmental factors—that are related to normative alcohol consumption. We do not discuss those involved in excessive or atypical use (e.g., youths with mental or addictive disorders). This is an important distinction because the factors that contribute to drinking patterns within the normative group of adolescents are different than those for youth who develop alcohol abuse patterns or dependency at a young age. WHY DO ADOLESCENTS SAY THEY DRINK? Adolescents say they drink for many of the same reasons as adults (Dunn and Goldman, 1996). Alcohol-related expectancies are well formed
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Reducing Underage Drinking: A Collective Responsibility BOX 4-1 Select Vignettes of Alcohol Messages to Youth Twelve-year-old Jenna rides her bike to and from school most days. Her route takes her past a large billboard advertising a popular malt liquor. Fourteen-year-old Joshua loves to watch basketball on television. During a typical game, he sees many beer commercials. At 15, Sarah enjoys going to movies with friends. Many of the movies she has seen lately include scenes of adults drinking alcohol with dinner and at parties. A recent favorite showed teenagers getting into a nightclub using fake identification. A favorite T-shirt for 16-year-old Sam says, “I’m trying to graduate with a 4.0 … blood alcohol level.” His best friend’s favorite sports shirt has an advertisement for a local bar on the back and “start drinking at 9 a.m. … it’s gotta be happy hour somewhere” on the front. Following the homecoming dance, 17-year-old Lynne attends an all-night party at a friend’s home. The parents greet the guests as they arrive and take their car keys because they are serving beer. They prefer that their children and their friends drink at their home in a “safe environment” since they assume that their children will be drinking anyway. After moving his belongings into his college dormitory and bidding his parents farewell, 19-year-old Jeremy attends an off-campus “welcome party” with a new acquaintance. He learns a lot on his first night on campus—how to play a drinking game, where to get a fake ID (identification), and which bars have happy hours on Thursdays. by age 12, among drinkers as well as among those who have never consumed alcohol (Christiansen et al., 1982; Jones et al., 2001). Although it is always difficult to know if individuals can accurately report the reasons for their behavior, including drinking (see Nisbett and Wilson, 1977), both adolescents and adults indicate that alcohol is an important ingredient in social interactions, allowing them to lower their inhibitions and feel more relaxed in social situations (Jones et al., 2001; Wood et al., 1992). Other reasons given for drinking include reducing tension, fostering courage, reducing worry, increasing a sense of power, and causing cognitive and behavioral impairment (Prendergast, 1994). In addition, most individuals assign some costs to drinking, as well, which are discussed later in this chapter. According to models such as the theory of planned behavior (Ajzen, 1991), social cognitive theory (e.g., Bandura, 1986), and alcohol expectancy theory (e.g., Goldman et al., 1991; Leigh, 1989), alcohol use can be largely explained by the alcohol-related expectancies for both positive and negative outcomes. Initiation and continuation of drinking, as well as the onset of problem drinking, are strongly and positively associated with expected benefits of drinking and negatively related to perceived negative
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Reducing Underage Drinking: A Collective Responsibility expectancies (Christiansen et al., 1989; Christiansen et al., 1982; Chen et al., 1994; Grube et al., 1995; Jones et al., 2001; Smith et al., 1995; Wood et al., 1992; Goldberg et al., 2002). Although children’s and adult’s alcohol expectancies are similar (Dunn and Goldman, 1996), younger children are more likely to report negative expectancies; perceptions of positive outcomes increase with age (Miller et al., 1990; Goldberg et al., 2002). Specific expectancies also differ by age: 12- to 14-year-olds rank reduced tension and impaired behavioral functioning highest; 15- to 16-year-olds cite enhanced social and physical pleasure and modified social and emotional behavior; and 17- to 19-year-olds cite enhanced sexual performance and increased power as top alcohol expectancies (Christiansen et al., 1982). There are also gender differences in alcohol expectations, with adolescent males perceiving more positive and fewer negative consequences of alcohol than do adolescent females. Although the relationship between quantity of alcohol use and social and physical outcomes was similar for adolescent males and females, the frequency of alcohol use may be associated with global positive effects, sexual enhancement, and pleasure for men, but reduced tension for women (Jones et al., 2001). DEVELOPMENTAL FACTORS During adolescence, individuals are going through rapid physical, social, and cognitive changes. These enormous changes to body, friendship, and thinking about the world are juxtaposed against changing expectations for behavior and increases in need and opportunities for autonomy. The desire to be autonomous and to be granted more decision making opportunities increases with age (Steinberg and Cauffman, 1996) and occurs in tandem with several other changes that serve to increase adolescents’ desires for autonomy. First, the physical changes of puberty result in adolescents’ seeing themselves as more deserving of adult-like privileges and opportunities to make decisions. In addition, as adolescents mature physically and develop secondary sex characteristics, they look older and are presumed to be able to take on more adult-like roles and responsibilities. Second, increased time spent with peers leads to more experiences and comparison of others’ authority, power, and privileges. Third, cultural and societal beliefs suggest that adolescence is a time to practice adult roles. All of these factors serve to underscore the importance of autonomy from parents and push adolescents toward assuming more adult roles. In the United States, alcohol use is an important symbol of adult status. The shift away from childhood and toward independence and adult roles is accompanied by a focus on peer acceptance and perceived norms in addition to parental standards. Adolescents need to develop their own sense of self or identity during this time, although expectations about the appro-
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Reducing Underage Drinking: A Collective Responsibility priate timing for increased autonomy during adolescence varies across cultures (e.g., Feldman and Rosenthal, 1990). Individuals adapt and modify their identities to enable them to function best in their particular social and cultural context (Baumeister and Muraven, 1996). Adolescents may “try on” various identities that will be defined, in part, by how time is spent and with whom it is spent. While constructing an identity, an adolescent’s motivation may be to gain new experiences that will allow them to evaluate what fits and what does not with their newly developing identities. This process allows them to create adult selves that are realistic and comfortable (Curry et al., 1994). During this period, adolescents report having a “true self” (who they really are inside) and a “false self” (who they want other people to think they are, to impress or please them) (Harter et al., 1996). At this point, adolescents may knowingly make choices that they know they may later regret “just to see what it is like,” to act more like an adult, or to impress others (e.g., Moffit, 1993). Some of these choices are likely to involve alcohol consumption. In order to understand the shifts that adolescents are undergoing, it is important to consider both changes in cognition and in the social world in which adolescents find themselves during this period. Cognitive Changes Cognitive changes during adolescence include gradual improvements in social perspective, to about age 16 (Steinberg and Cauffman, 1996). These newfound perspective-taking skills allow an adolescent to recognize how the thoughts and actions of one person influence those of another and to imagine how others might perceive them. Although generally an indicator of greater maturity, a downside of this new ability is that adolescents are highly concerned with peer conformity, which may make them particularly susceptible to peer influence. The majority of studies indicate a positive relationship between susceptibility to peer pressure and risk-taking behavior (such as drinking). For reasons not yet known, there is variation in the extent to which adolescents succumb to social influence, including pressure to engage in behaviors that are undesirable (see Steinberg and Cauffman, 1996, for a review). In general, thinking becomes more abstract and more future-oriented during adolescence, allowing adolescents to consider multiple aspects of any decision at one time, assess potential consequences of a decision, consider possible outcomes associated with various choices, and plan for the future. These cognitive changes enhance the adolescent’s capacity for competent decision making (see, for example, Halpern-Felsher and Cauffman, 2001; Steinberg and Cauffman, 1996). However, these newly formed competencies are not always practiced when adolescents are confronted with
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Reducing Underage Drinking: A Collective Responsibility real-world social situations. Many studies suggest that adolescents, as well as adults, may make less than optimal decisions when personal goals, beliefs, prior experience, values, social expectations, and emotions are added to the decision making equation (Jacobs and Klaczynski, 2002). This outcome is especially true for social decisions (like choosing whether to drink or how much to drink). This is so for a variety of reasons. First, outcomes of decisions in social situations are probabilistic, meaning that negative consequences of bad decisions may not occur and may not even be highly likely, although they are devastating if they do occur. For example, while the probability of having a car crash after drinking is much higher than after not drinking, drinking and driving does not always end in a crash or a ticket. Because outcomes are probabilistic, adolescents may interpret the fact that they previously drank too much and drove home without a crash as evidence that they can drink and drive safely (Jacobs and Ganzel, 1994). In one study, older adolescents who had a lot of experience drinking and driving, but had not experienced a negative outcome, such as a traffic citation or crash, believed that they were in little danger of having an accident after drinking (Finken et al., 1998), this result suggests that engaging in risky behaviors without consequence may have caused them to lower their perceptions of the risks of drinking and driving. Other correlational studies have shown that greater involvement in risk-taking behaviors was related to lower perceptions of personal risk (e.g., Halpern-Felsher and Cauffman, 2001; Goldberg et al., 2002). Second, the norms for social decisions are not typically known. Instead, individuals are often forced to make judgments on the basis of their own estimates of the norms of social behaviors or attitudes. This general dilemma, faced by people of all ages, is even more difficult for adolescents because they must make decisions based on a limited amount of experience and little feedback from earlier decisions (Jacobs et al., 1995). Several studies indicate that most adolescents overestimate the number of others who drink alcohol (e.g., Basch et al., 1989; Jaccard and Turrisi, 1987). Not surprisingly, the overestimation is greatest for those individuals who drink. This same pattern has been found for other risk-taking and deviant behaviors (e.g., Benthin et al., 1993; Nucci et al., 1991), and it may be related to the fact that those who drink have friends who drink and so they begin to believe that everyone is drinking. In one longitudinal study, adolescents who spent time with peers who encouraged drinking later reported more positive views of drinkers (Blanton et al., 1997). In addition, studies indicate that adolescents make more biased estimates when they are reasoning about populations with greater variability and when they are reasoning about unfamiliar others (Jacobs, 2004) Underage drinking and other forms of risk taking are likely to occur in social situations and when adolescents find themselves with large groups of unfa-
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Reducing Underage Drinking: A Collective Responsibility miliar peers. In these situations, they are left to estimate how others typically behave and what they think. The outcome may be overestimates of others’ drinking and acceptance of such behavior, leading them to believe that the norm is to drink and that they should do it, too. However, providing adolescents with more realistic information about the extent to which people drink alcohol may not by itself reduce alcohol consumption. Instead, a focus on injunctive norms—views concerning what others think about one’s drinking—might be more effective (Cialdini et al., 1990; Kallgren et al., 2000; Prentice and Miller, 1993). Social Situations The social situations in which adolescents find themselves also change during this period. Indeed, movement toward autonomy is accompanied by real and perceived changes in the social world as adolescents mature. Most move from environments in which they are protected, scheduled, and dominated by adults into environments that are primarily populated with other adolescents and in which they actually have much more autonomy. On average, middle-class adolescents spend about 20 percent of their time with parents and other relatives, 25 percent of their time alone, and the rest with friends and classmates (Csikszentmihalyi and Larson, 1984). Younger adolescents report that television and home- and family-centered activities fill much of their leisure time, but this shifts dramatically as they get older and report that peer-focused and solitary activities fill most of their time (Larson and Kleiber, 1990). Thus, as adolescents get older, they spend greater periods of their leisure time away from adult supervision, increasing the opportunities for becoming involved in such risk-taking behaviors as drinking alcohol. In addition to the actual changes in supervision, teens are much more focused on real or imagined peer norms. They are most likely to attend to the standards set by their friends than by another same-age group. The often reported, “peer pressure” is, in reality, “friend pressure.” As adolescents get older, they are more likely to choose friends who share their tastes and interests than when they were younger. Thus, they are likely to join crowds of teens who have similar values and life-styles. Crowd membership has been associated with alcohol consumption: some crowds or groups include drinking as part of how they spend their time, and an adolescent’s choice to be involved in that crowd will include the knowledge that drinking is a typical activity for that group (Prinstein et al., 1996). For example, participation in competitive sports in high school has been related to higher rates of alcohol use (Eccles and Barber, 1999). Unfortunately, information about a particular group’s norms may not be available until after an adolescent has had one or more experiences with
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Reducing Underage Drinking: A Collective Responsibility the group and has been faced with situations in which saying “no” to alcohol will be viewed unfavorably by peers. Younger adolescents report having more trouble moving between crowds than older adolescents, so it may be more difficult for them to go against the norms of a crowd if they feel uncomfortable (Brown et al., 1994). INDIVIDUAL DIFFERENCES Although we have concentrated on describing the normative changes that affect adolescents, there are clear individual differences in development as well, and some of these differences may be associated with higher alcohol consumption. These differences include personality, perceptions of risk, and self-efficacy, as well as gender and racial differences in adolescent alcohol consumption (noted in Chapter 2). Although numerous clinical studies indicate that individuals differ in their likelihood of experiencing alcohol dependency and related disorders (Kessler et al., 1997; Swendsen et al., 2002), our focus in this chapter remains on nonclinical populations. Personality Differences Is there a personality profile that is related to adolescent risk for alcohol abuse? Cloninger (1991) found that three traits, present as early as age 10, were associated with alcoholism at age 28: (1) being easily bored and needing constant stimulation; (2) being driven to avoid negative consequence for actions; and (3) craving immediate external rewards for efforts. In addition, antisocial personality disorder has been linked to alcohol misuse among adolescents (Clark et al., 1998). Similarly, a recent study of children aged 8 to 15 found that conduct disorder often predates and predicts later alcohol use (Clark et al., 1998). In nonclinical populations, a major personality characteristic that has been related to adolescent risk taking is sensation seeking, defined by seeking novel, complex, or risky situations (Zuckerman, 1979). The appeal of drinking alcohol and other “forbidden” behaviors for adolescents may be the novel and intense sensations provided by the experiences (Arnett and Balle-Jensen, 1993); students who have higher needs for sensation seeking are more likely to report higher levels of drinking, as well as other delinquent behaviors. Others have also reported associations between sensation seeking or novelty seeking and alcohol use (e.g., Martin et al., 2002). Donohew and colleagues (1999) argued that sensation seeking influences alcohol use indirectly, through peer affiliations: teens who are sensation seekers tend to choose friends with similar sensation seeking desires, and such peer group affiliations increase alcohol use.
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Reducing Underage Drinking: A Collective Responsibility Beliefs About Risk Although many adults believe that adolescents underestimate the risks of engaging in particular behaviors, most research indicates that adults and adolescents actually give similar estimates of various types of risk taking, including drinking alcohol (e.g., Beyth-Marom et al., 1993; Quadrel et al., 1993). Although sweeping age differences in risk estimates have not typically been found (Millstein and Halpern-Felsher, 2002), individuals’ perceptions of risk vary, and their perceptions have been linked to their behaviors. In general, drinkers of all ages view consuming alcohol as less risky than nondrinkers (Goldberg et al., 2002), although the absolute accuracy of various risk perceptions has been the topic of debate (e.g., Slovic, 2000). Although adolescents generally overestimate their mortality risks for a variety of activities including alcohol (e.g., Fischhoff et al., 2000), recent studies suggest that adolescents who perceive a higher likelihood of negative consequences following alcohol consumption do not drink at all or drink more moderately than others (e.g., Goldberg et al., 2002; Halpern-Felsher and Cauffman, 2001; Small et al., 1993.) Both adults and adolescents tend to overestimate how many other people are involved in activities in which they, themselves, are engaged (e.g., Kruglanski, 1989). Indeed, adolescents as well as adults who participate in high-risk activities generally believe that the rate of participation by others is higher than do nonparticipants (Benthin et al., 1993); thus, beliefs about normative practices may be related to older adolescents’ decisions to engage in risky behaviors (Basch et al., 1989; Beck and Treiman, 1996; Olds and Thombs, 2001). In one recent study, adolescents who reported higher levels of alcohol consumption and other risk-taking behavior than their peers overestimated how much other adolescents in their school were participating in the same high-risk behaviors (Jacobs, 2000). Extreme overestimaters engaged in significantly more mild and severe deviant behaviors than either the moderate overestimaters or those whose estimates were correct, and they reported poorer self-esteem, lower grade point averages, and less rational decision-making skills. One of the most intriguing implications of the research focusing on individual differences is that some adolescents are more likely than others to perceive drinking as low risk, to overestimate the likelihood of others’ drinking, and to look for sensation-seeking opportunities. This is the group that one would expect to drink the most and take the most risks when drinking. Prior Experience Although correlated with age, drinking experiences have a significant and independent effect on alcohol expectancies, which in turn play a role in
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Reducing Underage Drinking: A Collective Responsibility alcohol use (Christiansen et al., 1989; Christiansen et al., 1982; Chen et al., 1994; Grube et al., 1995; Jones et al., 2001; Smith et al., 1995; Wood et al., 1992; Goldberg et al., 2002). More specific expectancies, such as enhanced sexual feelings, power, and reduced tension have been reported by those with greater drinking experiences, while youth with little or no alcohol experiences have more global expectancies of increased pleasure (Christiansen et al., 1982). As one gains more experience with alcohol, positive outcomes are reinforced and predict future drinking behaviors (Goldberg et al., 2002; Jones et al., 2001). Furthermore, positive drinking-related expectancies increase and negative expectations for risks decrease among adolescents with more drinking experiences (Halpern-Felsher et al., 2000; Goldberg et al., 2002). Self-Efficacy Drinking refusal self-efficacy, borrowed from Bandura’s (1986, 1997) concept of general self-efficacy, refers to one’s belief in her or his ability to resist urges or social pressures to drink, to drink in particular situations, or to consume large amounts of alcohol at one time. Adolescents with more positive self-efficacy are less likely to drink or drink excessively (Oei et al., 1998; Webb and Baer, 1995), and those with fewer refusal skills are more likely to drink (Hays and Ellickson, 1996). Refusal skills may be a better predictor of problem drinking than alcohol expectancies, especially for heavy or frequent alcohol use (Connor et al., 2000; Oei et al., 1998). Given that adolescents are more susceptible to peer pressure, it stands to reason that they will have lower drinking refusal skills. However, there is evidence that adolescents can be taught drinking refusal self-efficacy skills and that such skills can then result in less substance use (Bell et al., 1993; Ellickson et al., 1993). CONTEXTUAL FACTORS As noted in the previous chapter, the highest rate of both heavy drinking and frequent heavy drinking is found in young adults between the ages of 18 and 25. In addition, if adolescents between the ages of 14 and 20 drink alcohol, they are more likely to report heavy drinking than other drinking patterns (National Household Survey on Drug Abuse, 2001). These findings suggest that there may be something about the context of youth drinking that results in this particular pattern of alcohol consumption. Indeed, macrolevel and microlevel contextual factors are likely to contribute to both the number of underage drinkers and their patterns of alcohol use.
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Reducing Underage Drinking: A Collective Responsibility Community U.S. culture is replete with messages touting the attractions of alcohol use, and—notwithstanding the legal norm—suggesting that drinking is acceptable for people under 21. Recent content analyses indicate that alcohol use was depicted, typically in a positive light, in more than 70 percent of a sample of episodes in prime-time television programming in 1999 (Christensen et al., 2000), and in more than 90 percent of the two hundred most popular movie rentals for 1996-1997 (Roberts et al., 1999b). Roberts et al. (1999b) also found that 17 percent of the 1,000 of the most popular songs in 1996-1997 across five genres of music popular with youth contained alcohol references, including almost one-half of the rap music recordings. The alcohol industry spent $1.6 billion on advertising in 2001, and probably twice that much in other promotional activity. Young people are exposed to a steady stream of images and lyrics presenting alcohol use in an attractive light. Within any country, the specific community environment may contribute to drinking to a greater or lesser extent. The drinking environment can be characterized as varying on a “wet-dry” continuum. A “wet” community environment is one in which drinking is prevalent and common, public opinion is generally tolerant or positive, and alcohol is readily available both commercially and at private social occasions and is advertised as available. A “dry” community would be one in which drinking at social occasions is not the norm and is generally frowned on, and alcohol outlets are relatively scarce. One commonly used statistical indicator for the “wetness” of the environment is the per capita consumption of alcohol (the average number of drinks per person) for the population age 14 and over per year. In the United States, for example, per capita consumption ranged from 1.3 gallons of ethanol per capita in Utah to 2.8 gallons in Wisconsin, in 1997; see Table 4-1. TABLE 4-1 Alcohol Consumption, 1999 State or Area Ethanol* Per Capita Alabama 6,656 1.88 Alaska 1,346 2.88 Arizona 9,971 2.68 Arkansas 3,725 1.82 California 57,195 2.20 Colorado 8,305 2.57 Connecticut 5,953 2.26 Delaware 1,812 2.96 District of Columbia 1,647 3.74 Florida 32,773 2.66 Georgia 14,019 2.27
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Reducing Underage Drinking: A Collective Responsibility State or Area Ethanol* Per Capita Hawaii 2,212 2.31 Idaho 2,355 2.39 Illinois 22,337 2.32 Indiana 9,371 1.97 Iowa 4,601 1.98 Kansas 3,925 1.85 Kentucky 5,662 1.76 Louisiana 8,678 2.50 Maine 2,348 2.26 Maryland 8,740 2.11 Massachusetts 12,290 2.45 Michigan 16,625 2.11 Minnesota 9,189 2.41 Mississippi 4,801 2.19 Missouri 9,962 2.26 Montana 1,828 2.55 Nebraska 2,979 2.24 Nevada 5,765 4.06 New Hampshire 3,943 4.07 New Jersey 14,416 2.20 New Mexico 3,308 2.43 New York 28,187 1.92 North Carolina 12,241 2.00 North Dakota 1,264 2.45 Ohio 18,203 2.01 Oklahoma 4,624 1.72 Oregon 6,239 2.32 Pennsylvania 18,723 1.91 Rhode Island 1,936 2.41 South Carolina 7,590 2.41 South Dakota 1,354 2.32 Tennessee 8,468 1.91 Texas 35,677 2.29 Utah 2,105 1.33 Vermont 1,144 2.34 Virginia 11,107 1.99 Washington 9,962 2.16 West Virginia 2,492 1.66 Wisconsin 11,664 2.75 Wyoming 961 2.48 Northeast 88,941 2.12 Midwest 111,474 2.20 South 170,712 2.21 West 111,551 2.32 U.S. Total 482,678 2.21 *Ethanol is the alcohol consumption measure used. SOURCE: Data from National Institute on Alcohol Abuse and Alcoholism (2002).
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Reducing Underage Drinking: A Collective Responsibility To what extent do environmental factors influence individual drinking choices by youth? It is interesting in this regard to analyze trends in youth drinking over time. Based on their analysis of Monitoring the Future data for high school seniors, Cook and Moore (2001) report that the 30-day prevalence of drinking and also of heavy drinking1 peaked in 1979, and then declined by approximately one-third (30.6 and 37.5 percent, respectively), reaching a low point in 1993 and increasing only slightly since then. This downward trend is unrelated to demographic changes in the composition of the population of high-school seniors and cannot be fully explained by trends in prices, minimum drinking age, or availability (Cook and Moore, 2001). However, this trend in drinking prevalence closely tracks the societal trend in drinking, as measured by national per capita consumption. Thus, whatever the reason for the decline in youth drinking during the 1980s, it seems to be related to, and perhaps in some sense is the result of, the overall decline in drinking in the society. More persuasive evidence of the link between “wetness” and youth consumption comes from a study of individual drinking behavior. Cook and Moore (2001) analyzed data from the National Longitudinal Survey of Youth (NLSY) that included annual items on individual drinking for 1982-1985 and 1988-1989. The initial cohort of 12,000 respondents ranged in age from 17 to 24 at the beginning of this period in 1982, so that the NLSY data provide information on drinking trajectories for older teens and those in their twenties. They found that, even after controlling for family, religion, schooling, aspirations, employment, and cognitive ability, various aspects of the environment contributed significantly to patterns of drinking. Specifically, youth with similar backgrounds and individual characteristics were more likely to drink if they lived in a state with relatively high per capita consumption. The minimum drinking age and the excise tax on beer are also related to youth drinking. Thus, an 18-year-old living in a state in which his drinking was legal in 1982 would have been more likely to drink (and to drink heavily) than an identical twin living in a state with a higher minimum drinking age. Increases in the beer tax (which has a direct effect on average price) generally tend to lower drinking, although it is harder to pin down with the NLSY data; however, other studies are quite consistent at documenting that taxes and prices influence youth drinking (Chaloupka and Wechsler, 1996). This research suggests that a “wetter” environment may provide adolescents with more social occasions to drink, more positive attitudes about drinking, more advertising and outlets, and more lenient regulations concerning the sale and consumption of alcohol. In short, such environments have an enabling effect on underage drinking. 1 Defined as five or more drinks in a row in the last 2 weeks.
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Reducing Underage Drinking: A Collective Responsibility In addition to specific community norms for drinking, several other societal factors may affect the prevalence of heavy drinking in adolescence. First, U.S. society is largely segregated by age. As adolescents get older, they spend more and more time alone or with other peers in unsupervised settings, and both age-segregation and lack of adult supervision have been related to higher levels of substance abuse and deviance, including greater alcohol consumption. “Hanging out” with friends in unstructured, unsupervised contexts is generally related to negative outcomes, while spending time with others in adult-sanctioned, structured contexts is generally related to positive outcomes (e.g., Osgood, 1998; Osgood et al., 1996). A particularly vulnerable time for youth is the after-school period, 3:00 to 6:00 p.m. This time is especially likely to be unsupervised as adolescents get older and parents believe that it is “safe” to leave them at home unattended. Youth who participate in after-school programs, such as sports, clubs, library-based activities, and youth-serving organizations are less likely to use alcohol than nonparticipants (Eccles and Barber, 1999). The same point about age segregation and lack of supervision applies to adolescents’ attendance at unchaperoned parties and other activities. It is not uncommon for caring parents to decide to host an all-night party with alcohol for their teenage children, taking the car keys from the guests as they arrive, on the theory that it is safer to allow drinking at home rather than to forbid it and have teens drink and drive. Individuals or organizations that host and support such events are providing opportunities that enable adolescents to drink to excess. Not surprisingly, having parents who sanction alcohol use (even in “controlled” settings) is related to heavier drinking among adolescents (Barnes et al., 1995; Peterson et al., 1994). By and large, adolescents are even segregated by age in the workplace. Adolescents who work for pay are often employed in fast-food and similar jobs in which most of their coworkers are other adolescents (Mortimer et al., 1992). It is not uncommon for a 17-year-old to be managing a fast-food establishment and supervising 15- and 16-year-olds. Given this situation, it may not be surprising that part-time work during adolescence is positively related to involvement in drugs, alcohol, and other deviant behaviors (e.g., Bachman and Schulenberg, 1993; Greenberger and Steinberg, 1986; Steinberg et al., 1993). The place in which adolescents are most segregated is likely to be at residential colleges. Although less than one-quarter of college students are in such settings, student-segregated apartments or college residence halls provide the conditions under which binge drinking is likely to occur: cultural norms that support drinking, little supervision by any adults, and peers who are likely to be heavily involved in drinking. In a recent study, Cook and Moore (2001) found support that college students are more likely to engage in drinking, especially heavy drinking, if they live in a
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Reducing Underage Drinking: A Collective Responsibility dormitory than if they live off campus, even after controlling for other factors (such as age) that might explain this difference. Social Setting While adolescents are experiencing community-level influences related to the place of alcohol in our society, each adolescent is also making decisions about drinking within a particular social setting. Of particular importance with regard to social influences are adolescents’ peers and friendship networks and their changing relationships with their parents. The effect of parents’ and peers’ alcohol consumption on adolescents’ drinking patterns is both direct, through observation and modeling (Bandura, 1986) and indirect, through its influence on alcohol-related expectancies and attitudes (see Kuther, 2002, for a review). Peers Adolescents in the United States spend approximately twice as much time with peers as they spend with parents or other adults. Accordingly, peers are a major source of socialization and development for adolescents. Research supports the notion that both selection and socialization factors contribute to observed similarities in behavior among friends. That is, adolescents are influenced by the normative behaviors of their peers and they choose peers who reinforce their own norms and values (Kandel, 1978). The influences of peers are both direct and indirect (Bauman et al., 1989; Biddle et al., 1980; Ennett and Bauman 1991; Pruitt et al., 1991; Kandel and Logen, 1984). That is, adolescents are influenced directly (e.g., by observing peers’ behavior or by peer pressure) and indirectly (e.g., by their perceptions of the extent to which their friends are drinking alcohol). The combination of the normative aspect of alcohol use and peer influences on underage alcohol use is also important. Youth are well aware of the normative nature of alcohol use, and they usually want to go along with their peer group (Aas and Klepp, 1992; Barnes et al., 1995; Beck and Treiman, 1996; Olds and Thombs, 2001). Perceived use of alcohol by one’s peers and friends independently predicts self-reported alcohol use (e.g., Olds and Thombs, 2001; Reifman et al., 1998), with peers having a greater influence on adolescent drinking than do parents (Kuther, 2002). It should be noted, however, that interventions that attempt to prevent or reduce alcohol consumption by focusing on changing perceptions of social norms must proceed cautiously. Research conducted by Cialdini and colleagues (Cialdini et al., 1990; Kallgren et al., 2000) points to the need to distinguish between descriptive norms (perceptions of what most others are doing) and injunctive norms (perception of what other people think one
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Reducing Underage Drinking: A Collective Responsibility should be doing or not doing). Cialdini argues that focusing on injunctive norms is more effective at changing behavior than targeting only descriptive norms. Parents Although peers are one important influence on adolescents’ choices, parents remain important during the teen years. Many adolescents report that they turn to their parents for advice regarding educational and career decisions, although they turn to their friends for advice about clothes and music (Montemayor, 1982). Indeed, most theoretical perspectives today suggest that close connections to both parents and peers are related to easier transitions to independence (e.g., Allen and Hauser, 1996). Yet peer influences also depend in part on the quality of parent-child relationships (Parke and Ladd, 1992). Adolescents who have positive relationships with their parents may be more likely to have friends who engage in socially valued activities than do adolescents with less positive parental interactions. Similarly, more involved parents may oversee and monitor their child’s peer relationships more than do less involved parents, thereby reducing adolescents’ engagement in undesired behaviors (see, for example, Fletcher et al., 1995). Parents also have a significant amount of influence on their children’s choice of friends. Parents help shape prosocial and antisocial behavior, which leads children to gravitate toward particular crowds. Parental monitoring and involvement are key components in reducing adolescent alcohol use. Monitoring of an adolescent’s behavior involves the parent or guardian supervising the adolescent; knowing the adolescent’s whereabouts; knowing the adolescent’s friends and peers; setting expectations that are clear and optimally challenging; delivering consequences that are fair, affirming, and useful; and communicating with the adolescent (Connell et al., 1995; Connell and Halpern-Felsher, 1997; Halpern-Felsher et al., 1997; Lee and Halpern-Felsher, 2001). Similarly, parental involvement is the extent to which parents show interest in, are knowledgeable about, and put effort into their child’s activities and development. Both parental monitoring and involvement serve to prevent or reduce adolescents’ health-compromising behaviors through the setting of curfews, awareness of and participation in after-school and weekend activities, prevention of adolescents’ association with risky peers, and the improvement of social skills (Beck and Lockhart, 1992; Cohen et al., 1994; Steinberg et al., 1994). Research on parental monitoring consistently shows protective effects on alcohol use (Barnes et al., 2000; Bogenschneider et al., 1998; Reifman et al., 1998; DiClemente et al., 2001). Families also provide an arena in which fledgling decision makers try their new skills and in which more experienced decision makers model
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Reducing Underage Drinking: A Collective Responsibility appropriate behavior or even provide instruction on how to make decisions (Jacobs and Ganzel, 1994). Learning to make decisions and live with their consequences and learn from them is an important developmental task that may be promoted or hindered by particular parenting practices. Although most parents give their adolescents increasing autonomy to make a wide range of decisions—in friendship, academics, extracurricular involvement, and consumer choices—many do so with little guidance or without letting adolescents experience the consequences of their actions. In addition, many parents provide an inconsistent pattern of restrictions and privileges (e.g., childlike restrictions about bedtime that don’t match the adult privilege of driving the family car) that may lead adolescents to make choices that are aimed at rebelling against parental restrictions or that give them adult status (such as drinking alcohol). Other aspects of parenting, such as parental norms and attitudes regarding adolescents’ alcohol use and parents’ own alcohol use, influence adolescent risk behavior. For example, Sieving and colleagues (2000) found that, in comparison with other variables, parent norms against underage drinking showed the strongest association with adolescents’ abstention from alcohol use. In addition, parents, like other adults, may overestimate or underestimate drinking norms for adolescents, depending on their own experiences or their perceptions of societal norms. If parents believe that most adolescents drink, they may be more willing to “look the other way” when their children drink or to sponsor parties at which alcohol is served. Parents may benefit from knowing about other parents’ practices and prohibitions concerning alcohol use by their children. Parents’ own alcohol use has also been linked to underage drinking (e.g., Pandina and Johnson, 1989), as well as to increased chance of experiencing alcohol-related negative consequences (Pandina and Johnson, 1990). However, family history of alcohol abuse and alcoholism alone may not be adequate to predict drinking patterns among children of parents with such drinking behaviors. It is possible that other factors, such as parental monitoring, personality, and stress coping strategies, mediate between family history of alcohol use and underage drinking (e.g., Johnson and Pandina, 1993; Reifman et al., 1998). Two studies have demonstrated that sibling alcohol use is a risk factor. Of particular interest is the study by McGue and colleagues (1996) that examined the effect of both parental and sibling alcohol use on both adoptive and biological children raised in the same families: while parental alcohol use only had an effect for the biological children, sibling use had an effect on both adoptive and biological children. The effect was stronger if the sibling was similar in age, gender, and ethnicity.
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Reducing Underage Drinking: A Collective Responsibility CONFLUENCE OF FACTORS In this chapter we have listed many social, cognitive, and contextual factors that are related to the reasons that adolescents drink. In a culture that promotes alcohol use, it is impossible to isolate one factor as the primary cause. Rather, understanding why adolescents drink is more likely to be found in the confluence of factors. Positive aspects of the normal developmental process (e.g., enhanced cognitive abilities and physical maturation) are directly related to the greater autonomy and freedom from supervision enjoyed by adolescents. However, increases in autonomy lead to more opportunities to obtain and use alcohol. Likewise, normal adolescent development includes focusing on peers and searching for one’s own identity and friendship niche; however, these normal developmental processes lead to trying risky behaviors and conforming to peer norms that often include alcohol use. Thus, the trends that are typically associated with healthy adolescent development also set the stage for increased opportunities for alcohol use. In addition, adolescents are coming of age in the United States are doing so in a culture that promotes and enables underage drinking. There is little that one can change about the timetable of cognitive and emotional development or personality characteristics, but one can consider interventions for some of the factors that have been related to adolescent alcohol consumption and can be changed. The most likely targets are adolescent, parent, and community attitudes about the acceptance of underage drinking. Media and educational campaigns with this goal, however, must keep in mind many of the factors that have been reviewed in this chapter. For example, messages to adolescents must consider factors such as developmental level; the need to act adult-like, try on new identities, and make decisions with little experience; and adolescents’ peer norms and biased reasoning about these norms. Communications aimed at parents and others must provide realistic information about the prevalence of underage drinking and the dangers associated with it. In addition, adults must be given clear messages about what they may be doing to enable underage drinking and concrete examples of what they can do to convey their expectations to their children, monitor their children, and provide a community environment that discourages rather than promotes underage drinking.
Representative terms from entire chapter: