# Presentation: 263351

## Welcome to Atlanta!

**Notes:**
On behalf of the NCCDPHP, I am pleased to welcome you to Atlanta and to this technical assistance meeting!  We’re delighted that you’re here. 

We are very pleased to have had the chance to work with the Department of Education in planning this meeting, and to share with you some of the work our agency has been doing related to the prevention of underage drinking. 

We value the partnership we have with the Dept of Education and with other federal agencies in addressing a number of key health issues, including underage drinking, and we applaud the work being done by educators such as yourself to address these issues in our nation’s schools on a daily basis.  

## Slide 2

**Notes:**
As noted 10 years ago by Drs. McGinnis and Foege, and reaffirmed by CDC a few years ago, excessive alcohol consumption remains the 3rd leading actual cause of death in the U.S., after tobacco and poor diet/physical inactivity.  

What’s more, over half of these alcohol-attributable deaths are due to binge drinking, which is typically defined as the consumption of 5 or more drinks per occasion.  Binge drinking usually leads to acute intoxication, and is the most common pattern of alcohol consumption among underage youth. 

## Burden of Disease Attributable to Ten Leading Risk Factors 

**Burden of Disease Attributable to Ten Leading Risk Factors **

**Murray, *****PLOS Medicine*****, 2006**

**Notes:**
This slide shows the percent of total disease burden related to both deaths and non-fatal conditions in the Regions of the Americas, which includes the United States, that can be attributed to various risk behaviors, including alcohol consumption.

In this analysis, alcohol is second only to tobacco as a leading cause of death and disability in our global region. This largely reflects the fact that alcohol plays a very significant role in a number of non-fatal conditions, including injuries, liver disease, and various cancers.   

These results also emphasize why it’s essential for public health to be involved in the prevention of underage and binge drinking.

## Trends in Current and Binge Drinking Among High School Students, YRBS, 1991-2003 

**Notes:**
Based on data from CDC’s Youth Risk Behavior Survey or YRBS, there has been relatively little change from 1991 through 2003 in the proportion of high school boys and girls who report any drinking in the past month (top lines) and binge drinking in past month (bottom lines). 

In fact, close to half of all high school students report drinking in the past month, and of those who drink, about two-thirds report binge drinking. 

## RISK FACTOR

**Driving after drinking**

**Sexual activity**

**Fighting and other violence**

**Suicide attempts**

**Tobacco use**

**Other drug use**

_**RISK FACTOR**_

_**POTENTIAL CONDITION**_

**Miller, *****Pediatrics*****, 2007**

**Notes:**
As recently reported in a study done by CDC scientists on our Alcohol Team and in our Division of Adolescent and School Health, underage and binge drinking are also strongly associated with a wide range of health and social problems, including drinking and driving, sexual activity, interpersonal violence, and other drug use. 

In this respect, underage and binge drinking are really quite similar to smoking, which is also a key risk factor for a wide range of health and social problems among youth and among adults as well.   

## School Performance by Drinking Status, YRBS, 2003

- Miller, *Pediatrics*, 2007

**Notes:**
As Educators who are interested in the prevention of underage drinking, you’re are already aware of the impact that youth drinking can have on another key outcome – namely, performance in school.  

While it can sometimes be hard to sort out which comes first – youth drinking or poor school performance – these findings from the 2003 YRBS clearly show that youth who perform poorly in school also tend to drink, and to drink a lot more, than students who do well in school. 

This suggests that the prevention of underage drinking could help improve school performance, or at least help to make youth more ready to learn, along with reducing the risk of the many other health and social problems that I mentioned before.  

## Public Health Approach

**Notes:**
What, then, is the role of public health in general and CDC in particular in preventing underage and binge drinking?

The approach we’re using to address these issues, which you’ll be hearing more about in subsequent presentations, is really quite consistent with the public health approach that we use to address many other health problems and risk behaviors. 

This approach typically begins with our defining the problem, which we often refer to as public health surveillance; continues with the assessment of predictors or risk factors for the problem of interest, followed by the evaluation of promising prevention strategies and the implementation and evaluation of effective strategies in the field. 

Applied to underage drinking, this approach complements the work that is being done by other state and federal agencies, including the Dept of Education, and can help engage state and local health departments in these prevention efforts as well.  

Consistent with the theme of your conference, this work clearly needs to be done in a highly collaborative manner, which is one of the reasons why we’re so pleased to have a chance to share with you at this meeting some of the work we’ve been doing at CDC and with our state public health partners on the prevention of underage and binge drinking.  

## Connecting the Dots

**Connecting the Dots**

**Notes:**
While we sometimes think of the various components of the public health approach as separate stages, the reality is that they are all quite inter-related.

In fact, the work we do on surveillance and evaluation should support public health practice, while also providing new insights that we can test through our public health research.  Similarly, our practice experience should inform our surveillance activities and our research as well.  These same principles clearly apply to our work on the prevention of underage and binge drinking. 

## CDC Identity ThemesValue and Uniqueness

**Protecting people’s health & safety**
**Providing health information people can count on**
**Improving health through strong partnerships**

**Notes:**
This public health approach has been incorporated into the CDC’s strategic planning process, called the Futures Initiative. 

This planning process has helped us to indentity a number of characteristics, or indentity themes, that apply to CDC.  Our work on the prevention of underage and binge drinking reflects these themes - including, in particular, the importance of strengthening our partnerships with schools and other community-based organizations.

## Role of Public Health/CDC in Preventing Excessive Drinking

**PH Surveillance and Technical Assistance**
**Capacity Bldg in State Health Departments**
**Implementation of policy & environmental strategies to prevent binge and underage drinking**
**Demonstration Projects and Applied Public Health Research**
**Building partnerships & collaborating with other organizations**

-  CDC State Alcohol Planning Mtg, 2004

**Notes:**
The application of this public health approach to the prevention of underage and binge drinking was also strongly endorsed by a panel of experts from state and local health departments and state substance abuse agencies that we convened a few years ago to help us define future directions for our Alcohol Team.   

This slide summarizes some of the Work Group’s key recommendations.  These recommendations clearly challenge us to improve public health surveillance on underage and binge drinking, build state public health capacity to address these issues,  and, once again, to build partnerships with other organizations to effectively address this key risk behavior.   

## Healthy People in Every Stage of Life 
Children 
Adolescents
 Healthy People in Healthy Places
Communities 
Homes
Schools

- Children
- Adolescents
-  **Healthy People in Healthy Places**
- Communities
- Homes
- Schools

**CDC Health Protection Goals****	**

**Notes:**
My focus on public health might lead you to believe that CDC’s work is confined to one particular segment of the population; however, CDC’s new health protection goals specifically emphasize the need to increase the number of children who grow up healthy, safe, and ready to learn; and to increase the number of adolescents who are prepared to be healthy, safe, independent, and productive members of society. 

We also recognize the need to assure that people have healthy places to live and work.  Therefore, CDC’s goals also require that we protect and promote health and safety in communities, homes, schools, and in the workplace. 

Various divisions and offices in CDC have been specifically charged with the responsibility of helping to achieve these goals.  For example, our Division of Adolescent and School Health directly supports the work of schools and other institutions in promoting the health of school-age youth.

## CDC Support for School Health

**Identify and monitor youth health risk behaviors and school health policies and programs **
**Synthesize and apply research **
**Enable partners to plan and implement effective policies and programs in school settings**
**Evaluate the effectiveness of school policies and programs **

**Notes:**
In fact, CDC’s work to improve school health is not new.  For over 20 years, CDC has helped to identify and monitor youth risk behaviors as well as school health policies and programs; synthesize and apply research to improve school health; enable partners to plan and implement effective policies and programs in schools; and evaluate the effectiveness of these intervention activities. 

We also recognize that schools are unique settings, and we as such, try to assure that our efforts to support school health complement the work you’re doing in the field, including the work you’re doing to prevent underage and binge drinking.  I trust this will be reflected in the presentations you hear throughout this conference.  We also look forward to receiving your feedback on how we can improve our collective efforts to prevent underage and binge drinking going forward. 

## Future Directions

**Surveillance and epidemiology**
**Evaluation of prevention strategies**
**Building state public health capacity**
**National leadership and collaboration**

**Notes:**
Clearly, much work remains to be done to prevent underage and binge drinking.

At CDC, we are committed to strengthening the science base for the prevention of excessive drinking through improved public health surveillance - using tools such as the YRBS, the Behavioral Risk Factor Surveillance System, the Pregnancy Risk Assessment Monitoring System, and others - and through the evaluation of public health prevention strategies, including policy and environmental strategies, such as enhanced enforcement of minimum legal drinking age laws. 

We also want to continue to support the building of state public health capacity in alcohol epidemiology, so that state and local organizations can more effectively use data to design and evaluate prevention strategies.  We are also committed to supporting the work of state education agencies to strengthen school health programs that can help reduce underage and binge drinking.

In addition, we look forward to continuing our work with DOE, SAMHSA, NIAAA, NHTSA, and other federal agencies on the prevention of underage and binge drinking.  

And finally, we look forward to learning from your experience, and from the experience of our other state and local partners, in preventing underage drinking, so that we can enhance our effectiveness in preventing this problem in the future. 

## Welcome to Atlanta!

**Notes:**
In conclusion, I want to thank you again for coming to this Technical Assistance conference.  I trust you will have an interesting and enjoyable meeting, and that you will have a chance to renew old friendships and to make new ones as well. 

I also hope you enjoy your stay in our lovely city of Atlanta, and that you come back again for another visit, soon!