Reducing Underage Drinking : A Collective Responsibility, Institute of Medicine, National Research Council, The National Academies Press, Washington, D. C., September, 2003.
Preface
By the time children are seniors in high school, about 30 percent are drinking heavily at least once a month. And 40 percent of full-time college students and more then 36 percent of other young adults (ages 18-22) report heavy drinking. Injuries due to impaired driving or violence, sexual assault and unwanted pregnancies, and educational failure. The best available estimate places the annual societal cost of underage drinking at $53 billion, far exceeding the cost of youthful use of illegal drugs.
And one thing we do know for sure is that raising the drinking age to 21 in the United States has saved many thousands of lives.
The most effective way to reduce the extent and adverse consequences of youthful drinking would be to reduce the extent and consequences of adult drinking.
Executive Summary
Alcohol is implicated in nearly one-third of youth traffic fatalities. Underage alcohol use is also associated with violence, suicide, educational failure, and other problem behaviors. All of these problems are magnified by early onset of teen drinking: the younger the drinker, the worse the problem. Frequent heavy drinking by young adolescents can lead to mild brain damage.
More youth drink than smoke tobacco or use other illegal drugs. Yet, federal investments in preventing underage drinking pale in comparison with resources targeted (mostly to youths) at preventing illicit drug use. In fiscal 2000, $71.1 million was targeted at preventing underage alcohol use. The budget for tobacco prevention was 25 times higher, $1.8 billion with the states spending more with Medicaid reimbursements against the tobacco companies.
THE STRATEGY
Recommendations:
The federal government should fund and actively support the development of a national media effort, as a major component of an adult-oriented campaign to reduce underage drinking.
All segments of the alcohol industry that profit from underage drinking inadvertently or otherwise, should join with other private and public partners to establish and fund an independent nonprofit foundation with the sole mission of preventing and reducing underage drinking.
Alcohol Advertising
Alcohol companies, advertising companies, and commercial media should refrain from marketing practices (including product design, advertising, and promotional techniques) that have substantial underage appeal and should take reasonable precautions in the time, place, and manner of placement and promotion to reduce youthful exposure to other alcohol advertising and marketing activity.
The alcohol industry trade associations, as well as individual companies, should strengthen their advertising codes to preclude placement of commercial messages in venues where a significant proportion of the expected audience is underage, to prohibit the use of commercial messages that have substantial underage appeal, and to establish independent external review boards to investigate companies and enforce the codes.
Congress should appropriate the necessary funding for the U. S. Department of Health and Human Services to monitor underage exposure to alcohol advertising on a continuing basis and to report periodically to Congress and the public. The report should include information on the underage percentage of the exposed audience and estimated number of underage viewers of print and broadcasting alcohol advertising in national markets and, for television and radio broadcasting in a selection of large or regional markets.
Entertainment Media
The entertainment industries should use rating systems and marketing codes to reduce the likelihood that underage audiences will be exposed to movies, recordings, or television programs with unsuitable alcohol content, even if adults are expected to predominate in the viewing or listening audiences
The film rating board of the Motion Picture Association of American should consider alcohol content in rating films, avoiding G or PG ratings for films with unsuitable alcohol content, and assigning mature ratings for films that portray underage drinking in a favorable light.
The music recording industry should not market recordings that promote or glamorize alcohol use to young people; should include alcohol content in a comprehensive rating system, similar to those used by the television, film, and video game industries; and should establish an independent body to assign ratings and oversee the industry code.
Television broadcasters and producers should take appropriate precautions to ensure that programs do not portray underage drinking in a favorable light, and that unsuitable alcohol content is included in the category of mature content for purposes of parental warnings.
Congress should appropriate the necessary funds to enable the U. S. Department of Health and Human Services to conduct a periodic review of a representative sample of movies, television programs, and music recordings and videos that are offered at times or in venues likely to have a significant youth audience (e.g., 15 percent) to ascertain the nature and frequency of lyrics or images pertaining to alcohol. The results of these reviews should be reported to Congress and the public.
Limiting Access
Limiting youth access to alcohol has been shown to be effective in reducing and preventing underage drinking and drinking-related problems. Since 21 became the nationwide legal drinking age, there have been significant decreases in drinking, fatal traffic crashes, alcohol-related crashes, and arrests for "driving under the influence" (DUI) among young people. Given the widespread availability of alcohol and easy access by underage drinkers, minimum drinking age laws must be enforced more effectively, along with social sanctions. The effectiveness of underage drinking laws could be enhanced through such approaches as compliance checks, server training, zero tolerance laws, and graduated driver licensing laws.
Recommendations:
The minimum drinking age laws of each state should prohibit purchase or attempted purchase, possession, and consumption of alcoholic beverages by persons under 21; possession of and use of falsified or fraudulent identification to purchase or attempt to purchase alcoholic beverages; provision of any alcohol to minors by adults, except to their own children in their own residences; and underage drinking in private clubs and establishments.
The states should strengthen their compliance check programs in retail outlets, using media campaigns and license revocation to increase deterrence.
Communities and states should undertake regular and comprehensive compliance check programs including notification of retailers concerning the program and follow-up communication to them communication to them about the outcome sale/no sale) for their outlet.
Enforcement agencies should issue citations for violations of underage sales, laws, with substantial fines and temporary suspension of licenses for first offenses and increasingly stronger penalties thereafter, leading to permanent revocation of license after three offenses.
Communities and states should implement media campaigns in conjunction with compliance check programs detailing the program, its purpose, and outcomes.
The federal government should require states to achieve designated rates of retailer compliance with youth access prohibitions as a condition of receiving relevant block grant funding, similar to the Synar Amendment's requirements for youth tobacco sales.
States should require all sellers and servers of alcohol to complete state-approved training as a condition of employment.
States should enact or strengthen dram shop liability statutes to authorize negligence-based civil actions against commercial providers of alcohol for serving or selling alcohol to a minor who subsequently causes injury to others, while allowing a defense for sellers who have demonstrated compliance with responsible business practices. States should include in their dram shop statures key portions of the Model Alcoholic Beverage Retail Licensee Liability Act of 1985, including the responsible business defense.
States that allow Internet sales and home delivery of alcohol should regulate these activities to reduce the likelihood of sales to underage purchasers. States should: require all packages for delivery containing alcohol to be clearly labeled as such; require persons who deliver alcohol to record the recipient;s age identification information from a valid government-issued document (such as a driver licenses or ID card); and require recipients of home delivery of alcohol to sign a statement verifying receipt of alcohol and attesting that he or she is of legal age to purchase alcohol.
States and localities should implement enforcement programs to deter adults from purchasing alcohol for minors. States and communities should: routinely undertake shoulder tap or other prevention programs targeting adults who purchase alcohol for minors, suing warnings, rather than citations, for the first offense enact and enforce laws to hold retailers responsible, as a condition of licensing, for allowing minors to loiter and solicit adults to purchase alcohol for them on outlet property; and use nuisance and loitering ordinances as a means of discouraging youth from congregating outside of alcohol outlets in order to solicit adults to purchase alcohol.
States and communities should establish and implement a system requiring registration of beer kegs that records information on the identity of purchasers.
States should facilitate enforcement of zero tolerance laws in order to increase their deterrence effect. States should: modify existing laws to allow passive breath testing, streamlined administrative procedures, and administrative penalties and implement media campaigns to increase young people's awareness of reduced BAC limits and of enforcement efforts.
States should enact and enforce graduated driver licensing laws.
States and localities should routinely implement sobriety checkpoints.
Local police, working with community leaders, should adopt and announce policies for detecting and terminating underage drinking parties, including: routinely responding to complaints from the public about noisy teenage parties, and entering the premises when there is probable cause to suspect underage drinking is taking place; routinely checking, as part of regular weekend patrols, open areas where teenage drinking parties are known to occur; and routinely citing underage drinkers and, if possible, the person who supplied the alcohol when underage drinking is observed at parties.
States should strengthen efforts to prevent and detect use of false identification by minors to make alcohol purchases.
States should: prohibit the production, sale, distribution, possession, and use of false identification for attempted alcohol purchase; issue driver licenses and state identification cards that can be electronically scanned:; implement administrative penalties (e.g., immediate confiscation of a driver's license and issuance of a citation resulting in a substantial fine) for attempted use of false identification by minors for alcohol purchases.
States should establish administrative procedures and noncriminal penalties, such as fines or community service, for alcohol infractions by minors.
Youth-Oriented Interventions
Intensive research and development for a youth focused national media campaign relating to underage drinking should be initiated. If this work yields promising results, the inclusion of a youth-focused campaign in the strategy should be reconsidered.
The U. S. Department of Health and Human Services and the U. S. Department of Education should fund only evidence-based education interventions, with priority given both to those that incorporate elements know to be effective and those that are part of comprehensive community programs.
Residential colleges and universities should adopt comprehensive prevention approaches, including evidence-based screening, brief intervention strategies, consistent policy enforcement, and environmental changes that limit underage access to alcohol They should use universal education interventions, as well as selective and indicated approaches with relevant populations.
The National Institute on Alcohol Abuse and Alcoholism and the Substance Abuse and Mental Health Services Administration should continue to fund evaluations of college-based interventions, with a particular emphasis on targeting or interventions to specific college characteristics, and should maintain a list of evidence based programs.
The U. S. Department of Health and Human Services and states should expand the availability of effective clinical services for treating alcohol abuse among underage populations and for following up on treatment. The U. S. Department of Education, the U. S. Department of Health and Human Services, and the U. S. Department of Justice should establish policies that facilitate diagnosing and referring underage alcohol abusers and those who are alcohol dependent for clinical treatment.
Community Interventions
Community leaders should assess the underage drinking problem in their communities and consider effective approaches --such as community organizing, coalition building, and the strategic use of the mass media--to reduce drinking among underage youth.
Public and private funders should support community mobilization to reduce underage drinking. Federal funding for reducing and preventing underage drinking should be available under a national program dedicated to community-level approaches to reducing underage drinking, similar to the Drug Free Communities Act, which supports communities in addressing substance abuse with targeted, evidence-based prevention strategies.
updated 08/09/10