Reducing Underage Drinking, Phase 2, Build on Success!

By Pamela Erickson

In 2003, “Reducing Underage Drinking, A Collective Responsibility”, was published by the National Research Council, Institute of Medicine.  At the outset, they noted, “Alcohol use by young people is dangerous, not only because of the risks associated with acute impairment, but also because of the threat to their long-term well-being.“  They also noted that a focus on youth alone will not work.  Instead, “The preeminent goal of the recommended strategy is to create and sustain a broad societal commitment to reduce underage drinking.”

Americans– and especially prevention professionals– took up the challenge.  They formed local coalitions, advocated for enforced liquor laws, engaged youth, and worked with elements of the alcohol industry to achieve great success!  According to the Centers for Disease Control and Prevention (CDC), the 1991-2019 High School Youth Risk Behavior Survey (YRBS), data revealed that in 1991, 50.8% of high school youth had drunk alcohol in the past 30 days.  In 2019 that dropped to 29.8%!

Equally impressive is data that shows fewer high school students had their first drink before age 13.  In 1991 33% had their first drink before age 13, but in 2019 it dropped to 15%.  This is exceptionally important because we now have research that tells us that delaying the “age of drinking onset” may result in fewer problems in the future.  (In a study of over 43,000 adults, those who drank before age 14 were more likely to experience alcohol dependence than those who waited to drink until age 21.

And, there has been a reduction in heavy drinking.  The 2019 YRBS study indicated that while binge drinking between 2017 and 2019 remained around 14%, drinking 10 or more drinks in a row declined from 6.1% in 2013 to 3.1% in 2019.

While these signs are encouraging, there is more work to do.  This is actually a good time to launch a second phase to reduce underage and binge drinking.  This phase can build on previous efforts that have contributed to success.  The following issues should be considered:

1. Underage drinking is still too high: While there has been a drop in use, almost 30% of high school students report drinking in the last month. Continued reduction is needed.

2. Binge and heavy drinking are dangerous practices: While heavy drinking declined, binge drinking hasn’t changed much in the last few years. (Binge drinking is defined as 5 drinks in a row for a male and 4 for a female.) The list of harms associated with binge drinking is very long and now includes pandemic issues such as weakened immunity, spreading the virus, and increasing the burden on the health care system. According to the CDC, these are the problems associated with binge drinking:

• Unintentional injuries such as car crashes, falls, burns, and alcohol poisoning.
• Violence including homicide, suicide, intimate partner violence, and sexual assault.
• Sexually transmitted diseases.
• Unintended pregnancy and poor pregnancy outcomes, including miscarriage and stillbirth.
• Fetal alcohol spectrum disorders.
• Sudden infant death syndrome.
• Chronic diseases such as high blood pressure, stroke, heart disease, and liver disease.
• Cancer of the breast, mouth, throat, esophagus, liver, and colon.
• Memory and learning problems.
• Alcohol use disorders.

3. Female youth drinking rates are now similar to or higher than males: Males have historically drunk alcohol at higher rates than females, but that is changing. In fact, the 2019 YRBS showed that 14.6% of females and 12.7% of males binged.  This is very concerning because alcohol is harder on a female body versus a male body.

4. Focus on parents’ influence, particular since many youths are at home. There is some evidence that a portion of the public is increasing their consumption of alcohol during the pandemic. A recent study by the Rand Corporation concluded that the “Frequency of alcohol consumption increased.”  Given that most people– including kids– are house-bound, this is a good time for adults to be role models when it comes to alcohol.  This could be an effective strategy as national surveys consistently find that it is parents who have the most influence on their child’s decision to drink or not.  For example, in a 2017 survey by the Roper organization, 83% of youth surveyed named their parents as having the most influence…the next highest was 33% for friends or teachers.

5. Support robust enforcement of alcohol regulations because they can help reduce spread of the virus…and help prevent violence. Many basic regulations are designed to reduce intoxication and dangerous behaviors. For example, food service is often a requirement because it can reduce the intoxicating impact of alcohol consumption.  Closing hours are based on the notion that the longer someone stays at a bar, the more they are likely to drink.  Bars which are very crowded with standing patrons milling around with raucous music in the background have been identified as situations where the virus is spread.  Because people are close together and must shout to converse, they are more likely to emit droplets that might infect another person.  Ironically, a lot of those factors are also those which contribute to bar violence.  These are things which may be prevented with good alcohol regulations well enforced.  Ironically, many of these regulations have been targeted for deregulation.

And a final note is that excessive alcohol consumption can damage your immune system making you more vulnerable to acquiring viruses and germs.  See the quote below from the National Institutes of Health:

“One of the least appreciated medical complications of alcohol abuse is its effect on the immune system. Excess alcohol consumption may lead to immune deficiency, causing increased susceptibility to certain diseases.”   NIH National Library of Medicine

Some conclusions/recommendations to consider:

1. All those who have worked on reducing underage and binge drinking deserve a great deal of credit, as well as youth who have listened and taken the message to heart. Spread the story, reward those who worked on it, and use the techniques that worked in your community to make further gains.

2. Focus some efforts on the practice of binge drinking to reemphasize how dangerous it is. Add issues from the pandemic such as how it reduces immunity and how intoxication impacts judgement to the point where people neglect social distancing, mask wearing and other standards.

3. Focus attention on girls’ and women’s drinking patterns. They may not know about how alcohol impacts a female body differently than a male’s.  Find ways to educate women about these issues.

4. Challenge adults to be good role models when drinking alcohol at home. Provide educational resources that help people understand how to consume moderately.  (Unfortunately, our society does not do a good job of this, so there is a real need.)

5. Work with regulatory authorities to educate the public on how regulations are designed to curtail intoxication and violence. Many of these regulations also help reduce transmission of viruses and other germs.  Advocate for fair and firm enforcement.

Sources: 

Youth Risk Behavior Survey Questions, Center for Disease Control & Prevention

“Age at drinking onset and alcohol dependence: age at onset, duration, and severity,” by Ralph W Hingson , Timothy Heeren, Michael R Winter

“Alcohol Use During the Great Recession of 2008–2009” Jacob Bor, Sanjay Basu, Adam Coutts, Martin McKee, David Stuckler, Alcohol and Alcoholism

Center for Disease Control & Prevention factsheet: https://www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm

Current & Binge Drinking Among High School Students Marissa B. Esser, PhD¹; Heather Clayton, PhD²; Zewditu Demissie, PhD²; Dafna Kanny, PhD¹; Robert D. Brewer, MD

Excessive Alcohol Use and Risks to Women’s Health, Center for Disease Control and Prevention

GfK Roper Youth Report

Alcohol and the Immune System, National Institutes of Health