ated with specific hazards, such as downhill skiing at high velocities and collisions with other players in football and hockey.


Alcohol has been identified as a top contributor to death in the United States (McGinnis and Foege, 1993), after tobacco use and diet and activity patterns. Compared with other threats to human health, alcohol causes the widest variety of injuries (Rose, 1992). Approximately 100,000 deaths are related to alcohol consumption in the United States each year (McGinnis and Foege, 1993; Rose, 1992), which translates into 15% of potential years of life lost before the age of 65 (Rose, 1992).

A significant proportion of the U.S. population drinks alcohol. Among current drinkers, 46% report having been intoxicated at least once in the past year, and almost 4% report having been intoxicated weekly (USDHHS, 2000). Almost 10% of current drinkers (approximately 8 million people) meet diagnostic criteria for alcohol dependence, and an additional 7% (more than 5.6 million people) meet diagnostic criteria for alcohol abuse (National Institute on Alcohol Abuse and Alcoholism [NIAAA], 1993; USDHHS, 2000). In 1995, the cost of alcohol abuse and alcoholism was estimated at $167 billion in the United States, of which more than two-thirds was due to lost productivity (Harwood et al., 1998; USDHHS, 2000).

Alcohol use and alcohol-related problems are common among adolescents (O’Malley et al., 1998; USDHHS, 2000). Research shows that the age at which a person starts drinking strongly predicts development of alcohol dependence over a lifetime. Approximately 40% of people who begin drinking before the age of 15 develop alcohol dependence at some stage in their lives. About 10% of people who begin drinking at age 21 or older develop alcohol dependence at some stage in life (Grant and Dawson, 1997; USDHHS, 2000). People with a family history of alcoholism have a higher prevalence of lifetime alcohol dependence than do those with no such history (Grant, 1998; USDHHS, 2000).

Socioeconomic Factors

Studies conducted in 1994–1996 showed that people of both sexes and all races and ethnic groups—with the exception of Hispanic women— displayed a strong inverse relationship between education and heavy alco-

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