The study found that adolescents who already use alcohol are less receptive to prevention programs aimed at all students. Intervening at earlier ages, specifically between third and fifth grade, would allow for truly universal anti-alcohol messages that would also provide support for high-risk students.

"Children who use alcohol in sixth grade respond differently to messages about alcohol use than those have not used alcohol," said Keryn Pasch, M.P.H., Ph.D., University of Minnesota School of Public Health and first author of the study. "By sixth grade it's too late; we'll miss many of the at-risk kids."

The study, published in the journal Health Education and Behavior, compared sixth-graders who had used alcohol in the past year to those who had not, in a multi-ethnic, urban sample of more than 4,000 students in 61 Chicago schools. Among this sample, 17 percent had used alcohol within the past year.

The study found that sixth-grade users of alcohol were significantly different from the non-users on almost all risk factors examined. For example, users were more likely to be male, engage in violent or delinquent behavior, and have friends who used alcohol.

Factors such as lacking the confidence to refuse alcohol and failing to perceive and value the negative consequences of alcohol use are critical in at-risk children. "These are important to note because they are amenable to intervention," Pasch said.

Researchers suggest a prevention program prior to sixth grade in which parent involvement is central. Students should receive developmentally-appropriate messages that correct inaccurate perceptions that 'drinking is normal' and that provide tweens with the skills to refuse alcohol. In addition, interventions should include parental involvement in order to help create opportunities for increased parent-child communication and provide parents with the skills to increase monitoring.

"Parents and the general public don't realize how early alcohol use starts," Pasch said. "However, in early intervention, parental involvement is a key factor in delaying alcohol use."

The article, "Sixth Grade Students Who Use Alcohol: Do We Need Primary Prevention Programs for 'Tweens'?" was written by lead author Keryn E. Pasch, PhD, MPH, of the University of Minnesota, and colleagues Cheryl L. Perry, PhD, MA, Melissa H. Stigler, PhD, MPH, of the University of Texas and Kelli A. Komro, PhD, MPH of the University of Florida.

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