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National Research Council (US) and Institute of Medicine (US) Committee on Developing a Strategy to Reduce and Prevent Underage Drinking; Bonnie RJ, O'Connell ME, editors. Reducing Underage Drinking: A Collective Responsibility. Washington (DC): National Academies Press (US); 2004.

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Reducing Underage Drinking: A Collective Responsibility.

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4Developmental and Environmental Influences on Underage Drinking: A General Overview

Bonnie L. Halpern-Felsher and Michael Biehl

How do we prevent underage drinking in a society in which youth receive positive messages about alcohol coupled with warnings that alcohol is illegal and risky? Alcohol pervades our culture, and youth are well aware of its popularity. Adolescents and young adults witness the casual use of alcohol by parents, other adults, and peers, and alcohol is commonly displayed in advertisements, in movies, on television, on t-shirts, at sports events, and through similar venues. Therefore, it is not surprising that experimental or occasional use of alcohol is reported by the majority of U.S. adolescents (Substance Abuse and Mental Health Services Administration, 2001), making it, by definition, a normative behavior during the second decade of life. This is not to say that underage alcohol consumption is condoned, as any alcohol use can lead to cognitive impairment, risk of injury or death if consumed before vehicle use, or violence. Futhermore, it is illegal for anyone under age 21.

In this chapter, we provide an overview of the developmental and environmental factors that have been implicated in normative underage alcohol use.1 In doing so, we apply a lifespan developmental systems approach (Baltes, 1987; Baltes, Reese, and Lipsitt, 1980; Lerner et al., 1994), whereby development is viewed as a lifespan process, with past events influencing current ones, which in turn influence future developments. A central tenet of lifespan models is that there is a dynamic, reciprocal interaction between the individual and his or her environment. Therefore, reducing risk behavior and promoting healthy pathways can only be accomplished through a fundamental understanding of the developmental and environmental factors that impinge on youths' lives.

In this chapter, we do not attempt to review all of the literature concerning the multitude of factors involved in adolescent alcohol use. Instead, we focus on developmental and environmental influences, with particular emphasis on factors we consider most amenable to prevention and intervention efforts. We refer readers to other, more extensive and lengthy reviews that have already made significant contributions to the field (e.g., Dielman, Butchart, Shope, and Miller, 1991; Halebsky, 1987; Hawkins, Catalano, and Miller, 1992; Vakalahi, 2001).

DEVELOPMENTAL INFLUENCES ON UNDERAGE ALCOHOL USE

Adolescence marks a period of great and rapid physical, cognitive, psychosocial, and emotional changes. All of these changes increase one's desire for more autonomy and decision making, which can result in risk taking, including alcohol use. Understanding how these individual-level developmental factors relate to alcohol use is critical in order to create developmentally appropriate and effective alcohol prevention and intervention programs. In this section, we review adolescent physical, cognitive, and psychosocial development, with particular emphasis on how such development influences underage alcohol consumption.

Physical Development

Adolescent development is typically marked by rapid and extreme biological changes—namely, the onset of puberty and menarche. During this time, hormones, brain development, and the environment interact to result in increased growth, change in voice characteristics, and the development of secondary sex characteristics.

Puberty often signals changes in one's own as well as others' expectations for the adolescent. For example, taller and more mature-looking adolescents are often expected to be more responsible and take on adult roles and behaviors earlier than less physically mature peers of the same age group. However, depending on the age at which puberty occurs, the adolescents' level of social and emotional maturation may not match their physical development. When this mismatch occurs, expectations for adult-like responsibilities may be met with negative or health-compromising self-perceptions and behaviors. For example, early maturing girls tend to show increased dissatisfaction with their bodies, have lower self-esteem, have school difficulties, and engage in problem behaviors such as drinking, smoking, and early sexual behavior as compared to late-maturing girls. In contrast, late-maturing boys express more dissatisfaction with their body image, tend to be less popular and less athletic, and perform less well academically than early maturing boys. The psychological and behavioral difficulties resulting from early or late pubertal onset can be ameliorated through parental involvement, communication, and support.

Cognitive and Psychosocial Development

During adolescence, thinking becomes more abstract and less concrete, and adolescents become more future oriented, allowing them to consider multiple aspects of any decision at one time, assess potential consequences of a decision, consider possible outcomes associated with various choices, and plan for the future. These cognitive changes are coupled with psychosocial development, including social perspective taking, susceptibility to peer pressure, and increased need for autonomy (e.g., Steinberg and Cauffman, 1996). Social perspective taking refers to the ability to recognize how the thoughts and actions of one person can influence those of another. Social perspective taking has been shown to gradually increase until about age 16 (Steinberg and Cauffman, 1996). Applied to underage drinking, it is expected that individuals who are more capable of social perspective taking will be more able to understand why underage alcohol use is not condoned and understand that not all people have the same views concerning alcohol use. Although generally an indicator of greater maturity, a downside of this new ability to understand different perspectives is that adolescents become highly concerned with peer conformity, which may make them more susceptible to peer pressure, including pressure to drink alcohol. A more detailed discussion of peer influences and social norms is presented later in this chapter.

These cognitive and psychosocial changes are also accompanied by adolescents' questioning of parental control and rules and their desire to be more autonomous, which often translates into their desire to participate in, and eventually dictate, their own decision making. The desire to be autonomous and make one's own decisions is considered an important hallmark of adolescence. The literature clearly indicates that the need to be more autonomous and be granted more decision making opportunities increases with age. Several other simultaneous changes during adolescence serve to increase adolescents' desire for autonomy. First, as indicated earlier, physical changes of puberty result in the adolescent seeing himself or herself as more deserving of privileges, and others tend to have similar expectations for youth. Second, increased time spent with peers leads to more experiences and comparisons of others' authority, power, and privileges. Finally, cultural and societal beliefs indicate that adolescence is a time to practice adult roles (Hill, 1973; see also Silverberg and Gondoli, 1996, for a review).

Perceptions of Alcohol-Related Risks

Two critical and overlapping areas of theory and research have emerged from our understanding of adolescent cognitive and psychosocial development: 1) adolescents' perceptions of risk, and 2) adolescent decision making. These areas have particular relevance to clinicians, policy makers, and researchers interested in understanding underage alcohol use. In this chapter, we discuss the notion of adolescent egocentrism, perceptions of invulnerability, and alcohol-related expectancies. For a discussion regarding alcohol-related decision making, see Jacobs, Chapter 5.

Both lay and scientific circles often have hypothesized that adolescents are not concerned about their health, that they make poor judgments about risks, and that they believe they are invulnerable to harm, and because of these perceptions, they engage in risk behaviors (see, for example, Social Cognitive Theory [Bandura, 1994], the Health Belief Model [Rosenstock, 1974], the Theory of Reasoned Action [Fishbein and Ajzen, 1975], the Theory of Planned Behavior [Ajzen, 1985], Self-Regulation Theory [Kanfer, 1970], and Subjective Culture and Interpersonal Relations Theory [Triandis, 1977]). The notion that adolescents do not adequately perceive risks largely stems from Elkind (1967, 1978), who argued that egocentric young adolescents hold an exaggerated sense of uniqueness and believe in a “personal fable”—that they are special and in some ways immune to the natural laws that pertain to others. Thus, they view themselves as invulnerable to harm, and therefore are more likely to engage in risk behaviors. Adolescent egocentrism and the associated perceptions of invulnerability are thought to become less evident as the adolescent matures cognitively.

Although Elkind's theory is appealing, it has not held up to empirical scrutiny. Evidence shows that adolescent egocentrism increases from childhood to early adolescence, and then gradually decreases through middle and late adolescence (De Rosenroll, 1987; Urberg and Robbins, 1984). But adolescent egocentrism does not appear to be linked to young adolescents' transition into formal operations (Gray and Hudson, 1984; Jahnke and Blanchard-Fields, 1993; Lapsley, Milstead, Quintana, Flannery, and Buss, 1986), nor has research supported a relationship between egocentrism and perceptions of invulnerability (Dolcini et al., 1989).

The majority of studies assessing the relationship between perceptions of invulnerability to harm and alcohol use have examined whether judgments of risk vary by behavioral engagement. Overall, results show that adolescents who have drunk alcohol perceive alcohol-related risks to be less likely to occur compared to adolescents without prior alcohol consumption (Goldberg, Halpern-Felsher, and Millstein, 2002; Halpern-Felsher et al., 2001; Hampson, Severson, Burns, Slovic, and Fisher, 2001; Kuther, 2002). Another set of studies has examined whether adolescents and adults differ in their estimates of risk. Contrary to hypotheses, most of this research has revealed that adults and adolescents give similar estimates of risk taking, including those related to alcohol use (e.g., Beyth-Marom, Austin, Fischhoff, Palmgren, and Jacobs-Quadrel, 1993; Quadrel, Fischhoff, and Davis, 1993).

Causal relationships between risk estimates and alcohol use must be made cautiously as most studies have used cross-sectional methodology, poor definitions of alcohol use, and inadequate assessments of risk perceptions (see Halpern-Felsher et al., 2001, for details). Despite lack of evidence, the concept of adolescent “invulnerability” remains pervasive in both scientific and lay circles, is used to explain adolescents' decisions to engage in potentially harmful behavior, and is incorporated into many intervention programs (Weinstein, 1983; Weisenberg, Kegeles, and Lund, 1980). Longitudinal, prospective studies are needed in order to fully understand the extent to which perceptions of low risk actually predict and motivate alcohol use.

Perceptions of Alcohol-Related Benefits

An emphasis on perceived risk alone may be inadequate to predict or change behavior because risk is only part of the behavioral decision making equation. What is missing is knowing the extent to which adolescents perceive benefits of risky behaviors. The decision making literature has argued that individuals should consider both the risks and benefits when making decisions (Baron, 1988; Weinstein and Fineberg, 1980). In addition, alcohol expectancy researchers have found that perceived benefits, in addition to perceived risks, are important predictors of drinking behavior (Christiansen, Goldman, and Inn, 1982; Christiansen, Roehling, Smith, and Goldman, 1989; Chen, Grube, and Madden, 1994; Goldberg et al., 2002; Grube, Chen, Madden, and Morgan, 1995; Jones, Corbin, and Fromme, 2001; Smith, Goldman, Greenbaum, and Christiansen, 1995; Wood, Nagoshi, and Dennis, 1992). More recently, Goldberg and colleagues (2002) found that, regardless of age, participants with more drinking experience perceived benefits to be more likely to occur, and risks less likely.

Indeed, adolescents' reasons for drinking alcohol often include an acknowledgment or identification of alcohol-related benefits, such as alcohol being used in social interactions to help them to reduce inhibitions, feel more relaxed (Jones et al., 2001; Wood et al., 1992), reduce tension, foster courage, and reduce worry (Prendergast, 1994).

Age, Gender, and Experiential Differences in Alcohol-Related Expectancies

Both positive and negative alcohol-related expectancies vary by age. By age 12, individuals with and without drinking experience have a well-formulated sense of alcohol-related expectancies (Christiansen et al., 1982; Jones et al., 2001). Although children's and adults' general alcohol expectancies are similar (Dunn and Goldman, 1996), negative expectancies are more often reported by younger children, with perceptions of alcohol-related benefits increasing with age (Goldberg et al., 2002; Miller, Smith, and Goldman, 1990). Specific expectancies also differ by age. Young adolescents (e.g., 12- to 14-year-olds) rank reduced tension and impaired behavioral functioning among the highest expectancies; 15- to 16-year-olds cite enhanced social and physical pleasure and modified social and emotional behavior; and older adolescents (e.g., 17- to 19-year-olds) list enhanced sexual performance and increased power among their highest expectancies (Christiansen et al., 1982).

There are also gender differences in alcohol expectations. Adolescent males typically perceive more positive and fewer negative consequences of alcohol use than do adolescent females. Furthermore, the frequency of alcohol use has been associated with global positive effects, sexual enhancement, and pleasure for men, but reduced tension for women (Jones et al., 2001). However, there were no differences between males and females in the relationship between amount of alcohol use and perceived outcomes.

Independent of age effects, prior experience with alcohol use also plays a large role in alcohol-related expectancies, alcohol-related decision making, and subsequent alcohol use (Christiansen et al., 1989; Christiansen et al., 1982; Chen et al., 1994; Goldberg et al., 2002; Grube et al., 1995; Jones et al., 2001; Smith et al., 1995; Wood et al., 1992). In particular, enhanced sexual feelings, power, and reduced tension have been reported by those with greater drinking experiences, while youth with little or no alcohol experiences have more global expectancies of increased pleasure (Christiansen et al., 1982).

ENVIRONMENTAL INFLUENCES ON UNDERAGE ALCOHOL USE

At the same time that youth are experiencing rapid physical, cognitive, psychosocial, and emotional changes, they are embedded within changing and multilayered contexts. These contexts and their reciprocal relationship with youth also must be understood in order to reduce underage drinking most effectively. In this section, we discuss the roles that parents, peers, and the larger society play in underage alcohol use.

Parents

Although multiple influences in adolescents' lives will determine their developmental course, parents have the single most important external influence on adolescents' development and behavior, including alcohol use. For more than 50 years, the relationship between parents' child-rearing orientations and child outcomes has been studied. This venture has resulted in a host of literature linking parenting styles to substance use (e.g., Lamborn, Mounts, Steinberg, and Dornbusch, 1991). Typically, researchers have found that children raised in homes in which parents were warm, loving, and involved, supported their children's independence and valued their children's opinions, and also set limits and monitored their children's activities were more likely to exhibit positive developmental outcomes and less likely to exhibit risk behaviors than were children reared in less supportive homes.

With respect to alcohol use, parental monitoring and involvement have emerged as particularly important parenting behaviors. Parental monitoring includes parental or guardian supervision and knowledge about their adolescents' activities and friends. Parental monitoring also entails setting clear expectations and having fair and direct consequences (Connell, Halpern-Felsher, Clifford, Crichlow, and Usinger, 1995; Connell and Halpern-Felsher, 1997; Halpern-Felsher, et al., 1997; Lee and Halpern-Felsher, 2001). Correlated with parental monitoring is parental involvement, which includes the parents having an active interest and participation in their child's activities and development. Parents can prevent or reduce adolescents' alcohol use in part by setting curfews, being aware of and participating in after-school and weekend activities, helping them to improve social skills, and reducing their adolescents' affiliation with peers who are engaging in risk activities (Beck and Lockhart, 1992; Cohen, Richardson, and LaBree, 1994; Steinberg, Fletcher, and Darling, 1994). Research on parental monitoring consistently shows protective effects on alcohol use (Barnes, Reifman, Farrell, and Dintcheff, 2000; Bogenschneider, Wu, Raffaelli, and Tsay, 1998; Reifman, Barnes, Dintcheff, Farrell, and Uhteg, 1998; DiClemente et al., 2001).

Parental norms and attitudes regarding adolescents' alcohol use (Ary, Tildesley, Hops, and Andrews, 1993; Baer, Barr, Bookstein, Sampson, and Streissguth, 1998; McGue, Sharma, and Benson, 1996; Stice, Barrera, and Chassin, 1998; Webb and Baer, 1995; Weinberg, Dielman, Mandell, and Shope, 1994) are also important influences on use (e.g., Sieving, Perry, and Williams, 2000). Studies have also shown that parents' own alcohol use is associated with underage drinking (e.g., Pandina and Johnson, 1989) as well as increased chance of experiencing alcohol-related negative consequences (Pandina and Johnson, 1990). Parents' use of alcohol is related to less family support, reduced parental monitoring, and less effective coping strategies, which in turn are related to a greater likelihood of alcohol use among adolescents (Barnes et al., 2000; e.g., Johnson and Pandina, 1993; Reifman et al., 1998).

Studies have also demonstrated that sibling alcohol use is a risk factor in a target individual's alcohol use (Ary et al., 1993; McGue et al., 1996). For example, McGue and colleagues (1996) showed that while parental alcohol use only had an effect for the biological children, sibling alcohol use was related to both adoptive and biological children's alcohol consumption. The effect was stronger if the sibling was similar in age, gender, and ethnicity.

Peers

Adolescents and adults spend a greater amount of time with their peers than with their family or other adults. Thus, peers become a major source of support and socialization for youth. Research shows that these peer networks can play a role in underage drinking. Adolescents are more likely to consume alcohol if they affiliate with peers who consume alcohol (Ary et al., 1993; Colder and Chassin, 1999; Fergusson, Horwood, and Lynskey, 1995; Curran, Stice, and Chassin, 1997; Dielman, Shope, Butchart, Campanelli, and Caspar, 1989; Sieving et al., 2000; Stice et al., 1998; Webster, Hunter, and Keats, 1994), have friends who offer them alcohol (Sieving et al., 2000), and are encouraged to use alcohol (Duncan, Duncan, and Hops, 1994; Keefe, 1994).

The potentially negative influence of peers on alcohol use can be ameliorated through positive adolescent-parent relationships, parental monitoring, and parental involvement (Parke and Ladd, 1992). For example, compared to less involved parents, parents who are more involved may oversee and monitor their children's peer relationships. Parents also have a significant amount of influence on their children's actual choice of friends, helping them to gravitate toward peers with fewer risk behaviors.

Several prevention efforts have attempted to alleviate the effects of peer influences on alcohol use. One area of programmatic focus has been to try to change perceptions of alcohol-related social norms. Such efforts have been based on research indicating that youth are aware of the normative nature of alcohol use and want to follow the crowd (Aas and Klepp, 1992; Barnes, Farrell, and Banerjee, 1995; Beck and Treiman, 1996; Olds and Thombs, 2001). Perceived use of alcohol by one's peers and friends independently predicts self-reported alcohol use (e.g., Olds and Thombs, 2001; Reifman et al., 1998), with peers having a greater influence on adolescent drinking than parents (Kuther, 2002). However, such programmatic efforts should proceed cautiously given evidence that two types of norms must be distinguished and acknowledged (Cialdini, Reno, and Kallgren, 1990; Kallgren, Reno, and Cialdini, 2000). One type, descriptive norms, are one's perceptions of what most others are doing. The second type, injunctive norms, are the perceptions of what other people think one should be doing or not be doing. Cialdini and colleagues argue that focusing on injunctive norms is more effective at changing behavior than targeting only descriptive norms.

Another effort to reduce the influence of peer pressure has been to teach and encourage drinking refusal self-efficacy (e.g., Bell, Ellickson, and Harrison, 1993; Ellickson, Bell, and Harrison, 1993). This concept, borrowed from Bandura's (19861997) general self-efficacy, refers to one's belief in his or her ability to resist urges or social pressures to drink, to drink in particular situations, or to consume large amounts of alcohol at one time. Adolescents with more positive self-efficacy are less likely to drink or drink excessively (Oei, Fergusson, and Lee, 1998; Webb and Baer, 1995), and those with fewer refusal skills are more likely to drink (Hays and Ellickson, 1996). Refusal skills may be a better predictor of problem drinking than alcohol expectancies, especially for heavy or frequent alcohol use (Connor, Young, Williams, and Ricciardelli, 2000; Oei et al., 1998).

Society and Community

We live in a society in which alcohol is ubiquitous, glamorized, and touted as a hallmark of adulthood. Advertisements for alcohol use are abundant, and alcohol is prominently displayed on television, in movies, in music, and at sports events. These societal messages compete with and even overshadow messages against underage drinking. Such mixed messages are particularly confusing to youth who are trying to make sense of their changing body and world, and who are trying to understand and meet societal expectations.

The extent to which alcohol consumption is considered to be the norm and is accepted within a given community contributes to variation in underage alcohol consumption. Underage drinking is less prevalent in communities in which youth are well monitored and where there is greater policing and enforcement of vendors who sell alcohol to youth. An especially vulnerable time in which youth particularly need supervision is after school (3 to 6 p.m.). Youth spend approximately 40 to 50 percent of their hours in discretionary time (Larson and Verma, 1999), with much of it unsupervised for older adolescents. Youth who participate in after-school programs, such as sports, clubs, library-based activities, and youth-serving organizations, are less likely to use alcohol (Eccles and Barber, 1999). Unfortunately, adolescents' participation in these after-school programs has lessened over the past two decades, largely because of reduced funding and because transportation and accessibility to these programs is often limited.

Colleges and universities are also a prime example of a community in which alcohol use is accepted and rampant. Despite college and university administration policies regarding underage drinking, the college environment continues to be a major time of alcohol use for youth. During college, underage youth can easily obtain alcohol from college mates older than age 21, and at times parents even supply college students with kegs of beer.

SUMMARY

Clearly, a great number of developmental and environmental factors contribute to underage drinking. All of these influences, from the most basic pubertal maturation to the most macrolevel societal policies, interact in complex ways. It must be recognized that behavior does not occur in a vacuum and cannot be understood adequately without considering the interplay between the individual and the many different types of environments in which he or she lives. For example, the confluence of cognitive and psychosocial maturation juxtaposed with societal expectations lead to shifts in youths' focus of affiliation gradually from parents to peers and from group relations to intimate relations with individuals outside of the family. These expanding social relationships broaden adolescents' sense of extra-familial reality and reinforce their increasing sense of individuality, need for autonomy, and desire to take on adult roles. Their newly acquired ability to think abstractly and to take a third person's perspective are important prerequisites for successful socialization that is tied to new responsibilities and freedom. However, such developments may also lead to risky choices, such as alcohol consumption.

Although we cannot change development, we can understand it, and we can use knowledge about adolescent and young adult development to inform the creation of more effective intervention programs. Knowledge about the development of future perspective taking, for example, is important to the development of alcohol-related prevention and intervention programs. Programs that focus on long-term outcomes will be less applicable and less effective for a young adolescent of about age 12 for whom there is an immature sense of the future and future consequences.

In addition, we can focus efforts on the environmental influences and the confluence between factors that are predictors of alcohol use. For example, enhancing parental monitoring and involvement, whereby parents are more aware of their child's whereabouts, is likely to result in youth who are less likely to use alcohol. Alcohol-related expectations are also related to alcohol use, with alcohol use positively related to perceived benefits and negatively related to perceived risks. As pointed out by Hawkins, Catalano, and Miller (1992: 87), prevention programs should include a “developmentally adjusted, multiple-component risk-reduction strategy that cuts across traditional health, education, and human service delivery systems.”

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Footnotes

1

We do not discuss factors that influence excessive or atypical alcohol use (e.g., mental or addictive disorders) because the factors generally responsible for these drinking patterns are not necessarily the same as those involved in normative alcohol use.

Copyright © 2004, National Academy of Sciences.
Bookshelf ID: NBK37579
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