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Which Underage Drinking Laws Have Been Effective?

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Title: Which Underage Drinking Laws Have Been Effective?


1
Which Underage Drinking Laws Have Been Effective?
  • James C. Fell
  • Senior Research Scientist
  • Pacific Institute for Research Evaluation
  • August 25, 2014

2
The Problem Young Drivers and Alcohol Graduated
Driver Licensing Underage Drinking Minimum Legal
Drinking Age 21 MLDA-21 Background MLDA-21 Law
Components Prior Research Current
Research Methods Strengths of the MLDA-21
Laws Results of Current Research Should the MLDA
Remain at 21?
3
The Problem
4
What are some of the leading causes of death for
young people?
5
Leading Causes of Death Ages 16-20 2009
Rank Cause Percent of Deaths Number of Deaths
1 Motor Vehicle Crashes 28 3,947
2 Homicide 17 2,386
3 Suicide 14 1,948
4 Other Injury (falls, drowning, etc.) 10 1,446
5 Cancer 5 714
6 Heart Disease 3 423
All Other Causes Combined 22 3,016
TOTAL 100 13,880
6
Leading Causes of Death Ages 16-20 2007
Rank Cause Percent of Deaths Number of Deaths
1 Motor Vehicle Crashes 34 5,360
2 Homicide 17 2,711
3 Suicide 11 1,784
4 Accidental Poisoning 8 1,178
5 Cancer 5 724
6 Heart Disease 3 396
All Other Causes (falls, drowning, etc.) 22 3,543
TOTAL 100 15,696
7
Young Drivers and Alcohol
The current problem and what is working to reduce
their crash risk
8
Young Drivers Aged 15-20 in 2012
  • More than one out of four (28) deaths of young
    people aged 16-20 are from motor vehicle crashes.
  • More than one out of five (22) young drivers
    aged 15-20 involved in fatal crashes had been
    drinking.
  • Almost three out of four (71) young drinking
    drivers killed in crashes were not wearing safety
    belts.
  • Half (50) of the underage 21 drinking drivers
    involved in fatal crashes were speeding.

9
Young Driver Over-Involvement in Fatal Crashes
Ages 15-20
13.6 of All Drivers Involved in Fatal Crashes
13 of All Alcohol- Involved Drivers in Fatal
Crashes
6.4 of All Licensed Drivers
Source NHTSA Traffic Safety Facts, 2003
10
The Problem
The problem is particularly acute for
16-year-old drivers
  • 16-year-old drivers have crash rates that are 3
    times that of 17 year olds, 5 times that of 18
    year olds, and even twice that of 85 year olds.
  • 15 of 16 year olds involved in fatal crashes in
    2012 had been drinking (BACsgt.01)

11
What are some of the reasons for the high crash
rates of young drivers?
12
The Research Risk Factors
  • Inexperience Especially the first few months of
    licensure
  • Late night driving (without supervision)
  • The number of teen passengers
  • The presence of alcohol (and other drugs) in
    young drivers
  • The low rate of seat belt usage
  • Type of vehicle driven
  • Distractions (especially cell phones)
  • Attention Deficit and Hyperactivity Disorder
    (ADHD)

13
Crashes per Million Miles by Driver Age in the
U.S.
50-
16
17
18
19
20-
25-
30-
35-
40-
45-
55-
60-
65-
70-
75-
80-
85
DRIVER AGE
14
Percent of Licensed Drivers in Crashes in One
Year by Age and Gender in the U.S.
16
17
18
19
20-
25-
30-
35-
40-
45-
50-
55-
60-
65-
70-
75-
80-
85
DRIVER AGE
15
Crash Rates in the U.S. by Driver Age and
Passenger Presence Per 10,000 trips
6
5
4
3
2
1
0
1
2
3
0
1
2
3
0
1
2
3
ages 18-19
ages 30-59
ages 16-17
number of passengers
16
Graduated Driver Licensing
17
Graduated Driver Licensing (GDL) in the U.S.
Premise
  • Permit beginning drivers to acquire on-the-road
    driving experience under low-risk conditions
  • Adopt special restrictions and requirements after
    initial learning phase
  • Allow young drivers to graduate to full license
    privileges after successfully completing certain
    stages

18
Graduated Driver Licensing in the U.S.
Stage 1 Learners Permit Model Components
  • Minimum age requirement
  • Vision/knowledge tests
  • Basic skills training
  • Licensed adult (at least age 21) required in
    vehicle at all times
  • Teenage passenger limitations
  • All occupants must wear safety belts
  • No alcohol or drugs (zero tolerance BAClt.02)
  • Crash- and conviction-free for at least six
    months
  • Parental certification of practice hours
  • Distinctive permit from other licenses

19
Graduated Driver Licensing in the U.S.
Stage 2 Intermediate or Provisional License
Model Components
  • Complete Stage 1
  • Minimum age requirement
  • Behind-the-wheel test
  • Advanced driver education training
  • Teen passenger restrictions
  • All occupants must wear safety belts
  • Nighttime driving restrictions Licensed adult
    required in vehicle for all late night driving
    (when drinking most likely to occur)
  • Zero tolerance (no alcohol or drugs)
  • Crash- and conviction-free for at least 12
    consecutive months
  • Distinctive license from full license

20
Graduated Driver Licensing in the U.S.
Stage 3 Full Licensure
  • Complete Stage 2
  • Minimum age requirement
  • Zero tolerance (no alcohol or drugs) up to age 21

21
Graduated Driver Licensing
Evaluations of Effectiveness in the U.S. and
Canada
Florida 9 reduction in crashes for drivers aged 16-17
California 5 reduction in crashes 10 reduction in convictions for drivers aged 16-17
Oregon 16 reduction in crashes for 16-17 year old male drivers
North Carolina 26 reduction in crashes for 16 year old drivers
Michigan 27 reduction in crashes for 16 year old drivers
Nova Scotia 24 reduction in crashes for 16 year old drivers
Ontario 31 reduction in crashes for drivers aged 15-19
22
Graduated Driver Licensing
Insurance Institute for Highway Safety Ratings
  • Good GDL Law if it has 5 out of the following 7
    components
  • Minimum age for learners permit
  • Mandatory waiting period to advance to
    intermediate stage
  • Minimum hours of supervised driving
  • Minimum age for intermediate license
  • Nighttime restriction in intermediate stage
  • Passenger limitation in intermediate stage
  • Minimum age for full unrestricted license

23
Graduated Driver Licensing
National Studies in the U.S.
  • Dee, et al., (2005) Significant 4.4 reduction
    in 15- to 17-year-old driver deaths attributable
    to GDL laws when covariate laws included
  • Chen, et al., (2006) GDL associated with an 11
    lower fatal crash involvement rate for 16 year
    olds 16-21 reduction with GDL programs with 5
    of 7 key components
  • Morrisey, Grabowski, Dee Campbell (2006)
    Good GDL programs reduce fatalities among 15-
    to 17-year-old drivers by 19 Fair GDL
    programs reduce nighttime fatal crash
    involvements by 13 but no effect on daytime
    fatal crashes Marginal GDL programs had no
    effect.
  • Vanlaar, et al., (2009) Meta-analysis showed
    significant reduction of fatal crashes of
    16-year-old drivers, but not 17, 18, or 19 year
    old drivers

24
Graduated Driver Licensing
National Studies in the U.S.
  • McCartt, et al., (2009) GDL laws rated as
    Good had 30 lower fatal crash rate for 15- to
    17-year-old drivers compared to GDL laws rated as
    Poor
  • Lyon, Pan Li (2012) a strict GDL permit stage
    was associated with a 58 reduction in fatal
    crash risk by 16-year-old drivers compared to a
    lenient permit stage. Intermediate stage
    associated with a 44 reduction in fatal crashes
    but little effect on injury crashes. Strongest
    effects were seen for crashes with passengers,
    followed by nighttime crashes, and then overall
    crashes.

25
Graduated Driver Licensing
Three National Studies in the U.S. First Study
Results
  • Fell, Jones, Romano, Voas (2011)
  • Traffic Injury Prevention, 12(5), 423-431
  • States that adopt a basic GDL law can expect a
    decrease of 7-11 in the proportion of 16- to
    17-year-old drivers involved in fatal crashes
    relative to 21- to 25-year-old drivers depending
    upon their other existing laws (zero tolerance
    primary belt .08 BAC use and lose)
  • States that adopt Good GDL laws can expect
    decreases of 8-13 in the proportion of 16- to
    17-year-old drivers involved in fatal crashes
    relative to 21- to 25-year-old drivers depending
    upon their other existing laws (zero tolerance
    primary belt .08 BAC use and lose)

26
Graduated Driver Licensing
Three National Studies in the U.S. Second Study
Results
  • Fell, Todd, Voas (2011)
  • Journal of Safety Research, 42, 283-290
  • GDL nighttime restrictions reduce 16- to
    17-year-old driver involvements in nighttime
    fatal crashes by 10
  • Nighttime restrictions reduce 16- to 17-year-old
    drinking drivers in nighttime fatal crashes by
    13.
  • Passenger restrictions reduce 16- to 17-year-old
    driver involvements in fatal crashes with teen
    passengers by 9

27
Graduated Driver Licensing
Three National Studies in the U.S. Third Study
Results
  • Romano, Fell, Voas (2011)
  • Annals of Advances in Automotive Medicine, 55,
    51-61
  • Found GDL effects for White, African-Americans
    and Asian young drivers but not Hispanic young
    drivers
  • GDL had no apparent effect on speeding-related
    fatal crashes of novice drivers
  • The observed differences involving young Hispanic
    drivers might be related to factors other than
    GDL (e.g., SES causing young Hispanics not to
    drive as much as Whites).

28
Graduated Driver Licensing Effectiveness Reduction
s in 16-17 year old drivers in fatal crashes
Fell, Jones, Romano, Voas, 2011
Fell, Todd, Voas, 2011
Fell, Todd, Voas, 2011
-7 GDL when other laws present
-9 in fatal crashes with teen passengers
-13 for drinking 16-17 year old driver
in nighttime fatal crashes
-10 in nighttime fatal crashes
-11 when GDL alone
GDL effects
Nighttime restriction effects
Passenger limitation effects
29
Graduated Driver Licensing
Summary
  • GDL is a rational way to deal with novice driver
    problems
  • GDL allows beginning drivers to gradually gain
    experience under low-risk conditions
  • GDL provides incentives to drive safely to
    graduate to full licensure
  • Surveys indicate substantial support for GDL by
    parents
  • GDL significantly reduces crashes involving 16-
    to 17-year-olds
  • GDL can save thousands of lives in the future if
    all States adopt it and if it is extended to all
    young drivers under age 21.

30
So, has Graduated Driver Licensing been a total
success?
31
Graduated Driver Licensing
Recent National Study
  • Masten, Foss, Marshall (2011)
  • Journal of the American Medical Association,
    306(10), 1098-1103
  • Good GDL programs associated with lower
    incidence of fatal crashes for 16-year-old
    drivers by 26, resulting in about 1,348 fewer
    fatal crashes.
  • However, Good GDL programs were associated with
    a 12 increase in fatal crashes by 18-year-old
    drivers, resulting in about 1,086 more fatal
    crashes.
  • Lead author (Masten) speculated that the increase
    in 18-year-old fatal crashes was due to them
    delaying licensure in the Good GDL states
    because of the strong restrictions.

32
Graduated Driver Licensing
Additional Recent Analyses
  • (based upon Fell, Romano Voas, 2013)
  • RESULTS
  • Any GDL law reduces fatal crash involvements of
    16-year-old drivers by 17 (plt.05) saving 1,945
    lives over the years.
  • Good GDL laws reduce fatal crash involvements
    of 16-year-old drivers by 20 (plt.05) saving
    2,347 lives over the years.
  • However, 18-year-old fatal crash involvements
    increased by 11 (plt.05) associated with Good
    GDL laws, resulting in 2,724 fatalities over the
    years. Why?

33
Graduated Driver Licensing
Possible Reasons for the Conflict
  • Drivers aged 18-19 are skipping GDL phases and
    driving at a later age---reducing their
    experience
  • Drivers aged 18-19 are exhibiting more
    risk-taking behaviors (e.g. impaired driving
    lack of safety belt use distracted driving)
  • Drivers aged 18-19 have increased exposure to
    risk for a fatal crash (more late night driving
    driving on high speed roads driving more miles)
  • Drivers aged 18-19 who have gone through two
    phases of GDL lack experience under high-risk
    conditions because of GDL restrictions

34
Graduated Driver Licensing
Further Research is Needed
  • Should States require GDL up to age 21? Only one
    State does (New Jersey).
  • Has the license status and license type changed
    over the years for 16-, 17-, and 18-year-old
    drivers compared to the same ages in fatal
    crashes before GDL?
  • Have 18-year-old drivers delayed licensure? In
    which states? Why?
  • What other components of GDL laws are effective?
    Minimum ages, holding periods, practice hours,
    etc.?
  • Which GDL components affect impaired driving the
    most?

35
Underage Drinking
36
What percent of 18-20 year olds in the U.S.
report drinking alcohol?
37
Some Young People Do Drink, But a Smaller
Percent Compared to Adults 2002
Drinking Among Youth (past 30 days)
18- to 20-year-olds
12- to 14-year-olds
1
10
5
24
18
49
94
72
27
15- to 17-year-olds
Drinking Occasions
0
1 to 4
5 or more
Source NSDUH, 2002
38
Some Young People Do Drink, But a Smaller
Percent Compared to Adults 2012
Drinking Among Youth (past 30 days)
18- to 20-year-olds
12- to 14-year-olds
5
1
3
19
15
55
96
80
26
15- to 17-year-olds
Drinking Occasions
0
1 to 4
5 or more
Source NSDUH, 2012
39
But, Young Drinkers Drink More Heavily than Adult
Drinkers 2002
Comparison of drinking patterns for adult and
underage drinkers (past 30 days)
Non-bingers
Bingers
Source NSDUH, 2002
40
But, Young Drinkers Drink More Heavily than Adult
Drinkers 2012
Comparison of drinking patterns for adult and
underage drinkers (past 30 days)
Non-bingers
Bingers
Source NSDUH, 2012
41
Relative Risk of Being Involved in a Fatal Crash
by BAC
  • BAC
  • Driver Age .05 - .079 .08 - .099 gt.15
  • 16-20 6.24 12.61 490.41
  • 21-34 4.78 8.74 200.03
  • 35 4.03 6.89 111.94
  • Risk relative to BAC.00 for same age group
  • Relative risks are the same for men and women at
    a given BAC. Relative risk for 16-20 year old
    women are now the same as 16-20 year old men at a
    given BAC (a change from 1996).
  • Source Voas, Torres, Romano, Lacey, JSAD, (2012)

42
Relative Risk of Being Killed as a Driver in a
Single Vehicle Crash (Relative to BAC .00)
Source Voas, Torres, Romano, Lacey (2012)
43
Minimum Legal Drinking Age Laws
44
Minimum Legal Drinking Ages Around the World
  • Australia 18 Canada 18
  • France 16 Italy 16
  • Japan 20 Sweden 18
  • Switzerland 14 Great Britain 16
  • USA 21 Venezuela 18

Source WHO
45
  • Background

46
Minimum Legal Drinking Age 21 (MLDA-21) History
in the United States
  • Minimum Legal Drinking Age (MLDA) Laws
    established in the States after the Repeal of
    Prohibition in 1933 (21st Amendment to the US
    Constitution)
  • Most States set the MLDA at 21 (e.g., 11 States
    set and stayed at 21)
  • AR (1935) CA (1933) IN (1934) KY (1938)
  • NV (1935) NM (1934) ND (1936) OR (1933)
  • PA (1935) UT (1935) WA (1934)

47
Minimum Legal Drinking Age 21 History in the
United States
  • Voting age lowered from 21 to 18 in 1971 (26th
    Amendment to the US Constitution)
  • Many States began to lower the drinking age to 18
    or 19 in the early 1970s
  • Studies in the 1970s and 1980s showed significant
    increases in alcohol-related fatal traffic
    crashes involving youth aged 16-20 in States that
    lowered their drinking age

48
Minimum Legal Drinking Age 21 History in the
United States
  • Mothers Against Drunk Driving (MADD) founded in
    1980
  • Presidents Commission on Drunk Driving
    established in 1982
  • MADD, Presidents Commission, Members of Congress
    recommended a National Uniform Drinking Age Law
    set at 21 in order to reduce youthful
    alcohol-related fatalities and eliminate the
    blood borders

49
MLDA 21 Milestones
All 50 States plus DC adopt age 21 as minimum
legal drinking age (illegal to possess alcohol
and illegal to purchase alcohol) by 1988 or risk
the withholding of a portion of Federal Highway
Construction funds.
  • President Ronald Reagan signs federal 21 Minimum
    Drinking Age law in 1984.

50
US Minimum Legal Drinking Ages as of December 31,
1969 35 states had 21 as the drinking age
NH
ND
WA
MT
VT
MN
ME
WI
SD
OR
ID
WY
NY
MI
MA
IA
NE
PA
IL
OH
IN
RI
NJ
NV
UT
CO
CT
WV
MO
KS
DE
VA
KY
CA
MD
TN
NC
OK
DC
AR
AZ
NM
SC
MS
AL
GA
LA
TX
21 years old
FL
AK
20 years old
18 years old
HI
51
US Minimum Legal Drinking Ages as of December 31,
1975 Only 12 states had 21 as the drinking age
NH
ND
WA
MT
VT
MN
ME
WI
SD
OR
ID
WY
NY
MI
MA
IA
NE
PA
IL
OH
IN
RI
NJ
NV
UT
CO
CT
WV
MO
KS
DE
VA
KY
CA
MD
TN
NC
OK
DC
AR
AZ
NM
SC
MS
AL
GA
LA
TX
21 years old
FL
AK
20 years old
19 years old
18 years old
HI
52
US Minimum Legal Drinking Ages as of July 1, 1988
All states had 21 as the drinking age
NH
ND
WA
MT
VT
MN
ME
WI
SD
OR
ID
WY
NY
MI
MA
IA
NE
PA
IL
OH
IN
RI
NJ
NV
UT
CO
CT
WV
MO
KS
DE
VA
KY
CA
MD
TN
NC
OK
DC
AR
AZ
NM
SC
MS
AL
GA
LA
TX
FL
AK
HI
53
What Have Been the Effects of the Minimum Legal
Drinking Age 21 in the United States?
54
What Have Been the Effects of the Minimum Legal
Drinking Age 21 in the United States?
  • Reduction in alcohol consumption by those lt21
  • Reduction in drinking driver fatal crashes by
    those lt21
  • Reduction in alcohol-related homicides, suicides,
    unintentional injuries by those lt21

55
Research
  • Studies in the 1980s and 1990s show that raising
    the drinking age saves lives
  • Studies from the National Highway Traffic Safety
    Administration (NHTSA) show that MLDA 21 laws
    reduce 18- to 20-year-old driver involvements in
    fatal crashes by 13 (Arnold, 1985 Womble, 1989
    Kindelberger, 2005)
  • MLDA-21 laws estimated to save 800-900 lives each
    year in reductions in traffic fatalities

56
Drivers Over Age 21 Involved in Fatal Crashes,
1982-2004 Sources FARS NHTSA
38
Sober drivers age 21
Drinking drivers age 21
-33
57
Drivers Under Age 21 Involved in Fatal Crashes,
1982-2004 Sources FARS NHTSA
9
Sober drivers under age 21
-62
Drinking drivers under age 21
58
  • Other than illegal to possess and illegal to
    purchase alcohol if you are under age 21, what
    other MLDA-21 laws are there in the States?

59
  • MLDA-21
  • Law Components

60
20 Key Components of Underage Drinking Laws in
the United States
  • MLDA 21 Law Components States with Law
  • CORE LAWS
  • Apply to Youth
  • Possession 51
  • Purchase/attempt to purchase 48
  • EXPANDED LAWS
  • Apply to Youth
  • Consumption 35
  • Internal possession 9
  • Use and lose driving privileges 40
  • Use of fake ID illegal 51
  • Apply to Youth Driving
  • Zero tolerance 51
  • GDL with night restrictions 51

61
20 Key Components of Underage Drinking Laws in
the United States
  • MLDA 21 Law Components States with Law
  • Apply to Providers
  • Furnishing/selling 51
  • Age 21 for on-premises Server (all 3 beverage
    types) 13
  • Age 21 for on-premises Bartender (all 3 beverage
    types) 24
  • Age 21 for off-premises Seller 23
  • Keg registration 31
  • Beverage Service Training 38
  • Retail Support Provisions for Fake ID 45
  • Hosting underage drinking parties 28
  • Dram Shop Liability 45
  • Social Host Civil Liability 33

62
20 Key Components of Underage Drinking Laws in
the United States
  • MLDA 21 Law Components States with Law
  • Apply to Manufacturers of Fake ID
  • Transfer/production of Fake ID illegal 24
  • Apply to State
  • State control of alcohol
  • (at least 1 beverage)
    11

63
20 Key Components of Underage Drinking Laws in
the United States
  • Utah has all 20 MLDA-21 Components
  • Kentucky has only 9 out of the 20 laws
  • Georgia has 11 of the laws
  • Only 5 laws have been adopted by all 50 States
    and DC

64
5 MLDA-21 Laws Adopted by all States and DC in
the United States
  • Illegal to possess alcohol
  • Illegal to use a fake ID to purchase alcohol
  • Zero Tolerance (BACgt.02) for driving
  • Graduated Driver Licensing System
  • Illegal to furnish alcohol to persons under age 21

65
Georgias MLDA-21 Laws
  • Possession
  • Purchase
  • Use Lose
  • Fake ID Use
  • Zero Tolerance for Driving
  • GDL with Night Restrictions
  • Furnishing
  • Keg Registration
  • Fake ID Retail Support
  • Dram Shop
  • Social Host Civil Liability

66
  • Prior Research from PIRE

67
Prior Research
  • We evaluated 6 of the 20 MLDA-21 laws
  • The Impact of Underage Drinking Laws on
    Alcohol-Related Fatal Crashes of Young Drivers
  • By Fell, Fisher, Voas, Blackman Tippetts
  • Alcoholism Clinical and Experimental Research
  • Vol. 33, No. 7, July 2009

68
Results
MLDA 21 Law Effects on Ratio of ltAge 21 Drinking
Drivers to Non- Drinking Drivers in Fatal
Crashes (1982-2004)
Core Laws Possession/ Purchase
Keg Registration
GDL with Night Restriction
Zero Tolerance Driving
Use Lose
69
Results
Traffic Safety Law Effects on the Ratio of
Underage 21 Drinking Drivers to Non-Drinking
Drivers in Fatal Crashes (1982-2004)
.08 BAC Per Se
.10 BAC Per Se
Seat Belt Law
ALR
10
0
-3
.041)
(
p
-5
(
p
.024)
-7
-8
(
.065)
p
-10
(p.002)
70
Results
Traffic Safety Law Effects and Enforcement on
the Ratio of Over Age 25 Drinking Drivers to
Non-Drinking Drivers in Fatal Crashes (1982-2004)
Sobriety Checkpoint Frequency
.10 BAC Per Se
.08 BAC Per Se
ALR
71
  • Current Research

72
  • Methods

73
MLDA-21 Laws
  • We selected for evaluation
  • Three False Identification (FID) laws
  • (1) FID for minors
  • (2) FID for suppliers
  • (3) FID for retailer support and
  • Two social host laws
  • (4) Social Host Prohibition (SHP) and
  • (5) Social Host Civil Liability (SHCL).

74
MLDA-21 Laws
  • Fake ID laws
  • for minors prohibited the use of false
    identification cards by minors (i.e., minors
    under age 21)
  • for suppliers prohibited a person from lending,
    transferring to, or producing false
    identification for an underage person (i.e.,
    suppliers) and
  • for retailer support established policies which
    allowed one or more of the following for
    retailers of alcohol outlets the use of
    identification scanners, distinctive licenses for
    those under age 21, seizure of identification
    cards deemed false, or the right to sue an
    underage person that uses false identification to
    purchase alcohol (i.e., retailer support).

75
MLDA-21 Laws
  • Social Host Laws
  • 1. Social Host Civil Liability (SHCL) laws
    involve the liability faced by noncommercial
    alcohol servers for injuries or damages caused by
    their intoxicated or underage drinking guests. In
    states with SHCL laws, injured third parties are
    able to sue social hosts (as well as the minor
    who caused the crash) for monetary damages. SHCL
    law is established by statute or by a state court
    through common law.

76
MLDA-21 Laws
  • Social Host Laws
  • 2. Social Host Prohibitions (SHP) involve
    underage furnishing and host party criminal
    policies which can result in penalties imposed by
    the state (e.g., fines, jail, etc.).

77
Data Sources
  • Legal Research
  • Alcohol Policy Information System (APIS)
    developed and maintained by the National
    Institute on Alcohol Abuse and Alcoholism
    (NIAAA) Westlaw HeinOnline
  • Crash Analyses
  • Fatality Analysis Reporting System (FARS)
    developed and maintained by the National Highway
    Traffic Safety Administration (NHTSA) for the
    years 1982-2010

78
Model
  • The model we used is composed of
  • Three FID laws (i.e., minor, retailer support,
    and supplier)
  • Two versions of the social host laws (i.e.,
    social host prohibitions (SHP) and social host
    civil liability (SHCL) laws)
  • Three drinking-and-driving laws (0.08 legal
    limit, 0.10 legal limit, and ALR)
  • Two driving-safety laws (use of sobriety
    checkpoints and seatbelt use laws)
  • Two variables determining economic strength
    (employment rate and VMT by state and year)
  • Per capita beer consumption by state and year
  • Ratio of underage 21 drinking drivers to underage
    21 non-drinking drivers in fatal crashes and
  • Ratio of drinking drivers to non-drinking drivers
    in fatal crashes among drivers aged 26 years and
    older as a comparison.

79
Structural Equation Modeling (SEM)
80
  • Strengths of the Laws

81
Scoring
Fake Identification Minor Fake Identification Minor
Scoring Criteria Weight Point Values
Fake Identification law 1.0 point for presence of the law
License sanction procedure 2.0 points for administrative sanctions OR 2.0 points for administrative and judicial sanctions OR 1.0 points for judicial sanctions only
82
Scoring
Fake Identification Supplier Fake Identification Supplier
Scoring Criteria Weight Point Values
Lending, transfer or sale of false IDs criminalized 1.0 point if yes
Manufacturing and distribution of false IDs criminalized 1.0 point if yes
83
Scoring
Fake Identification Retailer Support Fake Identification Retailer Support
Scoring Criteria Weight Point Values
Incentives for retailers to use scanners 1.0 point if yes
Use of distinctive licenses 2.0 points if yes
Seizure of suspicious ID by retailer permitted 1.0 point if yes
Right to sue minor 1.0 point if yes
Affirmative defense -1.0 point for general affirmative defense 0.0 points for specific affirmative defense or none
84
Scoring
Scoring Criteria Weight Point Values
Social Host Prohibitions Social Host Prohibitions
Type of statute 2.0 points for general OR 1.0 point for specific
Underage guest actions triggering violation 1.0 point for possession 1.0 point for consumption 1.0 point for intention to possess or consume
Property type covered by law 1.0 point for residence 1.0 point for outdoor area 1.0 point for other areas
Knowledge standard 2.0 points for negligence 1.0 point for knowledge 0 points for overt act
Preventive actions available to offender -1.0 if yes
Exceptions to law -1.0 point for family -1.0 point for resident of household -1.0 point for other
85
Scoring
Social Host Civil Liability Social Host Civil Liability
Common law or common law and statutory law 3.0 points
Statutory law only 3.0 points
Limitations to the law -1.0 point for limitation on who may be sued -1.0 point for limitation on elements or standards of proof
86
  • Which of the 5 MLDA-21 laws have had a
    significant effect on underage drinking driver
    fatal crashes?

87
  • Results

88
Effects of five MLDA-21 laws on the ratio of ltage
21 drinking drivers to ltage 21 nondrinking
drivers involved in fatal crashes (Source FARS
1982-2010)
89
Regression Weights and Significance Level for
Direct Effects Including Strength of Fake
Identification and Social Host MLDA-21
Laws values in bold and italics indicate a
significant effect
Model including strength of FID and SHP laws Model including strength of FID and SHP laws Model including strength of FID and SHP laws
Predictor Estimate S.E. p-value
Outcome under 21 FARS ratio Outcome under 21 FARS ratio Outcome under 21 FARS ratio Outcome under 21 FARS ratio
Alcohol-impaired driving laws -.160 .019 lt.001
Driving safety laws -.151 .007 lt.001
Economic strength .001 .003 .866
FID minor laws -.003 .006 .564
FID supplier laws -.010 .005 .030
FID retailer laws -.004 .003 .218
SHP laws -.001 .001 .937
SHCL laws -.006 .003 .054
Beer consumption .181 .022 lt.001
90
Conclusions
  • Only 24 States have Fake ID Supplier Laws and
    only 33 States have Social Host Civil Liability
    Laws
  • If all States adopt fake ID supplier laws (effect
    size 1.0) an additional 30 lives per year would
    be savedof which 14 lives are currently being
    saved in the 24 States that have the law.

91
Conclusions
  • Our prior study (Fell et al., 2009) estimated
    that the two core MLDA-21 laws (possession and
    purchase) and the zero tolerance law for driving
    (BACgt.02 illegal) are saving 732 lives per year.
  • Use Lose laws are saving an additional 132
    lives annually and if all states adopted Use
    Lose laws an estimated 165 lives could be saved
    per year.

92
Conclusions
  • An estimated 878 lives per year are being saved
    by these five effective laws. If all states
    adopted all five laws, up to 927 lives could be
    saved each year.

93
What does NHTSA officially say about MLDA-21 Laws?
94
Conclusions
95
Future Research
  • Eleven of the 20 MLDA-21 Laws have now been
    evaluated for their effectiveness on underage
    drinking driver fatal crashes.
  • Under a NIAAA grant R03 AA022446 we are
    currently evaluating
  • Dram Shop Laws
  • State Alcohol Control Laws
  • Responsible Beverage Service Training Laws
  • Eventually all 20 MLDA-21 Laws with strengths
    will be evaluated.

96
Acknowledgements
  • This study was conducted under a grant from the
    National Institute on Alcohol Abuse and
    Alcoholism (NIAAA) R21 AA019539. We thank Mr.
    Gregory Bloss of NIAAA for his excellent guidance
    and Dr. Ralph Hingson of NIAAA for his comments
    and suggestions.
  • The scoring of the 20 underage drinking laws was
    conducted under a NIAAA grant R03 AA022446 and
    a grant from the Office of Juvenile Justice and
    Delinquency Prevention (OJJDP) 2012-AH-FX-0005.
  • This study is scheduled to be published in
    Traffic Injury Prevention in October 2014.

97
Should the Minimum Legal Drinking Age Remain at
21?
98
Have you heard about the Amethyst Initiative led
by college president John McCardell?
99
  • John M. McCardell, Jr.
  • Director of Choose Responsibility
  • President Emeritus of Middlebury College and
    current Vice Chancellor of The University of the
    South in Sewanee, TN

100
MLDA-21 Does Not Make Sense
  • At 18, you can vote, get married, serve in the
    military, smoke, etc.
  • Why cant you drink at 18?
  • MLDA-21 is frequently and easily broken
  • Alcohol has become a forbidden fruit for those
    under 21
  • John McCardell

101
MLDA-21 Promotes Binge Drinking
  • Promotes drinking by lt21 in clandestine locations
    without supervision
  • Reason for a 50 increase in binge drinking by
    college students
  • Reason for a significant increase in
    alcohol-related off-road underage 21 deaths
  • Reason for increase in underage 21 alcohol
    poisoning deaths
  • John McCardell

102
MLDA-21 Not a Traffic Safety Issue Anymore
  • More youth die in off-road accidents than on-road
  • Canada had a similar decrease in underage 21
    drinking driver fatal crashes and they have MLDAs
    of 18 and 19
  • Youth in European countries with lower drinking
    ages dont have the problems we do in the US
  • John McCardell

103
Solution
  • Repeal the Federal Law
  • Lower the MLDA to 18
  • Require 40 hours of alcohol education to obtain a
    drinking license
  • License revoked for any violations
  • This will Promote Responsible drinking
  • Drinking will occur in supervised environments
  • John McCardell

104
Amethyst Initiative
  • 135 College Presidents have signed the initiative
    to take a harder look at the MLDA-21
  • Keep in mind This is only 3-4 of the 3500
    college presidents in the U.S. who have signed
    off
  • Initiated by John McCardell

105
Is Dr. McCardell right?
106
Evidence of MLDA 21 Law Effectiveness
  • Williams, Zador, Harris, Karpf, 1983
  • Arnold, 1985
  • Decker, Graitcer, Schaffner, 1988
  • Womble, 1989
  • OMalley Wagenaar, 1991
  • Toomey, Rosenfeld Wagenaar, 1996
  • Voas, Tippetts Fell, 2003
  • Ponicki, Gruenewald LaScala, 2007
  • Many Others

107
Reviews of the Literature on MLDA 21
  • Wagenaar Toomey, 2002
  • Examined all of the research from 1960 to 2000
    when states lowered the drinking age and then
    raised the drinking age
  • Every one of the 46 high-quality studies that
    found an effect found that the MLDA 21 saves
    lives
  • Shults, et al, 2001
  • Centers for Disease Control reviewed all of the
    high quality peer-reviewed published studies on
    drinking ages
  • Concluded
  • Lowering the MLDA crash increase of 10
  • Increasing the MLDA crash decrease 16
  • One of the best studied public health laws in
    history

108
30-day Alcohol Use by Youth Under Age 21 Minimum
Drinking Age Effect
109
Evidence of MLDA 21 Law Effectiveness
  • Drinking drivers over age 21 involved in fatal
    crashes the decrease between 1982 and 2004 was
  • -33
  • Drinking drivers under age 21 involved in fatal
    crashes the decrease between 1982 and 2004 was
  • -62
  • MLDA 21 accounted for much of the difference
    (Hedlund, et al., 2001)

110
Canada
  • Experienced similar decreases in underage 21
    drinking drivers in fatal crashes even though
    MLDA was 18-19
  • However, drinking drivers over age 21 experienced
    almost the same rate of decrease
  • Therefore, factors other than the MLDA accounted
    for the Canadian decrease
  • Remember, in the U.S., the lt21 drinking driver
    rate decreased twice as much as the gt21 drinking
    driver rate

111
More Evidence of Effectiveness
  • Additional studies have shown a decrease in other
    injuries associated with MLDA 21
  • Decrease in homicides by 18-20 year-olds
  • Jones, Pieper, and Robertson, 1992
  • Decrease in suicides by 18-20 year-olds
  • Links, 2000
  • Birckmayer and Hemenway, 1999
  • Decrease in other unintentional injuries by 18-20
    year-olds
  • Jones, Pieper, and Robertson, 1992

112
Do European youth drink responsibly?
113
The European Drinking Age Myth
A higher percentage of young people from a
majority of European countries in 2007 report
  • Experimenting with alcohol
  • Drinking in the past year
  • Drinking in the past 30 days
  • Heavy episodic drinking
  • Intoxication

26 countries show higher rates of adolescent
intoxication compared to the US rate. 9
countries show lower rates.
114
Prevalence of Intoxication in Past Year -
2007 Adolescents Aged 15-16
Sources Hibell, et al., 2009 Johnston,
OMalley, Bachman, Schulenberg, 2008
115
First Intoxication Before Age 13 -
2007 Adolescents Aged 15-16
Sources Hibell, et al., 2009 Johnston,
OMalley, Bachman, Schulenberg, 2008
116
Drunkenness Among 15-Year-Olds, 2005-6 (Drunk at
least twice in life)
Source O.E.C.D. Currie et al. (2008)
117
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118
July 17, 2008 French Combat Youth
Binge-Drinking By Bruce Crumley / Paris
50 increase in 15-24 year olds hospitalized for
excess drinking since 2004 50 of 17 year olds
reported being drunk in the past month Alcohol is
the leading factor in deaths among French youth
119
How long has binge drinking in U.S. colleges been
going on?
120
Binge Drinking
  • Straus Bacon (1953) Drinking in College
    discusses binge drinking since 1920s
  • Straus Bacon (1953) estimated 65 of college
    students drank in past 30 days in 1950
  • College Alcohol Survey (2007) estimated 70 of
    college students drank in past 30 days
  • College binge drinking is cultural and not caused
    by the MLDA-21

121
Is College Binge Drinking Increasing?
Percent of College Students Who Report Being
Drunk in the Past 30 Days
Source Monitoring the Future, College Students
and Adults, 1975-2006, NIH
122
Are Young People Binge Drinking More?
5 drinks in one session past 2 weeks 19-20 Year
Olds
Source Monitoring the Future, 1975-2006, NIH
123
Underage Binge Drinking 1975-2007 who had
5 drinks in a row in previous 2 weeks Source
Monitoring the Future 2007
124
How many young people under age 21 die of alcohol
poisoning each year?
125
Alcohol-Attributable Deaths Youth Under Age 21
2001 (Source CDC, Midanik, et al, MMWR, 2004)
  • Motor Vehicle Crashes 2,075
  • Homicides 1,227
  • Suicides 480
  • Poisoning (drug and alcohol) 234
  • Alcohol Poisoning 18
  • Drowning 125
  • Fires 41
  • Falls 37
  • Etc. .
  • TOTAL 4,492

126
Number of Deaths Attributable to the Harmful
Effects of Excessive Alcohol Use Among 18-20 and
21-24 Year Olds Alcohol Poisoning
2001-2006 Sources CDC Alcohol-Related Disease
Impact (ARDI) Software Alcohol Attributable
Deaths (AAD)
127
Number of Deaths Attributable to the Harmful
Effects of Excessive Alcohol Use Among 18-20 and
21-24 Year Olds Non-Highway Injury Deaths
2001-2006 Sources CDC Alcohol-Related Disease
Impact (ARDI) Software Alcohol Attributable
Deaths (AAD)
128
Surgeon Generals Call to Action to Prevent and
Reduce Underage Drinking, 2007
129
Reducing Underage Drinking A Collective
Responsibility National Academy of Sciences,
Institute of Medicine, 2004
Not one page, not one paragraph, not one word
even suggests that lowering the legal drinking
age is part of the solution
130
Has the MLDA 21 Been Effective? Yes.
  • 40-50 peer-reviewed studies say it has
  • Research also shows that when the drinking age is
    lowered, alcohol related problems increase
    traffic fatalities, suicides, STDs, assaults,
    etc.
  • Raising the drinking age reduces problems
  • Lowering the drinking age increases problems
  • Does the MLDA 21 eliminate underage drinking?
    No.

131
Should It Remain at 21? Yes.
Those who start drinking at age 18 vs. those who
start at age 21
  • 15 become alcohol dependent vs. 9
  • 2.4 times the odds of being in a motor vehicle
    crash as a drinking driver
  • 1.6 times the odds of being in a fight after
    drinking

132
Has the MLDA 21 Been Harmful? No.
There is no evidence of associations with
drinking age 21 and the following
  • Increases in alcohol poisoning
  • Binge drinking in uncontrolled, clandestine
    environments
  • Alcohol-related injuries of any kind

133
What are some of the arguments people use to
advocate lowering the drinking age?
134
Argument If Im old enough to vote and go to
war, I should be old enough to drink.
  • Response
  • Many rights have different ages of initiation
  • Drivers license Age 16
  • Vote Age 18
  • Serve in the Military Age 18
  • License to carry handgun Age 21
  • Rent a Hotel Room Age 21
  • Rent a Car Age 25
  • Serve in the House Age 25
  • Elected President Age 35
  • The brain is not fully developed until about age
    25.

135
Argument If people cannot drink until they are
21, will they just drink more when they reach
21?
  • Response
  • Research shows that they will not drink more once
    they turn 21
  • Early legal access to alcohol is associated with
    higher rates of drinking later in life
  • Those who wait until they are 21 to start
    drinking have significantly fewer alcohol-related
    problems later in life

136
Argument Since 19 and 20-year-olds drink
anyway, wouldnt it be better to let them drink
in controlled settings?
  • Response
  • Are bars safe and controlled?
  • Many individuals stopped for drinking and driving
    come from a bar
  • 79 of licensed establishments will sell to an
    obviously intoxicated person
  • MLDA 21 saves many 19- and 20-year-old lives
  • We need to enforce age-21 law in all settings

137
New Zealand Natural Experiment
  • It has been 30 years since the last state in the
    U.S. lowered its drinking age.
  • If a state were to lower its drinking age under
    the current conditionswould youthful crash
    injuries increase?
  • New Zealand lowered its drinking age from 20 to
    18 in 1999, providing an opportunity to study
    such a reduction.

138
New Zealand Study Conclusions (Kypri, et al.,
2006)
  • The size of the effect for 18- to 19-year-olds
    (increases of 12 for males and 51 for females
    in traffic crash injuries) was remarkable given
    the legal exceptions to the pre-1999 law and its
    poor enforcement.
  • There were large trickle-down effects for
    15- to 17-year-olds (increases of 14 for males
    and 24 for females).
  • There were significantly more alcohol-involved
    crashes among 15- to 19-year-olds than would have
    occurred had the purchase age not been reduced to
    18.

139
No Evidence that Lowering MLDA to 18 for those
who Complete an Alcohol Education Course will
Reduce the Problem
  • Driver education courses did not reduce crashes
    for beginning drivers
  • DARE education program did not reduce drug usage
    by youth
  • How can we expect an 18 year old to choose
    responsibility when they are drinking alcohol?
    They actually lose their inhibitions when under
    the influence.

140
College Interventions (IOM, 2004)
  • Campuses should adopt comprehensive
    evidence-based approaches
  • Screening and brief interventions
  • Limit alcohol availability and access for
    underage students
  • Consistent enforcement of laws and policies
  • Universal educational approaches as well as
    selective and indicated approaches
  • NIAAA and SAMHSA should continue to fund
    evaluation of college-based programs and should
    maintain list of evidence-based programs.

141
Promoting a College or University Climate that
De-Emphasizes the Role of Alcohol Strategies
that Work
Dr. Jonathan Gibralter President, Frostburg State
University
142
Policies and Procedures
  • Identified campus and community policies and
    practices addressing alcohol use and abuse
  • Addressing off-campus behavior as violations of
    University policyin Student Code of Conduct
  • Increased communications with two other local
    colleges
  • Are bringing High Schools into the mix also.

143
Results
  • Reduction in off-campus citations
  • Number of repeat offenders has decreased
    dramaticallyalmost no third offenses.
  • Built awareness that off-campus parties also
    consist of non-students
  • Improved relations with community
  • Addressed high-risk events
  • Students understand the message
  • Off-campus events involve fewer people

144
What can we do over the next 5 years to further
reduce underage drinking?
145
Strategies That Show Evidence of Reducing
Underage Drinking
  • Strengthen the Laws
  • Better Enforcement of the Laws (against the youth
    and the providers)
  • Educate Parents
  • Increase the excise tax and the price of alcohol
    consumption goes down (10 increase in price
    results in a 5 decrease in consumption)
  • Delay the age of onset of drinking
  • De-normalize binge drinking

146
U.S. Public Supports MLDA-21
  • The public is in favor of keeping the MLDA at 21
  • Latest Gallup Poll showed 74 opposed lowering
    the MLDA to 18
  • Virtually every major public health organization
    supports the MLDA-21 law
  • AMA CDC NHTSA NTSB IIHS APHA
    NSC
  • CADCA GHSA CSPI MADD
    SADD
  • Only 135 college presidents (3-4) out of 3500
    colleges signed the Amethyst Initiative

147
New Brain Research Validates 21
  • Alcohol on the developing brain can interfere
    with learning and memory
  • The hippocampus in an adolescent who drinks
    heavily can be up to 10 smaller
  • Teenage drinkers score worse on vocabulary and
    memory tests and are more likely to perform
    poorly in school

148
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149
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150
Why Should the Minimum Legal Drinking Age Stay
at 21?
  • Minimum drinking age 21 laws save 800-900 lives
    per year in reductions in traffic fatalities
    involving young drivers.
  • Early onset of drinking increases the risk for
    future alcohol abuse problems, crashes and
    assaults.
  • European countries with lower drinking ages
    experience higher percentages of youth that
    report intoxication in the past month.
  • Emerging medical research shows that the brain is
    not fully developed until about age 25 and
    excessive drinking by youth under age 21 may
    cause brain damage as well as reduce brain
    function.

151
QUESTIONS?
152
Strategies for Discussion
  • What strategies can you offer to change social
    norms around binge drinking?
  • What strategies can you offer to avoid adverse
    circumstances for someone elses excessive
    drinking?
  • Knowing the drinking culture on local college
    campuses, what recommendations would you make to
    the college administration to reduce the adverse
    effects of underage drinking? To law enforcement?

153
Contact Information
  • James C. Fell, M.S.
  • Pacific Institute for Research and Evaluation
    (PIRE)
  • 11720 Beltsville Dr., Suite 900
  • Calverton, MD 20705-3111
  • 301-755-2746
  • fell_at_pire.org
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