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American University researcher awarded $2.4 million NIH grant

How well can two questions identify underage drinking? Jonathan Tubman, Vice Provost for Graduate Studies and Research and a developmental psychologist, was recently awarded a $2.4 million grant from the National Institute on Alcohol Abuse and Alcoholism, (NIAAA) part of the National Institutes of Health, to investigate the validity of a two-question screener designed to promote early identification of and intervention with alcohol use problems among children and teenagers.

Tubman and his colleague Seth J. Schwartz, an associate professor at the University of Miami's Leonard M. Miller School of Medicine, are the principal investigators.

The screener at the center of Tubman's and Schwartz's study was developed as part of a guide developed by the NIAAA in collaboration with the American Academy of Pediatrics. The guide, released in 2011 and based on extensive clinical research and analyses of underage drinking data, centers on two questions that help child health care practitioners, such as pediatricians, quickly identify children and teens at risk for developing drinking problems.

The questions differ slightly in wording and order, depending on whether they are posed to elementary (ages 9-11), middle (ages 11-14), or high school students (ages 14-18), but in each scenario, the questions address how much alcohol the student has consumed during the past year and how much alcohol the student's friends have consumed during the past year. Risk is determined by a combination of the student's age and the quantity/frequency of alcohol consumption by the student and or the student's friends.

By asking these two questions, child health care practitioners are looking for developmentally abnormal behaviors with regard to alcohol consumption.

"If a high school student says he or she has consumed one drink during the past month, while it may not be legal, it is developmentally normal," Tubman said. "But if an elementary school student says the same thing, that is not developmentally normal and is a red flag."

For their study, Tubman and Schwartz will be examining whether the screener's validity varies and if so, how much, according to factors such as a student's ethnicity, socioeconomic status, family structure, problem behaviors other than alcohol consumption (e.g., sexual risk behavior and illicit drug use), and density of alcohol outlets within walking distance of a student's home and school. Three cohorts of students400 6th graders, 400 8th graders, and 400 12th graderswill be sampled from public schools in MiamiDade County, Florida, and Maryland suburbs of Washington, D.C. The schools are known for having large Latino and African-American student populations.

The students who are selected for the study will be assessed through a survey they will take on a computer tablet, rather than answer questions in a face-to-face interview. The students will be assessed twice a year in their classrooms, which is an important first as the vast majority of adolescents can be accessed at school.

"Ultimately, if we discover that the screener accurately and effectively identifies problems and leads to interventions for all students who need them regardless of these factors and others, we hope our results will prompt a recommendation that all practitioners who assess children's health use this tool with children ages 9 through 18," Tubman said.

Alcohol is the most widely abused substance among America's youth, and annually underage drinking results in about 5,000 fatalities among people under the age of 21.

According to the Office of the Surgeon General, at age 6 most children know alcohol is for adults, but between the ages of 9 and 13, they begin to view alcohol in a more positive light, making early detection and intervention for underage drinking problems a public health imperative.

Contact: Maggie Barrett
American University

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