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For many children, alcohol use begins early, during a critical developmental period: in 2002, 19.6 percent of eighth graders were current users of alcohol (use within the past 30 days), which can be compared with 10.7 percent who smoked cigarettes and 8.3 percent who used marijuana. Among each older age cohort of high school students, the prevalence, frequency, and intensity of drinking increase, contributing to increasing rates of educational failure, injury, and death as children move from grade to grade. By the time young people are seniors in high school, almost three-quarters (71.5 percent) report having drunk in the past year, almost half (48.6 percent) are current drinkers, and more than one-quarter (28.6 percent) report having had five or more drinks in a row in the past 2 weeks (Johnston et al., 2003). Among 18- to 22-year-olds, 41.4 percent of full-time college students and 35.9 percent of other young adults report heavy drinking (Substance Abuse and Mental Health Services Administration, 2002). Heavy childhood and teenage drinking injures the developing brain and otherwise interferes with important developmental tasks. In addition, children and adolescents who begin drinking early are more likely than others to wind up with alcohol problems throughout their adult lives.

The public is certainly aware of these problems, especially drunk driving by teens. However, recent surveys demonstrate that parents underestimate the prevalence and intensity of alcohol use by their own children and by the underage population (see Chapter 6). Moreover, as measured by media attention and government expenditures, public concern about teenage alcohol use has not been remotely commensurate with the magnitude of the problem. A telling measure of the current societal response is the large gap in the federal government’s investment in discouraging illicit drug use among teenagers and in discouraging underage drinking, given that the social damage from underage alcohol use far exceeds the harms caused by illicit drug use. In fiscal 2000, the nation spent approximately $1.8 billion on preventing illicit drug use (Office of National Drug Control Policy, 2003), which was 25 times the amount, $71.1 million, targeted at preventing underage alcohol use (U.S. General Accounting Office, 2001). The amount spent on preventing underage drinking also appears to be less than the amount spent on preventing tobacco use: in fiscal 2000, the Office of Smoking and Health, only one of many agencies in the Department of Health and Human Services concerned with smoking prevention, spent approximately $100 million. In addition, the states spent a great deal more, including funds generated by the agreement that settled the states’ Medicaid reimbursement suits against the tobacco companies.

There are signs that public attention to underage drinking is increasing and that the public recognizes the need to address the problem more aggressively than has thus far occurred. A recent study on public attitudes toward

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