Preventing and Reducing Underage Alcohol Use: A Public Health and Coordinated School Health Approach

1
Preventing and Reducing Underage Alcohol Use A
Public Health and Coordinated School Health
Approach

• Bob Brewer, MD, MSPH
• Alcohol Team Leader
• National Center for Chronic Disease Prevention
  Health Promotion/CDC

2
Outline

• Public Health Impact of Underage Drinking
• Mission of the CDC Alcohol Team
• Public Health Surveillance of Underage/Binge
  Drinking
• Prevention Strategies
• Initiating a Public Health Response

3
Institute of Medicine (IOM) Mission and
Substance of Public Health

• Mission The fulfillment of societys interest
  in assuring the conditions in which people can be
  healthy.
• Substance Organized community efforts aimed at
  the prevention of disease and promotion of
  health. It (public health) links many disciplines
  and rests upon the scientific core of
  epidemiology.

IOM, The Future of Public Health, 1988
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Clinical and Public Health Practice
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Public Health Impact of Underage Drinking

• Alcohol is the most commonly abused drug by
  youth.
• 90 consumed as binge drinks (i.e., while
  drinking to get drunk).
• Closely tied to leading health and social
  problems among youth (e.g., impaired driving,
  violence, risky sexual behavior).
• Results in 1 of 4 deaths among males and 1 of 6
  deaths among females age 15 to 20 years.

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Additional Facts on Underage Drinking in the U.S.

• 10.8 million youth ages 12-20 years in the U.S.
  reported past-month drinking in 2004, and 7.4
  million reported past-month binge drinking.
• 5,400 children under 16 years start drinking
  every day in the U.S.
• On average, 12-17 year olds report they began
  drinking at age 14 years.

Source Substance Abuse Mental Health Services
Administration, National Survey on Drug Use and
Health, 2005
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Bottom Line

• Underage/Binge Drinking is.
• Common
• Dangerous
• Preventable

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CDC Alcohol Team

• Established in July 2001.
• Public Health Surveillance on alcohol use and
  alcohol-related conditions.
• Applied research on health impacts and
  intervention effectiveness.
• State capacity building technical assistance.
• National leadership collaboration

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Alcohol-Related Disease Impact (ARDI) Software

• Initially released in 1989 out of date
  scientifically and technically
• Updated the software and released as web-based
  application
• Focus on state health impacts
• Funding from the Robert Wood Johnson Foundation
• Available at www.cdc.gov/alcohol

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Conditions included in ARDI

• Chronic conditions
• Liver disease
• Cancers
• Acute conditions
• Unintentional injuries (e.g., MV injuries)
• Violence

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Deaths and YPLL due to Excessive Drinking, 2001

• 75,000 Alcohol-Attributable Deaths
• 2.3 million YPLL (30 yrs lost/death)
• Over half of deaths and two-thirds of YPLL
  involved binge drinking.
• Half of deaths involved men gtage 35

CDC, MMWR, 2004.
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Deaths and YPLL among Youth lt21 years due to
Exposure to Excessive Drinking, 2001

• 4,500 Alcohol-Attributable Deaths
• 274,000 YPLL (60 yrs lost/death)
• gt95 of deaths and YPLL involved binge drinking.
• Three-fourths of the deaths involved young men.

CDC, ARDI Web Site (www.cdc.gov/alcohol), January
8, 2007.
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CDC National Youth Risk Behavior Survey (YRBS)

• Biannual school-based survey of high school
  students in grades 9 thru 12
• Monitors a variety of health risk behaviors,
  including substance use.
• Assess relationship between alcohol use and a
  variety of health risks.
• Over 15,000 students surveyed in 2003

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YRBS Definitions of Alcohol Consumption

• Current drinker Reports consuming at least one
  drink of alcohol on one or more days in the past
  30 days.
• Binge drinker Reports consuming 5 or more
  drinks of alcohol in a row on one or more days
  during the past 30 days.

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Trends in Current and Binge Drinking Among High
School Students, YRBS, 1991-2003
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Current and Binge Drinking Among High School
Students, YRBS, 2003
Miller, Pediatrics, 2007
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Current and Binge Drinking Among High School
Students, YRBS, 2003
Other includes American Indian, Alaskan Native,
Asian, Native Hawaiian, Pacific Islander, and
multi-racial.
Miller, Pediatrics, 2007
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Interpersonal Violence by Drinking Status, YRBS,
2003
Miller, Pediatrics, 2007
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School Performance by Drinking Status, YRBS, 2003
Miller, Pediatrics, 2007
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Drove after Drinking by Binge Drinking Days,
YRBS, 2003
Miller, Pediatrics, 2007
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Sexual Activity by Binge Drinking Days, YRBS, 2003
Miller, Pediatrics, 2007
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Underage Drinking and Adult Drinking

• Strong tie between adult drinking and youth
  drinking.
• Youth tend to model their behavior after adults.
• Adults are often the source of the alcohol
  consumed by youth.
• Many alcohol control policies (e.g., alcohol
  taxes) affect youth and adults.

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College and Adult Binge Drinking

• Binge drinking rates in states are a strong
  predictor of binge drinking rates on college
  campuses.
• Binge drinking rates among college students were
  about one-third lower in the 10 states with
  lowest adult binge drinking rates compared to
  those with the highest rates.
• States with lower binge rates tended to have more
  stringent alcohol control policies

Nelson TF, et al. Am J Public Health. 2005
95(3)1-6.
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CDC Behavioral Risk Factor Surveillance System
(BRFSS)

• Random-digit dial telephone survey of adults age
  18 years and older
• Data collected in all states, District of
  Columbia, and 3 territories
• State-based system coordinated by CDC
• Over 350,000 interviews in 2005

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Binge Drinking among U.S. Adults, BRFSS,
1993-2001
Measure Prevalence Total Episodes Episodes per
Person
1993 14.2 1.2 billion 6.3
2001 14.3 1.5 billion 7.4
Change 1 29 17
5 drinks on 1 occasion in the past 30 days
Naimi, JAMA, 2003
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Binge Drinking among U.S. Adults who Drink,
BRFSS, 2001
Naimi, JAMA, 2003
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BRFSS Binge Drinking Module

• Used to collect more detailed information on last
  binge episode
• 13 states in 2003 14 states in 2004
• 7103 total respondents in 2003 (Range 276-736
  per state)

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Mean Drinks per Binge Episode byGender and Age,
BRFSS, 2003
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Effective Strategies for Preventing Underage
Drinking

• Restrict alcohol availability (e.g., enforce
  minimum legal drinking age laws)
• Restrict alcohol marketing to youth
• Increase alcohol excise taxes
• Implement alcohol-impaired driving
  countermeasures (e.g., 0.08 laws)

World Health Organization, 2003 and Institute of
Medicine, 2004
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Community Guide Chapter

• Prevention and Control of Excessive Alcohol
  Consumption and Related Harms
• Systematic Reviews of 3-5 Interventions over next
  3 years
• Recommendations on Intervention Effectiveness by
  Task Force for Community Preventive Services

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Priority Interventions for Systematic Review

• Enforcement of minimum drinking age (MLDA) laws
• Increasing alcohol excise taxes
• Restricting Alcohol Outlet Density

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Potential Impact of Increasing Alcohol Taxes

• 10 increase in tax could reduce binge episodes
  by 8 (Sloan, 1995)
• 1 increase in the price of beer could reduce
  traffic fatalities by 0.9 (Ruhm, 1996)

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Public Support for Increasing Alcohol Taxes

• 51 strongly favor an increase in alcohol taxes.
• 65 support using alcohol tax to reduce budget
  deficits.
• When informed of their state beer tax, more than
  half think it should be increased.

AMA, 2004
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Initiating a Public Health Response to Underage
Drinking

• Conduct PH Surveillance ? ARDI, BRFSS, YRBS
  Chronic Disease Indicators (CDIs).
• Build partnerships ? Schools, State public health
  agencies, substance abuse agencies, traffic
  safety, law enforcement, etc.

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Initiating a Public Health Response to Alcohol

• Track Policy/Legislation ? Alcohol taxes, sales
  restrictions, DWI laws, enforcement of MLDA laws.
  
• Develop Evaluate Programs Policies ? Provide
  information to policy makers, assist in design of
  evidenced-based programs.

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In Conclusion.

• Underage/Binge drinking is a huge public health
  problem in the U.S. (Its Common)
• It is strongly tied to many health social
  problems. (Its Dangerous)
• Effective prevention strategies are available but
  underused. (Its Preventable)
• Public health agencies and schools must work
  together to prevent this key risk behavior.

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Acknowledgements

• Jackie Miller, MD
• Tim Naimi, MD, MPH
• David Nelson, MD, MPH
• Mandy Stahre, MPH

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Contact Information

• Bob Brewer, MD, MSPH
• Alcohol Team
• National Center for Chronic Disease Prevention
  Health Promotion/CDC
• E-mail bbrewer1_at_cdc.gov
• www.cdc.gov/alcohol