Underage Drinking: A South Carolina Priority

1
Underage Drinking A South Carolina Priority

• November 16, 2010
• CAST Training

2
State Epidemiological Outcomes Workgroup (SEOW)

• SEOW is a subcommittee of Gov. Council
• Began meeting in 2006
• Determined four state priorities, approved by GC
  in 2008
• Underage Drinking
• Alcohol-Related Traffic Crashes
• Youth Tobacco Use (including smokeless tobacco)
• Substance Use During Pregnancy

3
Strategic Prevention Framework

• Consequences
• Consumption
• Causal Factors

4
South Carolina Community Action for a Safer
Tomorrow (CAST) Environmental Logic Model
Underage Drinking
Consumption Pattern
Risk Factors Underlying Conditions
Environmental Strategies
Social norms accepting and/or encouraging use
Social event monitoring enforcement
Community media advocacy
Underage Drinking
Insufficient enforcement of laws
Adjudication systems enhancement
Easy social access
High-visibility best practice enforcement
operations
Easy retail access

• 35 of SC high school students drink
• 18 of SC high school students drank 5 or more
  drinks on one occasion in the past two week
• 1 in 10 SC high school students drove after
  drinking in the past month

Merchant education
Inappropriate promotion of use
Alcohol advertising restrictions
Low or discount pricing
Increase product price
Insufficient laws and policies
Community mobilization for policy change
Insufficient enforcement of school policies
Model school policies w/ enforcement
Lack of identification of early problem behaviors
Improved screening referral systems
Last updated 8/6/10
5
Consequences

• Death
• Traffic Crashes
• Homicide
• Suicide
• Violent Crime

• Injuries/Assaults Dependence
• Teen Pregnancy
• Academic Failure
• Cost

6
Death
5,000 people under age 21 in the U.S. die each
year from alcohol-related injuries
Using 2001-2005 data, CDC estimates 84
alcohol-related SC deaths for those under 21
annually.
7
SC Crash Statistics 2005
8
Youth Alcohol Use Crashes
of Fatalities Injuries in Alcohol-Related
Crashes with an At Fault Underage Driver
2006 2007 2008 2009
Fatalities 45 63 55 51
Injuries 422 408 427 347
DAODAS/PIRE Analysis of Office of Highway Safety
Crash Data
9
High School StudentsDriving after Drinking (past
month)
10
High School StudentsRiding with Drinking Driver
(past month)
11
Homicide

• Estimated 47 of homicides are alcohol-related
  (all ages)
• SC 7.7 deaths per 100,000
• 31 higher than US

12
SC Homicide Deaths per 1,000
13
Homicides by Age, SC 2004
15- to 24-year olds 2nd highest homicide death
rates
14
Suicide

• SC 11.3 deaths per 100,000
• SC rates similar to US
• Estimated 23 of suicides are alcohol-related
• Means 103 alcohol-related suicide deaths per year
  in SC
• SC high school drinker twice as likely as
  non-drinker to have attempted (13 in past year)
  (2007 YRBS)

15
Suicide Deaths per 100,000
16
Suicides by Age, SC 2004
Comparatively low rates among 15- to 24-year olds.
17
Violent Crime

• 7.7 reported offenses per 1,000 residents
• 64 higher than US

18
Violent Crime Reports per 1,000
19
Injuries/Assaults among Young Adults, US

• 599,000 18-24 year old students are
  unintentionally injured under the influence of
  alcohol
• 696,000 18-24 year old students are assaulted by
  another student who has been drinking
• 97,000 18-24 year old students are victims of
  alcohol-related sexual assault or date rape
• SC High school drinker twice as likely to have
  been forced to have sex (14) than non-drinker

Sources The Surgeon Generals Call to Action to
Prevent and Reduce Underage Drinking 2007 and SC
YRBS 2007
20
Teen Pregnancy

• In 2004, there were 52.1 live births per 1,000
  women ages 15 to 19 in SC
• 41.1 per 1,000 women in the US
• SC 27 higher than US

21
Teen Sex and Alcohol/Drug Use

• 19 of SC high school students report alcohol or
  drug use before the last time they had sex (2009
  YRBS)
• 22 nationally

22
Alcohol Dependence
23
Dependence/Abuse (DSM-IV Criteria)
Percent of Persons Age 12 to 17 and 18 to 25
Meeting DSM-IV Criteria For Alcohol Dependence
or Abuse in the Past Year, South Carolina and
US, 2002-2006
24
Academic Failure

• Grades Mostly Received by Students Reporting
  Alcohol Use (Using 2007 YRBS)

25
Other Drug Use

• High school drinkers, compared to non-drinkers,
  are . . .
• Seven times more likely to use smokeless tobacco
  or ecstasy
• Eight times more likely to use steroids
• Nine times more likely to use marijuana
• Eleven times more likely to smoke
• Twelve times more likely to use cocaine
• DAODAS/PIRE Analysis Using 2007 YRBS Data

26
Other Correlations

• High school drinkers, compared to non-drinkers,
  are . . .
• Twice as likely to have been in a fight
• Twice as likely to have had sex
• Three times as likely to be in a gang
• Three times as likely to carry a weapon
• Four times as likely to ride in a car with a
  drinking driver

27
Underage Drinking is a 1.1 Billion a Year
Problem in South Carolina.
Total Costof Underage Alcohol Usein SC for
2007 1.1 billion US Total Cost 68 billion
Medical Care121 million
Work Loss Other Costs263 million
Pain Lost Quality of Life 684 million
2,428 per year per youth
PIRE 2008
28
Costs of Underage Drinking by Problem, South
Carolina 2005
Problem Total Costs (in millions)
Youth Violence 693.2
Youth Traffic Crashes 168.1
High-Risk Sex, Ages 14-20 58.4
Youth Property Crime 55.6
Youth Injury 32.4
Poisonings and Psychoses 3.8
FAS Among Mothers Age 15-20 17.0
Youth Alcohol Treatment 38.8
Total 1,067.3
29
Consumption Patterns

• SC Middle School Use
• SC Adult Use
• SC College Use
• Age of First Use

• SC High School Use
• How much they drink
• What they drink
• Where they drink

30
SC Alcohol Use Across Lifespan

• Note This timeline uses a variety of data
  sources with different methodologies and samples
  and should not suggest a clean timeline. For
  general information only. Middle School 2009
  MS YRBS High School 2009 HS YRBS College
  2009 weighted Core Data from 10 SC colleges
  Adult 2009 BRFSS (18 older)

31
2009 South Carolina Middle School YRBS
Percentage of students who ever had a drink of
alcohol, other than a few sips
100
80
53.0
60
45.4
42.5
41.6
42.1
41.9
41.7
40
25.0
20
0
Total
Male
Female
6th
7th
8th
Black
Hispanic/
White
Latino
QN25 - Weighted Data
Non-Hispanic.
Missing bars indicate less than 100 students in
the subgroup.
32
Alcohol Other Drug Use Among HS Students, 2009
YRBS
33
Alcohol Other Drug Use Among HS Students, 2009
YRBS
34
HS Alcohol Use Over Time
Current (Past 30-Day) Alcohol Use among Youths in
Grades 9 through 12, South Carolina and US, 1995
to 2009
35
High School Use (2009 YRBS)

• 69 had at least one drink of alcohol on one or
  more days during their life.
• 35 of SC high school students drink down 19
  from 2005!
• 18 engaged in binge drinking in past month down
  22 from 2005!
• 31 of drinkers had their first drink of alcohol,
  other than a few sips, before age 13.

36
SC High School Drinkers
37
Past-Month Drinking 12 to 25
NSDUH
38
Initiation Before Age 13, SC
39
Past-Month HS Binge Drinking
40
High School Binge Drinking
41
Consumption Amounts (US)

• Adults average 2.6 drinks per occasion
• Youth average 4.6 drinks per occasion
• 96 of alcohol consumed by ages 15-20 is done
  while binge drinking

42
Frequency and Volume of Use
Adults drink more often, but youth drink more
when they drink.
43
Binge Drinking
44
WHO USES ALCOHOL MORE IN HIGH SCHOOLTHOSE GOING
TO COLLEGE OR NOT?WHO USES ALCOHOL MORE IN
COLLEGE-AGE YEARS, THOSE IN COLLEGE OR NOT?
45
The College Effect

• In HS, those not going to college drink more
• A year later, those at college drink more than
  non-college peers

46
US College Drinking

• Recent CASA Study
• No decline in proportion of college students who
  drink or binge drink from 1993-2005
• Proportion of students who frequently binge
  drink is up 16
• Who drink on 10 or more occasions in a month up
  25
• Those who get drunk at least 3 times/month is up
  26
• Who drink to get drunk up 21

47
But . . .

• Outside The Classroom says data theyve
  reviewed from past 3 years show of Freshman
  abstainers is rising for first time in many years

48
Core Survey

• National survey taken by 10 SC colleges/universiti
  es in 2009
• Random sample at each
• N ranged from 223 to 1,062
• Total 6,119

49
Prevalence

• 85 drank in past year
• Range 61 to 90
• National (Core Institute 06) 84
• 74 drank in past month
• Range 39 to 80
• National 72
• 51 engaged in binge drinking in past 2 weeks
• Range 23 to 61
• National 55

50
Comparison by Institution
SC Core Survey Data, 2009
51
Average Drinks Per Week

• Students average 6.4 drinks per week
• Range 1.9 to 8.4
• National 5.4
• If exclude non-drinkers, 9.5 drinks per week
• Range 5.3 to 11.0

52
Underage vs. Legal Age Drinking
Avg. Drinks/Week by School
SC Core Survey Data, 2009
53
Exploring DrinkingDrinks/week

• Multiple Regression based on of drinks per week
  (if gt0)
• Significant Factors
• Biggest Gender (males 12.9 females 6.3)
• Smaller Greek (more), religious group (less)
  affiliation
• Smallest, but significant off campus (more),
  year (Freshmen higher), athletic participation
  (slightly higher)
• Not significant institution, race/ethnicity

54
Exploring DrinkingUnderage Drinking

• Logistic Regression on underage drinkers
• Significant Factors
• Year (63 Freshmen, 69 Soph, 71 Jr.)
• Race/Ethnicity (White 71, AA 46)
• Residency (off-campus 72, on 64)
• Greek (not 60, attend 80, leader 87)
• Religious group (not involved 74, attended 67,
  active 52)
• Not significant Gender, Athletics

55
Exploring DrinkingBinge Drinking

• Logistic Regression on underage drinkers
• All Were Significant Factors
• Year (46 Fr., 49 Soph., 53 Jr., 55 Sr.)
• Race/Ethnicity (White 55, AA 26)
• Residency (off-campus 56, on 44)
• Greek (not 44, attend 66, leader 71)
• Religious group (not involved 57, attended 51,
  active 37)
• Athletes (non-athlete 50, active 52)
• Gender (male 57, female 45)

56
Drinking and Driving (SC Core)

• 31 drove after drinking in past year
• Range 12 to 37
• National 27
• 1.1 arrested for DUI
• Range 0.2 to 1.4
• National 1.5

57
Academic Impact (SC Core)
Average Number of Drinks Per Week by
GPA (Drinkers Only)
SC Core Survey Data, 2009
58
Academic Impact

• 26 performed poorly on test/project due to
  drinking/drug use
• Range 10 to 34
• National 22
• 36 missed class due to drinking/drugs
• Range 16 to 45
• National 30
• 25 of U.S. college students have alcohol-related
  academic problems (Dept. of Education, 2008)

59
Getting in Trouble (SC Core)

• 14 have been in trouble with police or other
  authorities due to drinking/drug use
• Range 4 to 22
• National 14

60
Arguments/Fights (SC Core)

• 35 have been in argument/fight due to
  drinking/drug use
• Range 17 to 42
• National 32
• 5 involved in physical violence, 74 of
  incidents after consuming alcohol/drugs
• Range 25 to 81

61
Unwanted Sexual Activity (SC Core)

• 9.5 of females have been taken advantage of
  sexually when alcohol/drugs involved
• Range 4 to 13

62
Injury (SC Core)

• 16 hurt/injured due to drinking/drug use
• Range 7 to 21
• National 16

63
Addiction (SC Core)

• 10.5 thought they have a drinking/drug problem
• Range 3 to 15
• National 11
• 5 tried unsuccessfully to stop using
  alcohol/drugs
• Range 2 to 8
• National 5

64
What is the drink of choice for SC high school
students?
65
Drink of Choice (2009 SC CTC)
66
ALCOPOPS
67
Production of Alcopops

• A liquid is derived from malt
• It is filtered to remove most or all taste, odor
  and alcohol
• Flavoring is added to the liquid, which
  includes distilled alcohol
• Product distributed as malt beverage (most or all
  brewed alcohol is removed distilled alcohol
  only)
• Beer classification

68
Why the Classification?

• Advantages Beer is
• Advertised on electronic media
• Taxed at substantially lower tax rates
• Available in a greater of retail locations,
  particularly those likely to be frequented by
  underage drinkers

69
Examples of Alcopops

• Bacardi Silver
• Mikes Hard Lemonade
• Smirnoff Ice
• Smirnoff Raw Tea

70
The New Kid on the Block

• Alcoholic Energy Drinks

71
South Carolina 2009 YRBS
Percentage of students who drank premixed
alcoholic energy drinks, such as Sparks, Tilt,
Rockstar 21, or Liquid Charge, on one or more of
the past 30 days
100
80
60
40
14.8
13.2
12.1
11.1
12.4
20
9.7
12.0
11.5
9.2
0
Total
Male
Female
9th
10th
11th
12th
Black
Hispanic/
White
Latino
QN90 - Weighted Data
Non-Hispanic.
Missing bars indicate less than 100 students in
the subgroup.
72
And where are they getting it?

• 1. Someone gave it to me 37
• 2. Gave someone to buy it 25
• 3. Took it from store or family 8
• 4. Retail (store/restaurant/event) 11
• Other 19

73
Underage Alcohol Sales in SC

• Local compliance checks sale rate (FY10) 14.5
• Dropping since 07 (20.3)
• In 2007, SC underage drinkers consumed 10 of all
  alcohol sold in SC.
• This accounted for 224 million in sales of
  alcohol in SC.
• These sales provided profits of 110 million to
  the alcohol industry.

74
Risk Factors Underlying Conditions

• Social norms accepting and/or encouraging use
• Insufficient enforcement of laws
• Easy social access
• Easy retail access
• Inappropriate promotion of use
• Low or discount pricing
• Insufficient laws and policies
• Insufficient enforcement of school policies
• Lack of identification of early problem behaviors

75
Social Norms

• 17,001 alcohol licenses in the state
• about 1 per 250 people
• AET enforcement operations decreased in FY 10,
  largely due to funding cuts
• 19 of HS students said they thought their
  parents would think it is not wrong at all or
  a little big wrong if they drank (SC CTC)
• 60 of HS students said alcohol is very easy or
  sort of easy to get (SC CTC)

76
Social Norms College

• 57 of SC college students think the campus
  environment promotes alcohol use

77
Insufficient Enforcement of Laws

• AETs have greatly increased enforcement in many
  areas, though decreases are happening
• All AETs do compliance checks, but party
  dispersals, fake ID checks, public safety
  checkpoints more sporadic
• 23 counties w/ dispersals
• 32 counties w/ safety checkpoints
• Many barriers to getting substantial
  administrative penalties against license holders
• Local enforcement normally cannot do this

78
Social Access

• SC YRBS Almost 2/3 of the time, alcohol
  provided by adult (non-retail)

79
Retail Access

• In FY 08, new counties to receive local
  enforcement had higher rates (22.3 vs. 18.7)
• FY 10, 6,438 alcohol and 1,088 tobacco
  compliance checks (local)
• SLED has dropped back to inspections based on
  complaints only
• Liquor sold more frequently in checks
• Youngest clerks most likely to sell

80
Retail Sales by Outlet Type
Type of Business N (Alcohol Purchase Attempts) Sales Completed (Alcohol)
Convenience Store/Gas Station 4,479 13.6
Bar 277 26.0
Restaurant 282 22.7
Liquor Store 456 18.2
Small Grocery 44 18.2
Large Grocery 636 10.8
Drug Store 143 4.9
81
Inappropriate Promotion

• Income from underage drinking 22 Billion/year
  (mostly from beer) (IOM, 2003).
• Total spent on alcohol advertising 4.8 billion
• Many ads work to normalize drinking alcohol
• Happy Hour laws reported to be confusing to law
  enforcement and retailers
• Rarely enforced

82
Low or Discount Pricing

• SC alcohol sales tax rates
• spirits tax 4.97
• table wine tax 1.08
• beer tax .77.
• SC ranked 21st, 11th, and 3rd in the nation for
  sales tax rates, respectively,
• Meaning SC has close to an average sales tax on
  spirits, a high tax on wine, and a very high tax
  on beer.

83
Pricing

• Alcopops taxed as beer
• Beer tax unchanged for 30 years but is still one
  of highest in US
• Happy Hour laws reported to be confusing to law
  enforcement and retailers
• Rarely enforced

84
Insufficient Laws Policies

• Underage drinking laws greatly strengthened in
  2007 (PUDAAA)
• Communities have very little ability to regulate
  alcohol sale issues (power lies with state)
• Department of Revenue and SLED alcohol sections
  not staffed as they once were

85
Insufficient Enforcement of School Policies

• Many school policies address penalties but not
  referral protocol or responsibility to provide
  prevention efforts

86
Lack of Identification of Early Problem Behaviors

• Many systems that could identify problematic
  early alcohol use are not taking full opportunity
  to do so
• Schools
• Physicians
• People working with youth
• Parents
• Prevention specialists

87
Action Steps

• Presented by Risk Factor/Underlying Condition
• Items listed as Being Done and Could be Done
  are simply examples
• Strengths/Weaknesses can be debated
• Not suggesting any planned or future courses of
  action or advocacy by DAODAS, CAST, or any other
  group

88
Social Norms

• Being Done
• Some areas using social norms campaigns
• Active AET enforcement
• Media advocacy (getting better)
• Parents Who Host, Lose the Most

• Could Be Done
• Working on community event alcohol sale policies
• Develop local advocacy groups (youth/adults)

89
Insufficient Enforcement

• Being Done
• AETs increased all types of enforcement, but
  dipped
• New underage drinking laws (2007)
• Hundreds of officers trained in laws

• Could Be Done
• Increased use of operations targeted towards
  consequences, sources
• Sustainability for AETs
• Increased EUDL training at Academy
• Better coordination regarding diversion programs

90
Social Access

• Being Done
• Some AETs doing party patrols, source
  investigations
• Parents Who Host campaign (currently suspended at
  state level)
• Publicity around transfer cases

• Could Be Done
• Social host law
• Felony transfer law
• Make source investigations standard procedure,
  uniformly collected

91
Retail Access

• Being Done
• Local compliance enforcement
• Increased number of merchants in education
  programs (PREP)
• Increased fines, mandated program for selling

• Could Be Done
• Mandated merchant education in some form
• Increased local control on administrative
  enforcement
• Stiffer, swifter penalties for multiple
  administrative violations
• Felony sale law
• Increased promotion of merchant education

92
Promotion

• Being Done
• Increased attention to youth-friendly products

• Could Be Done
• Remove alcohol sponsorship from community events
• Enforcement of Happy Hour violations
• Controls on alcohol advertising
• Restrict availability of youth-friendly products

93
Pricing

• Being Done
• Maintain high tax rates
• Implement keg registration

• Could Be Done
• Classify alcopops as liquor
• Educate law enforcement on Happy Hour enforcement

94
Insufficient Laws/Policies

• Being Done
• Enhanced laws in 2007

• Could Be Done
• Restrict alcohol outlet density
• Pass social host laws/ordinances
• Improve Happy Hour laws
• Enhance graduated drivers license laws

95
School Policies

• Being Done
• Educate SROs on underage drinking trends

• Could Be Done
• Work with schools on implementing model policies
• Increase enforcement at school events

96
Screening Referral Systems

• Being Done
• Educate enforcement, prevention, parents on youth
  alcohol trends
• Alcohol Education Program

• Could Be Done
• Increase medical providers use of screening/brief
  interventions
• Increase training on signs of underage drinking