Alcohol: A case study in the need for collaboration David H. Jernigan Ph.D. Associate Professor Department of Health, Behavior and Society Johns Hopkins Bloomberg School of Public Health

Kids and alcohol Mental health problem Criminal justice problem Traffic safety problem Educational problem Injury problem Health care utilization problem

Youth (age 12-20) Binge Drinking in the U.S.: Much better than it would have been without community efforts, but not making the progress we should be making Source: NSDUH 2007 (SAMHSA 2008)

Youth drinking In 2007, 10.7 million U.S. young people ages reported drinking in the past month, and 7.2 million reported binge drinking. (NSDUH)In 2007, 10.7 million U.S. young people ages reported drinking in the past month, and 7.2 million reported binge drinking. (NSDUH) Every day, 5,000 kids under age 16 start drinking. (NSDUH)Every day, 5,000 kids under age 16 start drinking. (NSDUH) Underage drinking causes between 4,500 and 5,000 deaths per year among persons under 21. (CDC ARDI/Office of the U.S. Surgeon General) It is a factor in the three leading causes of death among youth ages 12 to unintentional injuries, homicide and suicide. (CDC WISQARS)

Consequences of youth drinking Young people who begin drinking before age 15 are five times more likely to develop alcohol problems later in life than those who wait to drink until they are 21. (OSG, 2007) They are: – four times more likely to develop alcohol dependence (Grant and Dawson 1997); –seven times more likely to be in a motor vehicle crash because of drinking (Hingson et al. 2001); –eleven times more likely to be in a physical fight after drinking (Hingson et al. 2000); –twelve times more likely to suffer from other unintentional injuries after drinking (Hingson et al. 2001).

Brain activity in 15 year-olds during a memory task Heavy use of alcohol during adolescence can impair brain development, causing loss of memory and other skills.

Alcohol advertising and youth: adolescent brain research Brain imaging research has found that teens with alcohol use disorders show greater activity in areas of the brain previously linked to reward, desire, positive affect and episodic recall in response to alcoholic beverage advertisements. The highest degree of brain response was in youths who consume more drinks per month and report greater desires to drink. (Tapert et al., 2003)

Alcohol advertising as a risk factor Recently published longitudinal studies have all found that the more youth are exposed to alcohol advertising and marketing the more they are likely to initiate drinking, even after controlling for other variables. Forms of alcohol advertising and marketing that predict drinking onset among youth: –Television beer advertisements (Collins et al. 2007, Snyder et al. 2006, Stacy et al. 2004) –Alcohol ads in magazines (Collins et al. 2007, Snyder et al. 2006) –Alcohol ads on billboards (Snyder et al. 2006, Pasch et al. 2007) –In-store beer displays (Collins et al. 2007) –Beer concessions at sporting events (Collins et al. 2007) –Per capita spending on alcohol advertising in their media market (Snyder et al. 2006) –Alcohol use in movies (Sargent et al. 2006) –Ownership of alcohol promotional items (McClure et al. 2006, Henriksen et al. 2008, McClure et al. 2009)

Alcohol advertising: music, character, story…

The youth alcohol market The underage youth market is substantial, and dominated by heavy drinking: Underage drinking accounts for between 11 and 20 percent of the U.S. alcohol market. Young people drink less frequently than adults, but drink more per occasion than adults. More than 90% of the alcohol consumed by year-olds is drunk when the drinker is having five or more drinks at a sitting (usually defined as within two hours)

Alcohol industry self-regulation Beer Institute code: –Beer advertising and marketing materials should not…claim or represent that individuals cannot obtain social, professional, educational, athletic, or financial success or status without beer consumption.

Youth exposure to alcohol advertising: magazines In 2006, compared to adults 21 and over, youth ages saw per capita… 20% more beer ads 34% more ads for alcopops 50% fewer wine ads The overwhelming majority of youth exposure – 77% - came from ads placed in magazines with disproportionate youth audiences. (2005 data in MMWR, 8/3/2007)

Youth Exposure to Alcohol Ads on Television In 2007, 340,337 alcohol product commercials appeared on U.S. television. Underage youth ages were more likely than legal- age adults on a per capita basis to have seen 68,700 of them, or about 20%. These ads accounted for more than 40% of youth exposure to alcohol advertising on television. From 2001 to 2007 – the number of television alcohol ads seen by the average 12 to 20 year-old increased by 38%. The average TV-watching youth sees more than 300 alcohol ads on TV per year.

REPORT OF THE COMMITTEE ON DEVELOPING A STRATEGY TO REDUCE AND PREVENT UNDERAGE DRINKING

STRATEGY COMPONENTS Adult-oriented Media Campaign National Partnership Advertising Restraint Entertainment Responsibility Compliance with Access Limits Youth-Oriented Interventions Community Interventions Government Assistance and Coordination Alcohol Excise Taxes Research and Evaluation

Where is collaboration needed? Taking on the environment that undercuts our programs –Taxes – beer cheaper than orange juice or milk –Advertising –Outlet density/physical availability Requires political will and, usually community organizing/mobilization …much like tobacco did

Alcohol excise taxes High levels of popular support IF they are earmarked for prevention, other worthy activities Kentucky, Alaska have increased in past three years Many other states try and fail

Alcohol advertising reform: state and local First amendment limitations do not apply when the state is the “speaker” Local and state authorities can reduce youth exposure to alcohol advertising on public property: –Public transit and stations –Sports, concert and other arts facilities –Public post-secondary schools –Parks and recreational centers –Public publications (maps and tourist materials, magazines, etc.)

Evidence Base for Effects of Reducing Youth Exposure to Alcohol Advertising An econometric study published in Health Economics in 2006 predicted that 28% decrease in alcohol advertising would lead to a 4% to 16% drop in monthly youth drinking, and an 8 to 33% drop in youth binge drinking. (Saffer and Dave 2006) A demography-based test of likely effects of several alcohol policies on youth drinking behavior in the U.S. concluded that a complete ban on alcohol advertising would be the most effective for reducing premature mortality. –Complete ban: 7,609 fewer deaths from harmful drinking and a 16.4% drop in alcohol-related life-years lost. –Partial ban: 4% drop in alcohol-related life years lost. (Journal of Studies on Alcohol 2006) An analysis of the impact of evidence-based interventions on disability- adjusted life-years (DALYs) in 12 regions of the world found that in regions where heavy drinking is less prevalent, targeted strategies such as brief physician advice, roadside breath testing, and advertising bans would be most effective. (Journal of Studies on Alcohol 2004)

YOU can make a difference!