The proposed study is designed to provide evidence for convergent validity, discriminant validity, predictive validity, sensitivity, and specificity fr the two-item underage drinking screening instrument designed by the National Institute on Alcohol Abuse and Alcoholism and the American Academy of Pediatrics. The study will use an accelerated longitudinal design with three cohorts (400 6th graders, 400 8th graders, and 400 10th graders). Each cohort will be assessed 7 times over a 31/2-year period, supporting longitudinal analyses across the 7-year period from 6th grade until the year after 12th grade. Participants will be sampled from public schools in Miami-Dade County, Florida, and the Maryland suburbs of Washington, DC. Students will be assessed in their classrooms twice per year. We will measure alcohol use, alcohol-related problems, alcohol use disorders, illicit drug use, sexual risk behavior, and externalizing problem behavior through well-validated self-report measures. We will also examine the extent to which the validity and effects of the screener vary according to the density of alcohol outlets within walking distance (a practical 1/4 mile radius) o each adolescent's home and school addresses, and according to Census-level poverty, affluence, residential stability, and family structure indices. Our analytic objectives will be to examine the extent to which scores on the screener items predict current and subsequent alcohol use, alcohol-related problems, diagnosable alcohol use disorders, illicit drug use, sexual risk behavior, and externalizing problem behavior - as well as to identify cutoff scores for the screener items that maximize the sensitivity and specificity of the instrument to identify adolescents at risk for alcohol problems. The present study will be the first to use the screener in a school setting, where the vast majority of adolescents can be accessed.
The public health relevance of the proposed research lies in its ability to identify adolescents who associate with alcohol-using peers, and who may have begun using alcohol themselves. The evaluation of a brief screener can potentiate referral to preventive services before negative consequences of alcohol use begin to appear. In 2010, individuals 15-20 years old were more than four times as likely to be involved in car crashes compared to any other age group, and in more than one-fourth of car crashes involving adolescent drivers, one or more drivers involved in the crash had been drinking alcohol (CDC, 2010). Moreover, the CDC reports that, in the year prior to assessment, 3 in 10 adolescents aged 15-20 had ridden in a car with a driver who had been drinking. To the extent that we are able to identify adolescents at risk for alcohol-related problems (including driving while intoxicated, as well as other serious negative consequences of alcohol use) and to refer them to preventive services before the alcohol-related problems appear, we have the potential to save lives that might otherwise be lost.