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research suggests that the dangers of youth drinking are magnified. In 2000, 36.6 percent of youths (under age 21) traffic fatalities involved alcohol, a rate slightly lower than the rate for adults (41.7 percent). However, when the denominator is the number of licensed drivers, drinking drivers under age 21 are involved in fatal crashes at twice the rate of adult drivers (National Highway Traffic Safety Administration, 2002a). Moreover, alcohol use among youths is strongly correlated with violence, risky sexual behavior, poor school performance, suicide, and other harmful behaviors (Hingson and Kenkel, 2004). College students are also significantly and negatively affected by their peer’s drinking (Wechsler, 1996; Wechsler et al., 2001a, 2001b, 2001c), including being assaulted, having one’s property damaged or experiencing an unwanted sexual advance. Recent research also suggests that adolescent drinking can inflict permanent damage on the developing brain (Brown and Tapert, 2004). And as noted in Chapter 2, early onset of alcohol use greatly increases the probability of adult alcohol dependence. In addition to the negative consequences to individual youth who drink, the costs of underage drinking to society—in lost lives, lost productivity, and increased health care costs—are substantial.

CONSEQUENCES OF ACUTE IMPAIRMENT

Alcohol impairs one’s decision-making capacity. As a result, young people who drink are more likely to engage in risk-taking behavior that can result in illness, injury, and death. Acute consequences of underage drinking include unintentional death and injury associated with driving or engaging in other risky tasks after drinking, homicide and violence, suicide attempts, sexual assault, risky sexual behavior, and vandalism and property damage. In addition, these consequences appear to be more severe for those who start drinking at a young age. Hingson and Kenkel (2004), report on a series of studies that controlled for history of alcohol dependency, frequency of heavy drinking, years of drinking, age, gender, race or ethnicity, history of cigarette smoking, and illicit drug use. These studies reveal that youth who started drinking before age 15, compared to those who waited until they were 21, were 12 times more likely to be unintentionally injured while under the influence of alcohol, 7 times more likely to be in a motor vehicle crash after drinking, and 10 times more likely to have been in a physical fight after drinking.

Drinking and Driving

The consequences of driving after drinking have received intense media attention and targeted policy responses. Laws have been passed to lower allowable blood alcohol content levels for underage drivers to near zero



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