There is evidence that many adolescents in this research participated in risky behaviors, irrespective of whether they began their alcohol use early (12 years of age, or younger) or not. Therefore, it seems appropriate to screen underage drinkers for participation in other risky behaviors. Given the prevalence of alcohol use among adolescents, in nationally representative samples and this research, and the potential for immediate and long-term consequences associated with alcohol use, especially early use, the findings lend support for the routine screening for alcohol use, and additional screening for those who engage in early alcohol use. The American Academy of Pediatrics (AAP) recommends discussing alcohol use as part of adolescents’ routine health care (AAP, 2001; Kulig, 2005). Health care providers, including nurses, working with adolescents should consider screening for alcohol use, as even casual use, regardless of amount or frequency, is illegal, and carries risk for negative consequences. A provider might begin with the questions based upon the HEEADSS (Home, Education/employment, peer group Activities, Sexuality, Suicide/depression, Safety), a psychosocial interview providing structured questions to enhance communication and decrease stress when
