Overview of the Issues

Why Focus on 9- to 13-Year-Olds and Their Families?

The majority of 9- to 13-year olds are not using alcohol. They have strong negative attitudes about underage alcohol use, and they know that using alcohol is harmful to their health. So why are we focusing on these children and their families when it appears that most of them are making healthy choices related to alcohol use? Because 9 to 13 is the age range in which lifelong health behaviors are established. There-fore, influencing the attitudes and health behav-iors of 9- to 13-year-old children can benefit society for years to come.

Parents/caregivers of children 9 to 13 tend to underestimate their child’s vulnerability to alcohol use and their own ability to affect their child’s decisions to use alcohol. Yet the research suggests that parents who establish regular, open, and honest communication with their 9- to 13-year-old children set a pattern that encourages the discussion of anything, even “tough” issues like underage alcohol use. Through these discus-sions, parents can influence their child’s attitudes and health behaviors. Thus, contrary to popular belief . . .

Family is a major influence on children’s alcohol use.

Current research suggests children are less likely to use alcohol when their parents are involved with them and when they and their parents report feeling close to each other.^3,4
Adolescents use alcohol less and have fewer alcohol-related problems when their parents discipline them consistently and set clear expectations.³
Parents’ favorable attitudes about alcohol use have been associated with adolescents’ initiating and continuing alcohol use.^3,5,6

Underage alcohol use begins earlier than the late teens.

Almost 42 percent of ninth grade students reported having consumed alcohol before they were 13.⁷
About 44 percent of ninth grade students reported using alcohol in the past month.⁷
One-fourth (25 percent) of ninth grade students reported binge drinking (having had five or more alcoholic beverages on one occasion) in the past month.⁷
Three-quarters of eighth graders reported having friends who use alcohol. In fact, one-fourth of eighth graders said that most or all of their friends use alcohol.⁸
Although the majority of 9 to 13 year olds are not using alcohol, it is worth noting that underage alcohol use is a serious issue that has been linked with problems ranging from brain damage to truancy and poor school performance.

Underage alcohol use causes serious problems.

In 1994, suicides or homicides accounted for an estimated 18 percent of alcohol-related deaths of children ages 9 to 15.⁹
Among eighth graders, higher truancy rates were associated with greater rates of alcohol use in the past month.¹⁰
Of all children under age 15 killed in vehicle crashes in 1998, 20 percent were killed in alcohol-related crashes.¹¹
Forty percent of children who start using alcohol before the age of 15 will become alcoholics at some point in their lives.¹²

Keep the Focus in Context

As we focus on 9- to 13-year-olds to prevent underage alcohol use, we must address those issues that are relevant to them, not issues such as drinking and driving and enforcement, which are relevant to older children. Other issues to consider that will help keep efforts focused on this unique age group are:

The perceptions of 9- to 13-year-olds regarding the harms that underage alcohol use can cause
The stressful transitions that put them at risk for using alcohol
How they communicate with their parents/ caregivers about alcohol use.

Some implications for addressing each of the three issues are as follows.

Perceptions held by children ages 9 to 13 regarding the harms of underage alcohol use aren’t always correct. This age group tends to have strong negative attitudes about underage alcohol use and knows that using alcohol is harmful to their health. However, they often confuse the harms of underage alcohol use with those of illicit drug or tobacco use. For example, when asked to identify the harmful effects of underage alcohol use, 9- to 13-year-olds stated:

“If you drink too much alcohol, then it will ruin your brain and your lungs will get black.”
“Can cause you to be paralyzed.”
“Can cause you to eat a lot.”

Implications. Identify the perceptions of harm related to underage alcohol use held by the 9-to 13-year-olds in your community. Build a mechanism into your Too Smart To Start initiative that allows you to correct misinformation and reinforce correct information regarding the harms of underage alcohol use.

Stressful transitions put 9-to 13- year-olds at risk for using alcohol. Children’s vulnerability to alcohol use initiation is heightened during periods of transition that cause stress. One example of a stressful transition is the onset of puberty, which includes physical, biological, and behavioral changes. The transitions from elementary to middle or junior high school, and from middle or junior high school to high school, are also stressful for this age group. Nine percent of 12th grade students in 2001 reported using alcohol by the end of the sixth grade, the grade which often represents a child’s final year in elementary school or first year in middle or junior high school.¹³

Implications. Consider that the behaviors of 9- to 13-year-olds you may have written off in the past as bad behavior may be connected to one or more of the stressful transitions that all children must go through as they age. Plan activities that encourage children and their parents/caregivers to discuss these stressors and ways to handle them.

Children 9 to 11 years olds are more willing to communicate with their parents than with their 12- and 13-year-old peers. Although kids of every age in this group say that the ideal person to get information from should be their parents, only the younger ones (9- to 11-year-olds) actually feel comfortable bringing up alcohol-related issues with them. They tend to view their parents as trusted sources of informa-tion and to see such exchanges as evidence of their parents’ care and concern. For example, when asked how they felt when their parents talked to them about underage alcohol use, youth 9 to 13 responded:

“It makes me feel safe, like my parents really care about me.”
“It makes me feel like, I guess they want me to make the right choices in my life.”

Youth 12 to 13, however, are less likely to ask their parents about issues related to alcohol use for fear that such questions may raise their parents’ suspicions. In fact, parents themselves have confirmed this fear, saying that questions about alcohol would raise concerns.

“Because they’d [parents] be like, why are you asking this question? Are you going to do this or something?”

Implication. Consider developing and/or strengthening messages that urge parents to adopt more open communication with their kids.

³ Hawkins, J.D., et al. (1997). Exploring the effects of age of alcohol use initiation and psychosocial risk factors on subsequent alcohol misuse. Journal of Studies on Alcohol 58(3): 280-290.

⁴ Resnick, M.D., et al. (1997). Protecting adolescents from harm: Findings from the National Longitudinal Study on Adolescent Health. Journal of the American Medical Association 278(10): 823-832.

⁵ Andrews, J.A., et al. (1993). Parental influence on early adolescent substance use: Specific and nonspecific effects. Journal of Early Adolescence 13(3): 285-310.

⁶ Ary, D.V., et al. (1993). The influence of parent, sibling, and peer modeling and attitudes on adolescent use of alcohol. International Journal of the Addictions 28(9): 853-880.

⁷ Centers for Disease Control and Prevention. Youth risk behavior surveillance—United States, 1997. (Morbidity and Mortality Weekly Report: CDC Surveillance Summa-ries 47, No. SS-3), pp. 1-89.

⁸ Johnson, L.D., et al. (1998). National survey results on drug use from the Monitoring the Future Study, 1975-1997: Vol. 1. Secondary School Students. Rockville, MD: National Institute on Drug Abuse.

⁹ National Institute on Alcohol Abuse and Alcoholism, Alcohol Epidemiological Data System. (1999). [Estimates for alcohol-related deaths by age and cause.] Unpublished data based on National Center for Health Statistics 1994 Mortality Data.

¹⁰O’Malley, P.M., et al. (1998). Alcohol use among adoles-cents. Alcohol Health & Research World 22(2): 85-93.

¹¹ National Highway Traffic Safety Administration. (1999). Traffic safety facts 1998—Children. Washington, DC: U.S. Department of Transportation.

¹² Grant, B.F., & Dawson, D.A. (1997). Age at onset of alcohol use and association with DSM-IV alcohol abuse and dependence: Results from the National Longitudinal Alcohol Epidemiological Survey. Journal of Substance Abuse 9: 103-110.