Prenatal cocaine exposure: Direct and indirect associations with 21-year-old offspring substance use and behavior problems.

BACKGROUND: Prenatal cocaine exposure (PCE) has been linked to child/adolescent behavior problems and substance use in several longitudinal cohort studies. It is unclear whether these effects extend into adulthood and influence young adult behavior problems and substance use and, if so, whether they are mediated by childhood and adolescent experiences. METHODS: These data are from an ongoing longitudinal study of individuals born to women who were recruited early in pregnancy. Trimester-specific data on prenatal drug exposure were obtained. Caregivers and offspring were assessed at delivery and at 1, 3, 7, 10, 15, and 21 years postpartum. This report is from age 21, when 225 offspring (52% females; 54% African American, 46% Caucasian) reported on behavior problems, emotion regulation, and substance use. RESULTS: There were significant direct associations between PCE and early initiation of marijuana, 21-year emotion regulation problems, arrest history, and Conduct Disorder. The relation between PCE and young adult internalizing behavior was mediated by adolescent mood symptoms. The association between PCE and 21-year marijuana use was mediated by early initiation of marijuana use. CONCLUSIONS: PCE has both direct and indirect long-term associations with young adult development. Using statistical models that considered the complex interrelationships among PCE and adult outcomes, we demonstrated that the direct effects of PCE on young adult emotion regulation problems, arrest history, and Conduct Disorder are not completely explained by earlier adolescent behavior. Moreover, the analyses suggesting mediated pathways from PCE to young adult problems identify crucial variables to target interventions for exposed children and adolescents.

Progressive elaboration and cross-validation of a latent class typology of adolescent alcohol involvement in a national sample.

OBJECTIVE: Most studies of adolescent drinking focus on single alcohol use behaviors (e.g., high-volume drinking, drunkenness) and ignore the patterning of adolescents' involvement across multiple alcohol behaviors. The present latent class analyses (LCAs) examined a procedure for empirically determining multiple cut points on the alcohol use behaviors in order to establish a typology of adolescent alcohol involvement. METHOD: LCA was carried out on six alcohol use behavior indicators collected from 6,504 7th through 12th graders who participated in Wave I of the National Longitudinal Study of Adolescent Health (AddHealth). To move beyond dichotomous indicators, a "progressive elaboration" strategy was used, starting with six dichotomous indicators and then evaluating a series of models testing additional cut points on the ordinal indicators at progressively higher points for one indicator at a time. Analyses were performed on one random half-sample, and confirmatory LCAs were performed on the second random half-sample and in the Wave II data. RESULTS: The final model consisted of four latent classes (never or non-current drinkers, low-intake drinkers, non-problem drinkers, and problem drinkers). Confirmatory LCAs in the second random half-sample from Wave I and in Wave II support this four-class solution. The means on the four latent classes were also generally ordered on an array of measures reflecting psychosocial risk for problem behavior. CONCLUSIONS: These analyses suggest that there may be four different classes or types of alcohol involvement among adolescents, and, more importantly, they illustrate the utility of the progressive elaboration strategy for moving beyond dichotomous indicators in latent class models.

Antecedent predictors of children's initiation of sipping/tasting alcohol.

BACKGROUND: Sipping or tasting alcohol is one of the earliest alcohol-use behaviors in which young children engage, yet there is relatively little research on this behavior. Previous cross-sectional analyses determined that child sipping or tasting is associated with the child's attitude toward sipping and with a family environment supportive of alcohol use, but not with variables reflecting psychosocial proneness for problem behavior as formulated in Problem Behavior Theory (Jessor and Jessor, Problem Behavior and Psychosocial Development: A Longitudinal Study of Youth, 1977, Academic Press, New York). This study extended these analyses longitudinally to identify antecedent predictors of the childhood initiation of sipping or tasting alcohol in a multiwave study. METHODS: A sample of 452 children (238 girls) aged 8 or 10 and their families was drawn from Allegheny County, PA, using targeted-age directory sampling and random digit dialing procedures. Children were interviewed using computer-assisted interviews. Antecedent variables collected at baseline (Wave 1) were examined as predictors of the initiation of sipping/tasting alcohol in childhood (before age 12) among Wave 1 abstainers (n = 286). RESULTS: Ninety-four children initiated sipping/tasting alcohol in a nonreligious context between baseline and turning age 12. Initiation of sipping/tasting did not generally relate to baseline variables reflecting psychosocial proneness for problem behavior. Instead, as found in the previous cross-sectional analyses, the variables most predictive of initiating sipping/tasting were perceived parents' approval for child sipping, parents' reported approval for child sipping, parents' current drinking status, and children's attitudes toward sipping/tasting alcohol. CONCLUSIONS: These longitudinal analyses replicate the earlier cross-sectional results. Young children's sipping/tasting of alcohol reflects parental modeling of drinking and parental approval of child sipping and does not represent a precocious manifestation of a psychosocial proneness to engage in problem behavior.

Types of alcohol use experience from childhood through adolescence.

PURPOSE: There have been few reports of the development of alcohol involvement from childhood through adolescence. We examined the ages at which children first sipped or tasted alcohol, drank, had three or more drinks in a row, had five or more drinks in a row, were drunk, or had alcohol problems, to describe the types of drinking experience exhibited at each age from 8.5 through 18.0 years. Sipping and three or more drinks per occasion have been understudied to date. METHODS: We collected 14 waves of longitudinal data from 452 children aged 8 or 10 years, randomly sampled from Allegheny County, Pennsylvania. Ages of initiating each alcohol use behavior were determined, and the data were coded to reflect the child's status on each behavior at each age. We determined types of alcohol use experience using latent class analyses. RESULTS: From age 8.5 to 12.5 years, there were two latent classes: abstainers and sippers. The percentage of sippers increased to 67% by age 12.5 years. From ages 13.0 to 18.0, we identified three latent classes: abstainers, sippers/light drinkers, and drinkers with drunkenness. At ages 13.5-15.5 years, drinkers in the latter class reported drunkenness with just three to four drinks per occasion. By age 18 years, sippers/light drinkers comprised 55% of the sample and drinkers with drunkenness comprised 38%. CONCLUSIONS: Childhood experience with alcohol was surprisingly widespread. Sipping or tasting alcohol was common by age 12 years. A quarter of the sample drank before age 15 years. Experience of intoxication increased throughout adolescence, even among those who had ever consumed just three to four drinks on an occasion.

The burden of alcohol use: focus on children and preadolescents.

The study of alcohol use by children ages 12 and younger has been very limited. This article summarizes information from U.S. national and statewide surveys on the prevalence of alcohol use among children in grades 6 and lower, data on health conditions wholly attributable to alcohol, the prevalence of children's treatment admissions for alcohol abuse, and their rates of presentation at emergency departments for acute alcohol intoxication. Factors hampering the estimation of alcohol burden in this population include the lack of ongoing national surveys of alcohol use and problems in children, the hand-me-down nature of alcohol assessments in this population, and the lack of studies to establish whether there is a causal relationship between childhood-onset drinking and morbidity and mortality in adolescence and later in life that would permit determination of alcohol-attributable fractions. This article concludes that although the alcohol burden in childhood is low, it may be augmented by both referred alcohol burden through parental drinking and alcohol abuse and by deferred alcohol burden from longer-term consequences of early use.

Racial differences in the development of impulsivity and sensation seeking from childhood into adolescence and their relation to alcohol use.

BACKGROUND: Pronounced differences in drinking behavior exist between African Americans and European Americans. Disinhibited personality characteristics are widely studied risk factors for alcohol use outcomes. Longitudinal studies of children have not examined racial differences in these characteristics and in their rates of change or whether these changes differentially relate to adolescent alcohol use. METHODS: Latent growth curve modeling was performed on 7 annual waves of data on 447 African American and European American 8- and 10-year-old children followed into adolescence as part of the Tween to Teen Project. Both mother and child data were examined. RESULTS: European Americans had higher initial levels of (ß = 0.22, p < 0.001) and greater growth in sensation seeking (ß = 0.16, p < 0.05) compared with African Americans. However, African American children had higher initial levels of impulsivity compared with European American children (ß = -0.27 and -0.16, p < 0.01). Higher initial levels of sensation seeking (ß = 0.18, p < 0.01) and greater growth in both sensation seeking (ß = 0.24, p < 0.01) and impulsivity (ß = 0.30 to 0.34, p < 0.01) related to subsequent frequency of alcohol use. The association between race and alcohol use was partially mediated by initial levels of sensation seeking (ß = 0.04, p < 0.05; 95% CI: 0.004 to 0.078). Additionally, sharper increases in sensation seeking predicted greater levels of subsequent alcohol use for European Americans (ß = 0.33, p < 0.001) but not for African Americans (ß = -0.15, ns). CONCLUSIONS: This study revealed different developmental courses and important racial differences for sensation seeking and impulsivity. Findings highlight the possibility that sensation seeking at least partly drives early alcohol use for European American but not for African American adolescents.

Drinking frequency as a brief screen for adolescent alcohol problems.

OBJECTIVE: Routine alcohol screening of adolescents in pediatric settings is recommended, and could be facilitated by a very brief empirically validated alcohol screen based on alcohol consumption. This study used national sample data to test the screening performance of 3 alcohol consumption items (ie, frequency of use in the past year, quantity per occasion, frequency of heavy episodic drinking) in identifying youth with alcohol-related problems. METHODS: Data were from youth aged 12 to 18 participating in the annual National Survey on Drug Use and Health from 2000 to 2007. The screening performance of 3 alcohol consumption items was tested, by age and gender, against 2 outcomes: any Diagnostic and Statistical Manual, Fourth Edition alcohol use disorder symptom ("moderate"-risk outcome), and a diagnosis of Diagnostic and Statistical Manual, Fourth Edition alcohol dependence ("high"-risk outcome). RESULTS: Prevalence of the 2 outcomes increased with age: any alcohol use disorder symptom ranged from 1.4% to 29.2%; alcohol dependence ranged from 0.2% to 5.3%. Frequency of drinking had higher sensitivity and specificity in identifying both outcomes, compared with quantity per occasion and heavy episodic drinking frequency. For both outcomes, results indicate the utility of similar cut points for drinking frequency for males and females at each age. Age-specific frequency cut points, however, are recommended for both moderate- and high-risk outcomes to maximize screening performance. CONCLUSIONS: Drinking frequency provides an empirically supported brief screen to efficiently identify youth with alcohol-related problems.

Childhood risk factors for early-onset drinking.

OBJECTIVE: There is relatively little research on the childhood antecedent predictors of early-onset alcohol use. This study examined an array of psychosocial variables assessed at age 10 and reflecting Problem Behavior Theory as potential antecedent risk factors for the initiation of alcohol use at age 14 or younger. METHOD: A sample of 452 children (238 girls) ages 8 or 10 and their families was drawn from Allegheny County, PA, using targeted-age directory sampling and random-digit dialing procedures. Children and parents were interviewed using computer-assisted interviews. Logistic regression analyses were used to examine the age-10 univariate and multivariate predictors of the initiation of alcohol use by age 14 or younger. RESULTS: Twenty-five percent of the sample reported having more than a sip or a taste of alcohol in their life by age 14. Sex, race, and age cohort did not relate to early drinking status. Children with two parents were less likely to initiate drinking early. Early initiation of drinking related significantly to an array of antecedent risk factors (personality, social environment, and behavioral) assessed at age 10 that reflect psychosocial proneness for problem behavior. In the multivariate model, the variables most predictive of early-onset drinking were having a single parent, sipping or tasting alcohol by age 10, having parents who also started drinking at an early age, and parental drinking frequency. CONCLUSIONS: Initiation of alcohol use by age 14 reflects childhood psychosocial proneness to engage in problem behavior as measured by Problem Behavior Theory and having a family environment conducive to alcohol use.

Parent-child divergence in the development of alcohol use norms from middle childhood into middle adolescence.

OBJECTIVE: Despite the importance of alcohol use norms as predictors of adolescent and college drinking, there has been little research on their development from childhood into adolescence. This study used parental and child beliefs regarding the acceptability of sipping, drinking, and drunkenness for children ages 8-16 years to establish age norms for these alcohol use behaviors and examined differences in the growth of these norms between parents and children. METHOD: Data were collected as part of an ongoing cohort-sequential longitudinal study of 452 families with children initially 8 or 10 years old followed over 10 waves covering the age span from age 8 to age 16 years. Children completed interviews every 6 months. Parents completed interviews annually. Latent growth modeling was performed on the mother, father, and child data. RESULTS: Unconditional latent growth curve modeling showed that parental acceptance of child sipping increased with child age but that there was no increase in their acceptance of child drinking or drunkenness through age 16 years. In contrast, there was significant growth in children's acceptance of sipping, drinking, and drunkenness. Piecewise growth models with a transition at 11.5 or 12 years of age best described the development of child and adolescent alcohol use norms. CONCLUSIONS: From middle childhood into middle adolescence, there is increasing divergence between parents' acceptance of alcohol use by children and child/adolescent acceptance of alcohol use by people their age.

Familial loading for alcoholism and offspring behavior: mediating and moderating influences.

BACKGROUND: Familial loading for alcoholism is an important marker of risk for early-onset alcohol problems, but the early expression of this risk in community samples of children is understudied. METHODS: This study tested, for 452 8- and 10-year-old children, whether the density of alcohol problems in their biological relatives was associated with externalizing behaviors that are risk factors for later alcohol problems. RESULTS: Density of alcohol problems in first- and second-degree biological relatives was associated with behavioral disinhibition (BD; e.g., poor inhibitory control, attentional shifting, ß = 0.10, p = 0.04) and conduct problems (CP; i.e., defiance, aggression, delinquency, ß = 0.18, p = 0.00). These relations were moderated by parenting practices (parental warmth, discipline consistency, and parental monitoring). The density-behavior association lost statistical significance when at least 2 of 3 parenting practices were rated above median levels for the sample (p = 0.67 to 0.36). The density-behavior association was mediated by current demographic advantage (p = 0.00 for BD, p = 0.00 for CP), current maternal mental health (p = 0.01 for BD, p = 0.00 for CP), and current maternal deviant behavior (for CP only, p = 0.01). CONCLUSIONS: Findings support previously proposed but untested pathways in etiologic models of alcoholism and show the potentially important role of active parenting in reducing the expression of inherited vulnerability to alcoholism in childhood.

Concordance of adolescent reports of friend alcohol use, smoking, and deviant behavior as predicted by quality of relationship and demographic variables.

OBJECTIVE: The strongest predictor of adolescent alcohol use is affiliation with friends who drink, use other drugs, or engage in deviant behavior. Most studies measure this variable using adolescent perceptions of friend problem behavior, but some research suggests these perceptions may be inaccurate. The current study's objective was to determine the concordance between adolescent perceptions of their friend's drinking, smoking, and deviant behavior and the friend's self-report. Relationship characteristics and demographic variables were explored as predictors of report concordance. METHOD: Participants (targets) were 232 adolescents ages 13 or 15 (53% girls) from Wave 9 of the Tween to Teen Project. At least one reciprocally endorsed friend participated for 59% of target adolescents (n = 232/390). Targets completed computer-assisted interviews. Friends completed telephone interviews. RESULTS: The relations between target perceptions of friend and friend self-reports of drinking and smoking were statistically significant (p < .001), but concordance was driven largely by agreement regarding the absence of behavior. Although 22% of friends drank and 8.6% smoked, fewer than 60% of targets perceived these behaviors. Deviant behavior reports correlated moderately (r = .45), with 51% of adolescents underreporting friend deviance. There were few predictors of report concordance. CONCLUSIONS: Adolescents and their friends generally provided concordant reports of one another's drinking and smoking behaviors, but most agreement concerned the absence of behavior; most targets provided underreports of their friend's engagement in deviant behaviors. These findings suggest that adolescent perceptions of friends' problem behavior do not exaggerate the involvement of their friends in these behaviors.

Alcohol outcome expectancies as socially shared and socialized beliefs.

Alcohol expectancies are important predictors of alcohol involvement in both adolescents and adults, yet little research has examined the social origins and transmission of these beliefs. This paper examined alcohol outcome expectancies collected in a cohort-sequential longitudinal study of 452 families with children followed over seven waves. Children completed interviews every 6 months, and parents completed interviews annually. Eighteen of 27 alcohol expectancies were highly consensual, being endorsed by significantly more than 67% of the mothers and fathers. These consensual expectancies were also highly stable over a 3-year period. Over the same period, children increased their adoption of both the positive and negative consensual alcohol expectancies. Unconditional latent growth modeling showed that piece-wise growth models with a transition at age 12 fit the data best. Both the positive and negative consensual expectancies were adopted at a faster rate between ages 8.5 and 11.5 than between ages 12 and 13.5. For negative expectancies, there was no further growth between ages 12 and 13.5. Taken together, these findings support the conceptualization of alcohol outcome expectancies as socially shared and transmitted beliefs.

Estimated blood alcohol concentrations for child and adolescent drinking and their implications for screening instruments.

OBJECTIVE: Blood alcohol concentrations (BACs) in children after consumption of different numbers of standard drinks of alcohol have not been estimated previously. The goal was to determine the number of drinks at each age that led to a BAC of > or =80 mg/dL, the National Institute on Alcohol Abuse and Alcoholism criterion for binge drinking. METHODS: The updated Widmark equation to estimate BAC was modified to take account of the differing body composition (total body water) and accelerated rates of ethanol elimination of children. The modified formula was used with 1999-2002 National Health and Nutrition Examination Survey data to estimate BACs for >4700 children and adolescents from 9 through 17 years of age, for intake levels of 1 to 5 standard drinks. RESULTS: The estimated BACs for children after consumption of just 3 standard drinks within a 2-hour period were between 80 and 139 mg/dL for boys 9 to 13 years of age and for girls 9 to 17 years of age, indicating substantial potential alcohol impairment. With 5 drinks within 2 hours (the level used to define binge drinking among college students), children 9 to 13 years of age were estimated to have BACs 2 to 3 times the adult legal limit for intoxication of 80 mg/dL. CONCLUSION: Binge drinking should be defined as > or =3 drinks for 9- to 13-year-old children, as > or =4 drinks for boys and > or =3 drinks for girls 14 or 15 years of age, and as > or =5 drinks for boys and > or =3 drinks for girls 16 or 17 years of age.

Brief screens for detecting alcohol use disorder among 18-20 year old young adults in emergency departments: Comparing AUDIT-C, CRAFFT, RAPS4-QF, FAST, RUFT-Cut, and DSM-IV 2-Item Scale.

BACKGROUND: This study compared six of the briefest screening instruments for detecting DSM-IV-defined Alcohol Use Disorder (AUD) among older adolescents treated in Emergency Departments (ED). METHODS: The AUDIT-C, the RAPS4-QF, the FAST, the CRAFFT, the RUFT-Cut, and 2-Items from the Diagnostic and Statistical Manual IV of the American Psychiatric Association [American Psychiatric Association (1994). Diagnostic and Statistical Manual of Psychiatric Disorders, (1994) (DSM-IV). 4th ed. Washington D.C.: American Psychiatric Association] criteria for AUD (heretofore referred to as the DSM-IV 2-Item Scale) were evaluated against the criterion of a current DSM-IV diagnosis of either alcohol abuse or dependence. The instruments were administered to 181 alcohol-using older adolescents (57% males; age range 18-20 years) in an ED and compared using Receiver Operator Characteristic (ROC) analyses against the criterion of a current DSM-IV diagnosis of alcohol abuse or dependence. RESULTS: Of these instruments, the DSM-IV 2-Item Scale performed best for identifying AUD (88% sensitivity and 90% specificity), followed by the FAST and the AUDIT-C. CONCLUSIONS: Two items from the DSM-IV criteria for AUD performed best for identifying ED-treated older adolescents with alcohol use disorders. The FAST and AUDIT-C performed well, but are longer and more difficult to score in the hectic environment of the Emergency Department.

Risk factors for young adult substance use among women who were teenage mothers.

Teenage mothers may not "mature out" of substance use during young adulthood, and this non-normative trajectory of use may contribute to negative outcomes for teenage mothers and their offspring. Pregnant teenagers (age range=12-18 years; 68% Black) were recruited from a prenatal clinic and interviewed about their substance use, and subsequently re-interviewed six and ten years later (n=292). Consistent with the literature, early tobacco and marijuana use were risk factors for young adult use. Other substance use, peer adolescent use and mental health indicators were more important than race and socioeconomic status (SES) in determining which teenage mothers would use tobacco, engage in binge drinking, and use marijuana as young adults. However, race and SES were significant predictors of quitting tobacco use and marijuana use by the 10-year follow-up. Depression was associated with both persistent tobacco use and marijuana use in teenage mothers. These results illustrate the long-term consequences of teenage childbearing and identify modifiable risk factors for later health risks that should be addressed among younger mothers.

Developmental processes and mechanisms: ages 0-10.

Little information is available on alcohol use in children up to age 10, although rates appear to be low. This age-group is not without risk, however. In fact, numerous nonspecific and specific risk factors for subsequent alcohol use are prevalent in childhood. Alcohol-nonspecific risk factors include externalizing and internalizing behaviors, as well as environmental and social factors (e.g., stress, physical abuse, or other aspects of social interaction). Nonspecific childhood factors (i.e., predictors) are being identified to target specific population subgroups for preventive interventions. These efforts have identified a variety of predictors of drinking onset during childhood or early adolescence that predict adolescent and young-adult problem drinking, as well as adult alcohol use and alcohol use disorders. Alcohol-specific risk factors also are being identified, including children's beliefs and expectancies about alcohol, as well as childhood social contexts (e.g., modeling of alcohol use by parents, portrayal of alcohol use in the mass media, and growing up in a family with an alcoholic family member). Together, these specific and nonspecific influences play a heavy role in determining a child's risk of or resilience to later alcohol use and related problems.

Early developmental processes and the continuity of risk for underage drinking and problem drinking.

Developmental pathways to underage drinking emerge before the second decade of life. Many scientists, however, as well as the general public, continue to focus on proximal influences surrounding the initiation of drinking in adolescence, such as social, behavioral, and genetic variables related to availability and ease of acquisition of the drug, social reinforcement for its use, and individual differences in drug responses. In the past 20 years, a considerable body of evidence has accumulated on the early (often much earlier than the time of the first drink) predictors and pathways of youthful alcohol use and abuse. These early developmental influences involve numerous risk, vulnerability, promotive, and protective processes. Some of these factors are not related directly to alcohol use, whereas others involve learning and expectancies about later drug use that are shaped by social experience. The salience of these factors (identifiable in early childhood) for understanding the course and development of adult alcohol and other drug use disorders is evident from the large and growing body of findings on their ability to predict adult clinical outcomes. This review summarizes the evidence on early pathways toward and away from underage drinking, with a particular focus on the risk and protective factors and the mediators and moderators of risk for underage drinking that become evident during the preschool and early school years. It is guided by a developmental perspective on the aggregation of risk and protection and examines the contributions of biological, psychological, and social processes within the context of normal development. Implications of this evidence for policy, intervention, and future research are discussed.

Children's introduction to alcohol use: sips and tastes.

BACKGROUND: Sipping or tasting alcohol is one of the earliest alcohol use behaviors in which young children engage, yet there is relatively little research on this behavior. The present research describes the prevalence of sipping or tasting in a community sample of children, examines the sociodemographic correlates and social contexts of this behavior, and tests whether variables reflecting psychosocial problem-behavior proneness, that predict adolescent drinking, account for this behavior. METHODS: A sample of 452 children (238 girls) aged 8 or 10 and their families was drawn from Allegheny County PA using targeted-age directory sampling and random digit dialing procedures. Children were interviewed using computer-assisted interviews. Logistic regression analyses were used to examine the univariate and multivariate correlates of sipping/tasting. RESULTS: Thirty-nine percent of the sample had only sipped or tasted alcohol (35% of 8 year olds and 48% of 10 year olds), while 6% reported having had a drink of alcohol (5% and 7%, respectively). African-American children were less likely than White children to be sippers. Neither gender nor mother's education related to sipping status. Most sipping was done in a family context. Sipping/tasting did not generally relate to variables reflecting psychosocial proneness for problem behavior. Instead, the variables most predictive of sipping/tasting were perceived parents' drinking status, perceived parents' approval for child sipping, mother's drinking frequency, and children's attitudes toward sipping/tasting alcohol. CONCLUSIONS: Young children's sipping/tasting of alcohol reflects parental modeling of alcohol use and increased opportunities to try alcohol in the home rather than deliberate family socialization of alcohol use, and appears not to be a precocious manifestation of a psychosocial proneness to engage in problem behavior.

Really underage drinkers: the epidemiology of children's alcohol use in the United States.

Little attention has been paid to alcohol use by children aged 12 and younger. The present article summarizes findings on the prevalence of alcohol use from US national and statewide surveys of children in grades 6 and younger based on reports located in searches of the literature and the Internet. Four national surveys and seven statewide surveys of children's alcohol and drug use were located that present rates of lifetime sipping and tasting, lifetime experience of more than a sip, alcohol use in the past year, use in the past month, and use in the past week. Prevalence rates decrease with the level of involvement assessed. Alcohol use increases with age, doubling between grades four and six, with the largest jump in prevalence between grades five and six. At each grade level, boys are more likely to have used alcohol than girls. African-American children are nearly as likely as white and Hispanic children to have used alcohol. Over the past decade or so, the prevalence of both lifetime and current alcohol use has been declining in children. The failure to assess intensity of children's use hampers evaluation of the level of risk experienced by children. There is a need for ongoing nationwide surveillance of alcohol use in this population and for greater education of parents regarding the dangers of introducing children to alcohol use.