# Presentation: 431282

##  Magnitude and Prevention of Underage and College Age Drinking Problems

- Albuquerque, NM
-  April 20, 2006

- Ralph Hingson, ScD
- National Institute on Alcohol Abuse and Alcoholism
- Learning Community Pilot

## Underage Drinking and Prevention U.S.A.

## Alcohol is the Drug of Choice Among Adolescents

**Alcohol is the Drug of Choice Among Adolescents**

**Source:  Monitoring the Future, 2004**

**Percent Using in Past Month**

**Grade**

**Notes:**
10.7 million youth 12 to 20 were current drinkers.  
7.2 million of current drinkers were binge drinkers. 
2.3 million of binge drinkers were heavy drinkers who engaged in binge drinking on at least five different days during the past 30 days

## Adolescents Drink Less Frequently Than Adults, But Drink More Per Occasion

**Adolescents Drink Less Frequently Than Adults, But Drink More Per Occasion**

**Source:  SAMHSA National Survey on Drug Use and Health 2003 **

** ****Drinking days/ month**

**Usual # drinks/ occasion**

**4.61**

**9.06**

**4.65**

**2.65**

**Underage 12-17**

**Adult 26 and older**

**Notes:**
10.7 million youth 12 to 20 were current drinkers.  
7.2 million of current drinkers were binge drinkers. 
2.3 million of binge drinkers were heavy drinkers who engaged in binge drinking on at least five different days during the past 30 days

## Slide 5

## CDC Youth Risk Behavior Survey2003

**N= 15,240**
**School Response 81%, Student Response 83%**
-  U.S. Student Pop.	 Grades 9-12   15,267,000
- 28% of high school students start to drink before age 13
- By age 17 they are 7 times more likely to binge frequently (5 or more drinks/ 6 or more times per month)
- There are over 1 million frequent bingers in high school
- Over 2 million age 12-20 are frequent binge drinkers (NHSDUH 2003)

## Youth Risk Behavior Survey2003

-    Frequent binge drinkers compared to abstainers in high school were much more  likely in the past 30 days to
- Ride with a drinking driver                   80% vs. 13%
- Drive after Drinking				61% vs.   0%
- Never wear safety belts			18% vs.   5%
- Carry weapon					45% vs. 10%
- Carry gun					24% vs.   3%
- Be injured in a fight				17% vs.   2%
- Be injured in a suicidal attempt		10% vs.   1%

## Youth Risk Behavior Survey2003

-    Frequent binge drinkers compared to abstainers in high school were much more  likely to
- Be forced to have sex			22% vs.  5%
- Had sex with 6 or more partners	32% vs.  3%
- Use condoms last time had sex		56% vs. 65%
- Been or gotten someone pregnant	13% vs.  2%

## Youth Risk Behavior Survey2003

-    Frequent binge drinkers compared to abstainers in high school were much more  likely to have in the past month
- Used marijuana			71% vs.   6%
- Used cocaine				26% vs. <1%
- Ever injected drugs			15% vs. <1%

## Youth Risk Behavior Survey2003

**   **Frequent binge drinkers compared to  abstainers in high school were much more  likely in the past month to:
- Drink at school					31% vs. 0%
- Use marijuana at school			29% vs. 1%
- Earned mostly D’s and F’s in 		13% vs. 4%
- school within the past year

## Slide 11

## United States 2002Underage Drinking Related Injury Deaths Persons Under 21

- 1735  Traffic crash deaths*
- 		1,143 drinking drivers under 21
- 		   592 other persons under 21
- 		   483 persons older than 21
- 1921 Other unintentional injury deaths**
- 1900 alcohol related homicides/suicides
- _____  35% of homicides   11% of suicides***
- 5,555		* NHTSA
- 			** CDC 33% alcohol related
- 			*** Percentage Reported by Levy et al. Cost 		     of Underage Drinking OJJ DP, 1999

## Slide 13

## Magnitude of Alcohol Problems on U.S. College Campuses

-  Dr. Margaret            Jonathan                  Travis
-  Moore                      Levy	                      Stedman

**Magnitude of Alcohol Problems ****on U.S. College Campuses**

- Hingson et al. (2002) *J. Studies on Alcohol*

## Annual Review of Public Health

- Brad McCue
- www.brad21.org

## Data Sources Examined

- Fatality Analysis Reporting System (FARS, NHTSA)
- Mortality Statistics (CDC)
- US Census Bureau Population Statistics
- College Enrollment Data US Department of Education
- Smith, et al. Fatal Non-Traffic Injuries Involving Alcohol: A Meta Analysis, Annals of Emergency Medicine 1999, 33:29 19-25
- National Household Survey on Drug Abuse 1999, 2002
- Harvard School of Public HealthCollege Alcohol Survey (CAS) 1999, 2001

## Change in percent binge drinking and driving under the influence among 18-24 year olds

- Persons ages 18-24	1999		2002		Change
- Past month binged
-       5+ at least once       						                                                                                                     	College		41.7 		43.2 		+4%  		Non-College	36.5		39.8		+9%
- Drove under the influence 				             	 in past year							College 		26.5		31.4		+18%	Non-College   	19.8		25.7		+30%

- Source: National Household Survey on Drug Use and Health

## Changes in Alcohol Related Injury Deaths college and non-college 18-24 year olds 1998-2001

|  | 1998 | 2001 | Percent Change
Total   Per Pop. |  |
| --- | --- | --- | --- | --- |
| All Alcohol Related Injury Deaths |  |  |  |  |
|       College | 1,550 | 1,700 | + 9% | + 6% |

- Source:  FARS, CDC, Smith et al. 1995

## Change in Numbers of College Students 18-24 Experiencing Alcohol Problems1999-2001

- 				             	 _1999_		_2001_
- Binge 5+ Drinks 			       3.6 million     3.8 million
- Drove under influence 		       2.3 million     2.8 million
- Injured under influence of alcohol    	588,000	599,000
- Assaulted by another college student	730,000	690,000
- Sex assault/date rape 			  82,400	  97,000									      Full time 4 year college students	       6.1 million     6.4 million
-  						 Change of +4.5%

- Sources:  College Alcohol Survey, National Household Survey on Drug Use and Health

## Alcohol Related Behaviors and Consequences of 18-24 Year Olds in the U.S. 2001

|  |   College | Non College |     Total |
| --- | --- | --- | --- |
| Drank 5+ on an occasion past month | 3.8 million |   7.6 million | 11.4 million |
| Past year drove under the influence of alcohol | 2.8 million |   4.5 million | 7.3 million |
| Died of  alcohol-related unintentional injury |   1,700 |     3,700 |   5,400 |

## College Alcohol Study

- The younger college students were when first drunk, the more likely they will experience in college:
- Alcohol Dependence
- Drive after drinking
- Alcohol related injury
- Unplanned and unprotected sex after drinking
**Source: Hingson, Heeren, Winter. J. Studies on Alcohol 2003, Pediatrics 2003**

## Conclusion

- In the U.S. there is an urgent need to expand and improve  prevention, screening and treatment programs and policies to reduce alcohol related harm
- Persons under 21
- Among college students
- Persons of similar ages not in college

## Interventions

- Individually oriented
- Family
- School
- Environmental
- Comprehensive Community Interventions

## Brief Motivational Alcohol Intervention in a Trauma Center

- 46% of injured trauma center patients age 18 and older screened positive for alcohol problems.
- Half (N=336) randomly allocated to receive 30 minute brief intervention to reduce risky drinking and offers links to alcohol treatment

- Source: Gentilello *Annals of Surgery*, 1999

## Brief Motivational Alcohol Intervention in a Trauma Center

**Results:**
- Reduced alcohol consumption by an average 21 drinks per week at 1 year follow up
- 47% reduction in new injuries requiring treatment in ED
- 48% reduction in hospital admissions for injury over 3 years
- 23% fewer drunk driving arrests

- Source: Gentilello *Annals of Surgery*, 1999

## Brief Alcohol Intervention for Older Adolescents  

- 94 ED patients, mean age 18.4, injured after drinking
- Half randomly allocated to a 35-40 minute motivational intervention to reduce drinking and related risky behaviors such as DWI
**Results at six months:**
- Brief intervention group had
- 1⁄4 drinking and driving occasions
- Fewer moving violations 3% vs. 23%
- 1⁄4 alcohol related injuries

- Source: Monti et al. *J. Consulting and Clinical Psychology *(1999)

## Fifteen Studies Provide Strong Support for the Efficacy of This Approach Among College Students

- Marlatt, 1998
- Anderson et. Al., 1998
- Larimer, 2000
- D’Amico & Fromme 2000
- Dimeff, 1997
- Aubrey, 1998
- Monti, 1999
- Baer, 2001

- Barnett et al. 2004
- Borsari and Carey (in press)
- Labrie 2002
- Gregory 2001
- LaChance 2004
- Murphy et al. 2001
- Murphy et al. 2004

**Source: Larimer and Cronce (2002, 2005 In Review****)**

## Fewer than
1⁄2 of pediatricians screen all adolescents for use of alcohol and drugs
1⁄4 screen for drinking and driving.

Pediatric Medical Care Providers considerably underdiagnose alcohol use, abuse, and dependence among patients ages 14-18.

1.5 million 12-17 year olds need alcohol treatment

Only 216,000 14% received treatment

- 1⁄2 of pediatricians screen all adolescents for use of alcohol and drugs
- 1⁄4 screen for drinking and driving.
- Pediatric Medical Care Providers considerably underdiagnose alcohol use, abuse, and dependence among patients ages 14-18.
- 1.5 million 12-17 year olds need alcohol treatment
- Only 216,000 14% received treatment

**Sources: American Academy of Pediatrics, 1997; ****Wilson, Sheritt, Gates, Knight ****	*****Pediatrics,***** 2004; National Household Survey on Drug Use and Health, 2003**

**Implementation Gap**

## 19% of College Students 18-24 met DSM IV    	Alcohol Abuse or Dependence Criteria
 5% of them sought treatment in the past year
 3% thought they should seek help but did not

Source:  National Epidemiologic Study of Alcohol 	   	    Related Conditions 2002

-  5% of them sought treatment in the past year
-  3% thought they should seek help but did not
**Source:  National Epidemiologic Study of Alcohol ****	****   ****	****    Related Conditions 2002**

## Insurers’ Liability for Losses   Due to Intoxication As of January 1, 2004

**28 States and DC allow with holding of medical reimbursement if injured under the influence**

##   Family Interventions  Iowa Strengthening Families Program

**Goals:**
- Improve parent/child relations
- Strengthen family communication skills
- Increase child coping skills
**Implementation:**
- 7 sessions at school
- 13 hours total
- Parent and child separately and together

## Family Interventions

**Source: Spoth, Redmond, Shin *****J Consulting Clinical Psychology***** (2001, 2004)**

- Trajectory for ISFP Condition

- Trajectory for Control Condition

- 0

**Months**

- 6

- 18

- 30

- 48

- 72

- Lifetime Drunkenness Through 6 Years Past Baseline:
- Logistic Growth Curve

**A randomized controlled trial with families of 6th graders:**
- Iowa Strengthening Families Program (ISFP) (206 families)
- Preparing for Drug Free Years Program (PDFYP) (221 families)
- Control (221 families)

## School Based Programs

- Programs that rely primarily on increasing knowledge about consequences of drinking _are not effective._
- Effective Programs :
- Are based on social influence models
- Include norm setting
- Address social pressures to drink and teach resistance skills
- Include developmentally appropriate information
- Include peer-led components
- Provide teacher training
- Are interactive
- School only program effects are generally small
- Less effective with students who initiate drinking prior to grades 5 or 6

**Source: NIAAA, Alcohol and Development in Youth: A Multidisciplinary Overview**

## School Based Life Skills Program

-    Junior High- 30 sessions, most in Year 1
- 		Curricula:
- 			Drug Information
- 			Alcohol/Drug Resistance Skills
- 			Self Management Skills
- 			General Social Skills
- 		Results:
- 			Beneficial Effects
- 			Alcohol & Tobacco Use
-       Through High School, Not After

**Sources:  Botvin et al. *****J. Consulting and Clinical Psychology***** (1990); ****	*****JAMA ******	******	******	******	******	******	******	******	******	******	******	******	******  *****(1995); ****	*****Addictive Behaviors***** (2000)**

##    Combined Family Interventions& School Based Life skills Program

**Results:  2 1⁄2 Years Later**
- Weekly drunkenness rate among intervention students 1/3 lower
- Strengthening Family plus Life Skills (p=.03)
- Life Skills Training (p=.08)

**Conclusion:**
**Family and school interventions c**_**ombined**_** are more effective than school interventions only**

**Source: Spoth, et al Ps*****ychology of Addictive Behaviors***** (2005)**

**Randomized controlled trial of 7****th**** graders from 36 rural **
**schools:**
- ISFP Plus Life Skills Training (n=549)
- Life Skills Training Only (n=517)
- Control (n=453)

##   Environmental Approaches

**  ****Environmental Approaches**

## Drinking Trends AmongHigh School Seniors, 1975-2003

**Source:  Monitoring the Future, 2004**

**Federal 21 drinking age**

**Drinking age 21 in all States**

## Frequency of use of any alcoholic beverage during the last 12 months: Students age 15- ESPAD 2003

- Comment: Of 35 European nations only Turkey has a lower percentage of 15 year olds who drank alcohol in the past year than the United States

## Frequency of being drunk in last 12 months:   Students age 15- ESPAD 2003

- Comment: Of 35 European countries 31 had a higher percentage of 15 year olds than in the U.S. who reported being drunk in the past year

## Trends in Alcohol Related and Non Alcohol Related Traffic Fatalities persons 16-20 U.S. - 1982-2004

**Trends in Alcohol Related and Non Alcohol Related Traffic Fatalities persons 16-20 U.S. - 1982-2004**

**US MLDA Age 21 Law**

**MLDA 21 in All 50 States**

- 3,781

- 2,738

- 2,115

- 5,244

- ↑38%

- ↓60%

- Non Alcohol Related Fatalities

- Alcohol Related Fatalities

**Source: U.S. Fatality Analysis Reporting System **

## Legal Drinking Age Changes

- CDC reviewed 49 studies published in scientific journals
- Alcohol-Related Traffic Crashes:
- -  _Increased_ 10% when the drinking age was _lowered_
- -  _Decreased_ 16% when the drinking age was _raised_

**Source: Shults et al., *****American Journal of Preventive Medicine*****, 2001**

## Cumulative Estimated Number of Lives Saved by the Minimum Drinking Age Laws 1975-2003

**Source:  National Highway Traffic Safety Administration**

## 10 Reasons for Legal Drinking Age of 21

- Alcohol-related traffic fatalities and injuries
- Other unintentional injuries (falls, drownings, burns)
- Homicide and assault
- Sexual assault

- Suicide
- STDs, HIV/AIDS
- Unplanned pregnancy
- Alcohol dependence
- Teen drug use
- Poor academic performance

## Source:  Grant and Dawson J. Substance Abuse (1997) 

- Source:  Grant and Dawson *J. Substance Abuse *(1997)

## Purpose

- To assess whether an earlier drinking onset is related to:
- Unintentional injuries under the influence of alcohol
- Motor vehicle crashes because of drinking
- Physical fights after drinking
- 		-  ever in the respondent’s life
- 		-  during the year prior to the survey

## Micheal Timothy Wilder

## Slide 47

## Slide 48

## Slide 49

## Ever in a Physical Fight While or After Drinking According to Age of  Drinking Onset,   National Longitudinal Alcohol Epidemiologic Survey

**Controlling for age, gender, black, non hispanic, Hispanic, other, education, marital status, current, past, never smoke current, past, never use drugs,  family history of alcoholism, current, past, never alcohol dependent, frequency  drank 5+ during respondent’s period of heaviest drinking**

**Odds Ratio and Confidence Intervals**

- P<.001

**Age Started Drinking**

## Why Are These Findings Important?

- Injuries are the leading cause of death among youth 1-44
- Unintentional injuries #1 1-44
- Intentional injuries #2  8-34

**Source:  Centers for Disease Control and Prevention**

## Why Are These Findings Important?

**Source G. Smith et. al 1999**

|  40% unintended injury deaths                                                  |  | 39,000 |
| --- | --- | --- |
|  47% Homicides	 |    8,000 |  |
|  29% Suicides |    8,500
 |  |

**Alcohol is involved over 50,000 injury deaths annually***

- * Over half under age 44

## Slide 53

**Notes:**
61-scan

## BAC and Impairment

- Concentrated Attention, Speed Control,
- Braking, Steering, Gear Changing,
- Lane Tracking, Judgement

- Tracking, Divided Attention, Coordination,
- Comprehension, Eye Movement

- Simple Reaction Time, Emergency Response

- Choice Reaction Time

**Source: National Highway Traffic Safety Administration**

** ****Key driving functions are impaired at levels as low as .02-.04%.**

## Relative Risk of Fatal CrashDrivers Age 16-19 and 20+ as a function of BAC

**Relative Risk of Fatal Crash****Drivers Age 16-19 and 20+ as a function of BAC**

- 16-19 y.o.

- 20+ y.o.

**Source:  Simpson, H.  1989**

**The risk of fatal crash increases more with each drink among young drivers than drivers age 20 and older.**

##   Proportion of Teen Fatal Crashes                 Involving Single Vehicles at Night Before and After Zero Tolerance Laws for Youth

_**  **__**SVNF    **_**	****              **_**1439**_**       **_**1079**_**	****	**_**1150**_**         **_** 717**_
**Fatal Crashes       4597       3400****	****	****3637         2851**

- 1%

- 21%

**Source:  Hingson, Heeren, Winter, 1994**

- Percent

- Comparison

- Zero Tolerance

- Before

- After

- Before

- After

## Slide 57

## States with Primary Safety Belt Laws

**States with Primary Safety Belt Laws**

- As of July 2004, 21 states, DC and Puerto Rico have primary safety belt laws.  New Hampshire is the only state that has no adult safety belt law

**Primary Law**

## Younger heavier drinkers more affected than older heavier drinkers
	Kenkel, 1993
	Godfrey, 1997
	Chaloupka & Wechsler, 1996
	Sutton & Godfrey, 1995

Higher prices reduce alcohol related problems 
Motor vehicle fatalities (Kenkel, 1993)
Robberies
Rapes
Liver cirrhosis mortality

See: Cook & Moore, 1993; Cook & Tauchen, 1982; Ruhm, 1996

- 	Kenkel, 1993
- 	Godfrey, 1997
- 	Chaloupka & Wechsler, 1996
- 	Sutton & Godfrey, 1995
- Higher prices reduce alcohol related problems
- Motor vehicle fatalities (Kenkel, 1993)
- Robberies
- Rapes
- Liver cirrhosis mortality
- See: Cook & Moore, 1993; Cook & Tauchen, 1982; Ruhm, 1996

**Increase Price of Alcohol**

## Restricting Alcohol Licenses

- Density of alcohol outlets is associated with
- -  Higher alcohol consumption
- -  Violence
- -  Other crime
- -  Health problems

- Sources: Ornstein & Hanssens, 1985;  Gliksman & Rush, 1986;  	 		  Gruenewald et.al, 1993;  Scribner et.al., 1995;  Stitt and 	  	  Giacopassi, 1992;  Chaloupka & Wechsler, 1996

## Is Passing Laws Enough?

**Notes:**
56-scan

## Potential Process of Change After a Drinking Age Increase

- Legal Drinking Age Increase

- Police and Enforcement

- Court Enforcement

- General Legal Deterrence

- Public Education
**Who**
- - Minors
- - Alcohol Outlets
**What**
- - Reasons for Law
- - Enforcement

- Changes in Public Perception about Alcohol

- Reduction
- In
- Drinking
- &
- Driving
- After
- Drinking

- Fatal and
- Night
- Fatal
- Crash
- Reductions

## Comprehensive Community Interventions

- Involve multiple departments of city government and private citizens
- Use multiple program strategies
- Education
- Media advocacy
- Community organizing and mobilization
- Environment policy change
- Heightened enforcement

## Successful Comprehensive Community Interventions

- Project Northland Perry (1996)
- Communities Mobilizing for Change Wagenaar (2002)
- Community Trials Holder (2000)
- A Matter of Degree Weitzman (2004)
- Fighting Back Hingson (2005)
- Saving Lives Program Hingson (1996)
- Clapp et al. (2005)

## Project Northland

- Intervention to prevent or reduce alcohol use   among 6, 7, and 8th grade students
- School Education Programs (general program
-    each grade)
- Parent Involvement
- Peer Participation
- Community task forces to engage citizens
- Compliance Checks
- Server Training
- Ordinances

**Source:  Perry C. et al. *****American Journal of Public Health,***** 1996;**
**Perry C. et al. Health Education Research, 2002.**

**Notes:**
63-type

## Project Northland

**Results:**
- 	3 Years Later
- Drinking 50% lower among baseline non-drinkers
-     (5% vs 10%)
- Lower rates of cigarette and marijuana use
- Monthly and weekly drinking 20-30% lower
-    among entire sample
- Grades 11 & 12
- Fewer Northland students drink 5+
- 80% reduction in youth ability to purchase
-    alcohol (Off Sale)

**Notes:**
63-type

## Communities Mobilizing for Change  

- _Interventions to Reduce Availability_:
- Merchants record underage buy attempts
- Beer kegs prohibited at University Homecoming
- Policies to discourage motels from permitting underage drinking parties
- Security at high school dances
- Model local ordinances to restrict underage access to alcohol
- Compliance checks

- Source:  Wagenaar et al., *J. Studies on Alcohol*, 2000

## Communities Mobilizing for Change

**  ****Results****:**
- 	-17% increase in outlets checking age ID
- 	-24% decline in bar and restaurant sales
- 	-25% decrease in the proportion of 18-20 year olds
-     	    attempting alcohol purchase
- 	-17% decline in the proportion of older teens
-              providing alcohol to younger teens
- 	-7% decrease in the percent under 21 who drank
- 	-14% decline in alcohol traffic injuries, drivers 18-20

- Source:  Wagenaar et al., *J. Studies on Alcohol*, 2000

##    Community Trials

**Intervention:**
- Reduce youth alcohol availability
- Drinking and driving enforcement
- Alcohol outlet density reduction
- Community mobilization & media
- Advocacy
- Responsible alcohol service
**Results:**
- Self reported DWI cut in half
- 10%-11% decrease in single vehicle night crashes
- 43% decrease in emergency department alcohol related assault admissions

**“****Mountain of Beer”**

**Source: Holder et al., *****JAMA***** (2000)**

##     Program Components

- School based education
- Community education
- Increased police
- 	enforcement
- Business for safety
- Alcohol beverage server education
- Community task forces – key public and private sector community leaders
- Full-time coordinator Mayor’s office
- Encourage local initiatives
- Evaluation feedback

**Hingson et al.  *****Am. J. Public Health *****(1996)**

## Saving Lives vs. Rest of Mass. 5 Pre Program Years Compared to 5 Program Years

***p<0.05**

|  | Pre-Program |  Program | Change |
| --- | --- | --- | --- |
| Fatal Crashes
 | 178 | 120 | ↓ 25%* |
| Fatal Crashes Involving Alcohol
 | 69 | 36 | ↓ 42%* |
| Fatally Injured Drivers with Positive BAC
 | 49 | 24 | ↓ 47%* |
| Fatal Crashes Involving Speeding
 | 68 | 33 | ↓ 27%* |
| Pedestrian Fatalities
 | 45 | 33 | ↓ 18%* |
| Drivers in Fatal Crashes Age 15-25 | 98 | 45 | ↓ 39%* |

## A Matter of Degree 

- Intervention Components:
- College/ Community Partnerships
- Environmental strategies to reduce drinking problems:
- Keg registration
- Mandatory responsible beverage service
- Police wild party enforcement
- Substance free residence halls
- Advertising bans

- Source: Weitzman et al. _American Journal of Preventive Medicine_. 2004

## A Matter of Degree 

- Results:
- Achieved reductions among college students in
- Binge drinking
- Driving after drinking
- Alcohol related injuries
- Being assaulted by other drinking college students

**Source:  Weitzman et al. **_**American Journal of Preventive Medicine**_** 2004**

## Fighting Back Program

- First Community Program to combine:
- Environmental interventions to limit alcohol availability
- Efforts to increase substance abuse treatment

- Source:  Hingson et al. *Injury Prevention *(2005)

## Fighting Back Program Selected Interventions

**Limit Alcohol Availability**
- Youth access compliance check surveys
- Responsible beverage service training
- Monitoring and closing problem liquor outlets
- Bill board restrictions
**Expand Treatment**
- Sales tax increase for expanded treatment
- New treatment programs- courts, jails, health care
-      agencies, public housing
- Emergency department screening/brief interventions
- New inpatient, outpatient and recovery programs

**Source:  Hingson et al. 2005**

## Fighting Back - ResultsGreater Relative Reduction in Alcohol-Related Fatal Crashes VS Fatal Crashes with Zero BAC

**Communities: Kansas City, MO, Milwaukee, WI, San Antonio, TX, Santa Barbara, CA, and Vallejo, CA**

- Courtney Birch

| Pooled Effects |  BAC .01%+ 
  vs Zero BAC   |  |
| --- | --- | --- |
| Drivers | All Ages | 16-20 |
| 5 FB sites vs controls | 22% 
P=.01 | 26% 
P=.08 |

## Conclusions

- Research indicates reductions in Underage Drinking and Related Problems can be achieved with Interventions that focus on
- -  Individuals
- -  Families
- -  Schools
- Environmental Changes
- Interventions targeting multiple levels are more effective
- Comprehensive community interventions address underage drinking at multiple levels

## Conclusions

- Community Level Interventions can include
- -  Coordination of multiple city departments
- -  Clear measurable objectives and strategic plans
- Combine education and enforcement
- Treatment programs
- -  Use of data to plan and evaluate
- Involvement of private citizens
- Youth involvement (be inclusive)

## Slide 79

## Slide 80

## Slide 81

## Slide 82

## Slide 83

## Slide 84

## Acknowledgements

- NIAAA staff who assisted with this presentation
- 	Rachel Goutos