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Excessive alcohol consumption contributes to an average of approximately 4,700 deaths among underage youths in the United States each year (e.g., from homicides, motor-vehicle crashes, and suicides) and an average of 60 years of life lost per death.1 Although drinking by underaged persons (<21 years) is illegal in every state, youths aged 12-20 years drink nearly 20% of all the alcohol consumed in the United States.2 To characterize alcohol consumption by high school students in Georgia, the Georgia Division of Public Health analyzed data from the 2007 Georgia Youth Risk Behavior Survey (YRBS). This report summarizes the results of that survey, which indicated that 38% of Georgia high school students reported current alcohol use, and 19% reported binge drinking in the past 30 days. Among students who reported current alcohol use, 44% reported that the usual type of alcohol they consumed was liquor (e.g., bourbon, rum, scotch, vodka, or whiskey), 58% reported that their usual location of alcohol consumption was at another person's home, and 37% reported that their usual source of alcohol was someone giving it to them. These results underscore the need for further research in Georgia and other states on underage drinking behavior, motives, and access to alcohol, which could facilitate development of additional effective intervention strategies. Evidence-based interventions should be sustained and strengthened; these include enforcing the age 21 minimum legal drinking age; increasing alcohol excise taxes; limiting alcohol outlet density; and maintaining existing limits on the days when alcohol can be sold.
The Georgia YRBS is conducted in the spring of every odd-numbered year using a two-stage cluster sample design to produce data representative of the state's public school students in grades 9-12. Data from 2007 are the most recent data available. A total of 2,465 students from 46 Georgia high schools completed anonymous, self-administered questionnaires that included questions on health-risk behaviors, including alcohol consumption. Local parental permission procedures were followed before survey administration. The school response rate was 92%, the student response rate was 89%, and the overall response rate was 81%.* Data were weighted to produce estimates representative of the state's public school students in grades 9-12. Subgroup analyses were conducted only among subgroups with more than 50 students. Current alcohol use was defined as having had at least one drink of alcohol on at least 1 day during the 30 days before the survey. Binge drinking was defined as having had five or more drinks of alcohol in a row (i.e., within a couple of hours) on at least 1 day during the 30 days before the survey. Among students who reported current alcohol use, prevalence estimates for type of alcohol usually consumed,† source of alcohol usually consumed,‡ and usual location of alcohol consumption§ were calculated overall and by sex, grade, race/ethnicity and binge drinking status. Statistical testing for significant differences was performed via t-test using the SUDAAN diffvar statement. Not all statistically significant results are presented in this report.
Among all Georgia high school students, 37.7% reported current alcohol use, and 19.0% reported binge drinking in the past 30 days. Liquor was the most prevalent type of alcohol usually consumed overall (43.7%) and across all subgroups. Among those who reported current alcohol use, significantly more binge drinkers (54.0%) reported liquor as the type of alcohol usually consumed than did non-binge drinkers (31.9%) (p<0.001). Beer was the second most prevalent type of alcohol usually consumed by male students (24.3%), and malt beverages were the second most prevalent type of alcohol usually consumed by female students (24.1%). The prevalence of reporting malt beverage as the type of alcohol usually consumed was higher among non-Hispanic black students (29.3%) than non-Hispanic white students (13.8%) (p=0.001) or Hispanic students (13.5%) (p=0.020), and higher among non-binge drinking students (26.4%) than binge drinking students (11.8%) (p<0.001).
Among students who reported current alcohol use, the most prevalent usual location of alcohol consumption was at another person's home overall (57.6%) and across all subgroups. The prevalence of reporting “at another person's home” as the usual location of alcohol consumption was higher among 12th-grade students (68.3%) than 9th-grade students (49.2%) (p=0.006), higher among non-Hispanic white students (62.7%) and Hispanic (61.1%) students than non-Hispanic black students (46.3%) (p<0.001 and p=0.047, respectively), and higher among binge drinking students (64.7%) than non-binge drinking students (49.5%) (p<0.001). The second most prevalent usual location of alcohol consumption was “at my home” (29.9%). The prevalence of reporting “at my home” as the usual location of alcohol consumption was higher among 9th-grade students (38.7%) than 12th-grade students (19.6%) (p<0.001), higher among non-Hispanic black students (38.6%) than non-Hispanic white students (26.5%) (p=0.008), and higher among non-binge drinking students (40.7%) than binge drinking students (20.6%) (p<0.001).
Among current drinkers, the most commonly reported source of alcohol was “someone gave it to me” (37.0%) followed by “I gave someone else money to buy it for me” (25.4%) and “I got it some other way” (19.9%). The prevalence of reporting “I someone gave it to me” was higher among female students (44.8%) than male students (29.1%) (p<0.001), and higher among non-binge drinking students (42.0%) than binge drinking students (32.5%) (p=0.021). The prevalence of reporting “I gave someone else money to buy it for me” was higher among 12th-grade students (34.0%) than 9th-grade students (16.5%) (p<0.001), higher among non-Hispanic white students (32.2%) than non-Hispanic black students (14.3%) (p<0.001), and higher among binge drinking students (35.5%) than non-binge drinking students (14.0%) (p<0.001).
D Kanny, PhD, J Horan, MD, Georgia Div of Public Health. PC Melstrom, PhD, EIS Officer, CDC.
The findings in this report indicate that, in 2007, a high proportion of the 38% of high school students in Georgia who were current drinkers usually consumed liquor rather than other alcoholic beverages, drank in their own or another person's home, and were provided alcohol by someone who gave it to them or purchased it for them. These results are generally consistent with other recent nationwide or state-specific studies. For example, the finding that liquor was the most prevalent type of alcohol usually consumed by Georgia students is comparable to findings from four other state YRBSs3 and from the Monitoring the Future study.4 In 2005, Arkansas (44.7%), Nebraska (34.1%), New Mexico (35.6%), and Wyoming (40.2%) each reported liquor as the most prevalent type of alcohol usually consumed.3 Likewise, the results of this report pertaining to drinking in homes are similar to results from the 2002-2006 National Surveys on Drug Use and Health, which indicated that 53% of persons aged 12-20 years who drank during the past 30 days were at someone else's home, and 30% were in their own home.5 The results in this report concerning how students got their alcohol also are consistent with that study, which estimated that approximately 40% of the nation's underage current drinkers are provided free alcohol by adults aged ≥21 years.5
This analysis did not assess the characteristics of persons who provided alcohol to students, including the age difference between the drinker and the person who supplied the alcohol. Other research has highlighted how underage drinkers obtain alcohol from peers by using false identification or by approaching strangers (i.e., “shoulder tapping”),6 emphasizing the importance of enforcing laws prohibiting alcohol sales to underage youth or the purchasing of alcohol for underage youths.
Additional studies are needed to better understand the drinking behaviors of Georgia high school students and the underlying motives. For example, future studies in Georgia and other states should examine the reasons why liquor is the type of alcohol usually consumed among youths. Previous research has determined that liquor is attractive to high school students because it is more potent, more portable, more easily concealed, and potentially more palatable (i.e., it can be flavored).7 Future research also should examine underage drinking in homes and the effectiveness of social host liability laws in reducing youth access to alcohol and underage drinking. In all states, persons aged <21 years may not possess alcohol legally. Georgia law prohibits furnishing alcohol to a person aged <21 years, but allows an exception in the person's home if the person's parent or guardian provides the alcohol and is present.8
The findings in this report are subject to at least four limitations. First, these data are from students who attend public schools and therefore might not be representative of all youths in these grades, including those who attend private, military, or home-based schools, or youths who do not attend school. In Georgia, approximately 8% of the total student enrollment (1,735,684) was enrolled in nonpublic schools during the 2005-06 school year.9 Second, the extent of underreporting or overreporting of behaviors cannot be determined. Third, the YRBS questionnaire does not quantify what constitutes a drink. Finally, YRBS does not collect data pertaining to student socio-economic status, which might have been a confounder in subgroup analysis, particularly for race.
A better understanding of youth drinking behavior and motives in Georgia and other states could aid development of effective intervention strategies to prevent underage and binge drinking, including maintaining and enforcing the age 21 minimum legal drinking age (e.g., enforcing ID checks at retail alcohol outlets); increasing alcohol excise taxes; limiting alcohol outlet density; and maintaining existing limits on the days when alcohol can be sold.10
*Overall response rate = (number of participating schools / number of eligible sampled schools) × (number of useable questionnaires / number of eligible students sampled).
†Determined by response to the question, “During the past 30 days, what type of alcohol did you usually drink?” The mutually exclusive response options were “liquor, such as vodka, rum, scotch, bourbon, or whiskey,” “beer,” “malt beverages, such as Smirnoff Ice®, Bacardi Silver®, or hard lemonade,” “wine coolers, such as Bartles & Jaymes® or Seagrams®,” “wine,” “some other type,” or “I do not have a usual type.”
‡Determined by response to the question, “During the past 30 days, how did you usually get the alcohol you drank?” The mutually exclusive response options were “I bought it in a store such as a liquor store, convenience store, supermarket, discount store, or gas station,” “I bought it at a restaurant, bar, or club,” “I bought it at a public event such as a concert or sporting event,” “I gave someone else money to buy it for me,” “someone gave it to me,” “I took it from a store or family member,” or “I got it some other way.”
§Determined by response to the question, “During the past 30 days, where did you usually drink alcohol?” The mutually exclusive response options were “at my home,” “at another person's home,” “while riding in or driving a car,” “at a restaurant, bar, or club,” “at a public place such as a park, beach, or parking lot,” “at a public event such as a concert or sporting event,” or “on school property.”
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The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Original Article: A Primer on the Precision and Accuracy of the Clinical Examination
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