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

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Title: 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
4
Clinical and Public Health Practice
5
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.

6
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
7
Bottom Line
  • Underage/Binge Drinking is.
  • Common
  • Dangerous
  • Preventable

8
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

9
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

10
Conditions included in ARDI
  • Chronic conditions
  • Liver disease
  • Cancers
  • Acute conditions
  • Unintentional injuries (e.g., MV injuries)
  • Violence

11
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.
12
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.
13
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

14
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.

15
Trends in Current and Binge Drinking Among High
School Students, YRBS, 1991-2003
16
Current and Binge Drinking Among High School
Students, YRBS, 2003
Miller, Pediatrics, 2007
17
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
18
Interpersonal Violence by Drinking Status, YRBS,
2003
Miller, Pediatrics, 2007
19
School Performance by Drinking Status, YRBS, 2003
Miller, Pediatrics, 2007
20
Drove after Drinking by Binge Drinking Days,
YRBS, 2003
Miller, Pediatrics, 2007
21
Sexual Activity by Binge Drinking Days, YRBS, 2003
Miller, Pediatrics, 2007
22
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.

23
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.
24
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

25
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
26
Binge Drinking among U.S. Adults who Drink,
BRFSS, 2001
Naimi, JAMA, 2003
27
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)

28
Mean Drinks per Binge Episode byGender and Age,
BRFSS, 2003
29
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
30
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

31
Priority Interventions for Systematic Review
  • Enforcement of minimum drinking age (MLDA) laws
  • Increasing alcohol excise taxes
  • Restricting Alcohol Outlet Density

32
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)

33
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
34
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.

35
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.

36
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.

37
Acknowledgements
  • Jackie Miller, MD
  • Tim Naimi, MD, MPH
  • David Nelson, MD, MPH
  • Mandy Stahre, MPH

38
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
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