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viewed with some caution, however, both because of the shortcomings of self-reported data and because of the difficulty of determining the extent to which underage drinking causes other health risks rather than simply being associated with these risks. We then explore research on the economic consequences of underage drinking, including both immediate health care expenditures and earnings losses experienced by underage drinkers over their entire life-course. Finally, we present a brief discussion and conclusion about the program and policy implications of the social and economic consequences of underage drinking.

UNDERAGE ALCOHOL CONSUMPTION

Despite the legal drinking age of 21 in all states, according to the 2001 National Household Survey on Drug Abuse (NHSDA) (N = 68,929 age 12 and over, 32,002 ages 12 to 20, response rate 67 percent), 28.5 percent of persons ages 12 to 20 reported using alcohol in 2001 at some point in the 30 days prior to the survey (Substance Abuse and Mental Health Services Administration [SAMHSA] 2002). Projected onto the U.S. population that age, 10.1 million persons ages 12 to 20 drank in the past 30 days. Nearly 6.8 million, or 19 percent, were binge drinkers (consumed 5 or more drinks on an occasion at least once in the past 30 days). More than 2 million, or 6 percent, drank 5 or more drinks on at least 5 occasions in the past 30 days. Since 1980, the average age people began drinking has dropped from 17.4 to 15.9 years old (SAMHSA, 2002).

Males ages 12 to 20 were more likely to report binge drinking in the past month than their female peers (22 percent versus 16 percent). Binge drinking was reported by 21.7 percent of underage whites and 18.5 percent of underage American Indians or Alaska Natives, but only by 10.7 percent of underage Asians and 10.5 percent of underage blacks.

Among persons under age 21, those ages 18 to 20 were the most likely to drink. Just over half drank in the past month, 30 percent reported binge drinking at least once in the past 30 days, and 13 percent reported consuming 5 or more drinks on at least 5 occasions in the past 30 days.

The Centers for Disease Control and Prevention’s (CDC’s) National Youth Risk Behavior Survey examined a national random sample of high school students (Grunbaum et al., 2002), nearly all of whom are ages 14 to 18. Completed for CDC in 2001, the survey used a three-stage probability sample to obtain 13,601 completed questionnaires from a representative sample of high school students in public and private schools in the United States, with a response rate of 65 percent. Large numbers in that age group also drink and drink heavily. That survey showed 47 percent of high school students drank alcohol in the past month. Projected to the U.S. high school student population, 7,018,364 drank alcohol in the past month. Thirty-



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