Despite public recognition of the hazards of 21st birthday drinking, there is little empirical information concerning its prevalence, severity, and risk factors. Data from a sample of 2,518 college students suggest that 21st birthday drinking poses an extreme danger: (a) 4 of every 5 participants (83%) reported drinking to celebrate, (b) birthday drinkers indicated high levels of consumption, (c) 12% of birthday drinkers (men and women) reported consuming 21 drinks, and (d) about half of birthday drinkers exceeded their prior maximum number of drinks. Current problematic alcohol involvement and its typical correlates strongly predicted both the occurrence and severity of 21st birthday drinking. It is imperative that investigators consider a variety of potential interventions to minimize the harm associated with this rite of passage. Keywords 21st birthday; legal drinking age; alcohol use; college students Drinking among young adults, particularly those in college, is an important public health issue (e.g., Hingson, Heeren, Winter, & Wechsler, 2005). From an array of risky collegiate drinking practices, hazardous drinking associated with the 21st birthday has emerged as a major concern for college administrators, student health service professionals, and public officials (e.g., American College Health Association, 2002). Furthermore, media reports have highlighted the problem by describing practices such as "21 for 21" and the "power hour" and by reporting the tragic deaths due to these risky practices (e.g., Zernike, 2005). Nevertheless, despite increased awareness of the problem, the prevalence and severity of and risk factors for 21st birthday drinking are not well characterized.We have identified only three published studies on this topic (Neighbors, Oster-Aaland, Bergstrom, & Lewis, 2006;Neighbors, Spieker, Oster-Aaland, Lewis, & Bergstrom, 2005;Smith, Bogle, Talbott, Grant, & Castillo, 2006). These studies provided preliminary evidence that a majority of 21st birthday celebrants consume alcohol and that their drinking levels are alarmingly high; however, these findings are limited by ascertainment biases of unknown magnitude resulting from low participation rates, 1 and it is likely that the prevalence and severity of birthday drinking are underestimated in these studies. In the present study we extend what is known about alcohol consumption on the 21st birthday by using data from a large prospective study of college drinking. Our first goal was to estimate the prevalence and severity of 21st birthday drinking in a large sample with high participation rates. In addition, our study examined the existence of the "21 for 21" phenomenon reported by the media. Our second goal was to examine risk factors associated with the occurrence and intensity of 21st birthday drinking. Although a range of possible variables could be considered, we elected to focus on those variables most consistently associated with drinking in college students (e.g., Jackson, Sher, & Park, 2006), including demographics, high-risk...

BACKGROUND Health literacy is crucial to develop health-related knowledge, adopt healthy lifestyles, and benefit from health care services. However, research on the association between health literacy and adolescent health outcomes, particularly on their prospective associations, is rare. We assessed health literacy using three validated measures, and examined cross-sectional and prospective associations between health literacy and adolescent health behaviors and outcomes. METHODS We conducted a short-term prospective study of 250 adolescents (mean age = 14 years; 57% female; 48% African-American) who were entering or in the 9th grade in an urban school district. Health literacy was assessed by individual interviews at baseline, and health-related behaviors and outcomes were assessed by a paper-and-pencil survey at baseline and at a 6-month follow-up. RESULTS Nearly half of the sample was reading at least two grades below expected levels. Lower baseline health literacy was associated with a lower self-rating of general health, unhealthier diet, heavier weight, and greater engagement in problem behaviors and sexual behaviors at baseline. Lower baseline health literacy also was associated with a greater increase in substance use over time. CONCLUSIONS Results point to the pressing need to improve health literacy in urban high school students.

Heavy drinkers prior to college have been shown to increase their drinking in college via their selfselection into the Greek societies and subsequent Greek influence on their drinking. This study characterized the dual mechanisms underlying these processes: (a) the Greek selection on the basis of personality and precollege drinking and (b) the Greek influence through alcohol-conducive environmental factors. Prospective data obtained in the summer prior to college and over the first 6 semesters of college (N = 3,099) indicated strong precollege drinking-based selection, strong initial influence immediately after college entrance, and sustained influence afterward. Impulsivity/novelty seeking was associated with Greek affiliation both directly and indirectly via precollege drinking, whereas extraversion and neuroticism were associated with Greek affiliation largely independent of precollege drinking. Greek affiliation was related to higher levels of drinking norms immediately after college entrance and alcohol availability by the sophomore year, but not afterward, after controlling for prior drinking. Findings highlight the diverse mechanisms underlying accentuation of risky drinking over the transition to college and during the college years, through dynamic interplay between individuals and high-risk environments.

This study aimed to resolve the direction of the relation between Greek affiliation and substance use by taking advantage of the quasi-experimental nature of change in college fraternity/sorority affiliation. Precollege individual differences and college substance use were examined as a function of time-varying Greek status to characterize self-selection (by which heavy substance users opt into Greek systems) and socialization (by which Greek systems foster heavy substance use). Prospective data on continuously enrolled college students (N=2,376), assessed at precollege and in the first 6 semesters of college, were used. Latent class analysis indicated 4 discrete groups of status: constant Greek members (30%), constant nonmembers (64%), late joiners (2%), and droppers (4%). Random coefficient models demonstrated disaffiliation with Greek systems is associated with decreases in risky drinking and alcohol-conducive environmental factors (peer norms and alcohol availability), whereas affiliation is associated with increases, indicating Greek socialization via sociocognitive and physical environments. Future Greeks differed from nonmembers in diverse individual characteristics and heavier substance use at precollege, suggesting multiple selection paths into Greek systems. Findings suggest a reciprocal relation between Greek environment and individuals in determining the trajectories of college drinking and heterogeneity in drinking as functions of changes in Greek affiliation.

Research shows high comorbidity between Cluster B personality disorders (PDs) and alcohol use disorders (AUDs). Studies on personality traits and alcohol use have identified coping and enhancement drinking motives as mediators in the relations among impulsivity, affective instability, and alcohol use. To the extent that PDs reflect extreme expression of these traits, drinking motives should mediate the relation between PD symptoms and alcohol involvement. This was tested using path models estimating the extent to which coping and enhancement drinking motives mediated the relation between Cluster B symptom counts and alcohol use and problems both concurrently and at a 5-year follow-up. Three hundred fifty-two adults participated in a multiwave study of risk for alcoholism (average age = 29 years at Wave 1). Enhancement motives mediated (a) the cross-sectional relation between Cluster B symptoms and drinking quantity/frequency, heavy drinking, total drinking consequences, dependence features, and AUD diagnosis and (b) the prospective relation to AUDs. Although coping motives mediated the relation between Cluster B symptoms and drinking consequences and dependence features cross-sectionally, prospective effects were limited to indirect effects through Time 1.