1. Epidemiology and Policy Prevention of Underage Drinking
Terry Sterling
Ralph Hingson, Sc.D., M.P.H.
Director, Division of Epidemiology and Prevention Research
National Institute on Alcohol Abuse and Alcoholism

2. Need to test all injury deaths under age 21 for alcohol

3. Consequences of Underage Drinking: United States
Nearly 5,000 unintentional injury deaths
1,527 alcohol-related traffic crash deaths
Poor academic performance
Potential cognitive deficits
Unplanned and unprotected sex after drinking
Physical and sexual assaults
Higher tobacco and drug use
Hangovers
Poisoning/overdoses (400/year; ↑58% )
Second-hand effects to others
Source: Surgeon General’s Call to Action, 2007

4. Sources: Zeigler et al, Prev Med, 2005; Squeglia et al, Clin EEG Neurosci, 2009; Squeglia et al, J Stud Alcohol Drugs, 2012; Norman, Drug & Alcohol Depend, 2011

5. Source: Grant and Dawson (1997) J. Substance Abuse z37
Source: Grant and Dawson (1997) J. Substance Abuse z

6. Interventions Individually-Oriented Family School Web-Based
Environmental/
Policy
Comprehensive Community Interventions

7. Alcohol: Trends in 2-Week Prevalence of 5 or More Drinks in a Row among College Students vs Others 1-4 Years Beyond HS,
Federal 21 Drinking Age
Drinking Age 21 in all states
Full-time College Students
Others Yrs. Past HS
12th Graders
2013
Source: Monitoring the Future, 2014

8. Non-Alcohol-Related ↓ 34%
Alcohol- vs. Non-Alcohol-Related Traffic Fatalities, Rate Per 100,000, Ages 16-20, United States,
U.S. MLDA Age 21 law
MLDA 21 in all 50 states
(n=5,244)
Non-Alcohol-Related ↓ 34%
8.89 (n=1,896)
13.36 (n=2,738)
Alcohol-Related ↓ 80%
(n=1,102)
Sources: U.S. Fatality Analysis Reporting System, 2016; U.S. Census Bureau, 2016

10. Fell et al., Impact of 20 Underage Drinking Laws, J Stud Alcohol and Drugs, 2016
Methods:
Examined the ratio of drinking to non-drinking drivers in the U.S. in all states from using the Fatality Analysis Reporting System data
Used structural equation modeling to compare drivers ≥age 20 versus 26+
Controlled for:
per capita beer consumption
per se 0.10 and 0.08% laws
Results
Nine underage drinking laws produced significant declines in alcohol-related traffic deaths involving drivers under age 21
– administrative license revocation
– seat belt laws

11. Fell et al. (continued) Results (cont.)
Law
Percent
Fake ID support
-11.9
Possession of alcohol
-7.7
Purchase of alcohol
-4.2
Use/lose
-7.9
Zero tolerance
-2.9
Age of bar tender ≥21
-4.1
State responsible for beverage service
-3.8
Dram shop liability
-2.5
Social host laws
-1.7
Collectively, the 9 laws prevent 1,135 deaths per year
210 more lives would be saved annually if all states passed these laws

12. Is Passing Laws Enough?
56-scan

13. Potential Process of Change After a Drinking Age Increase
Police and Enforcement
General Legal Deterrence
Legal Drinking Age Increase
Reduction In
Drinking
&
Driving
After
Court Enforcement
Alcohol-Related
Fatal
Crash
Reductions
Public Education
Who
- Minors
- Alcohol Outlets
What
- Reasons for Law
- Enforcement
Changes in Public Perception about Alcohol

14. Comprehensive community interventions address college age and underage drinking at multiple levels
- Coordinate multiple city departments
- Clear measurable Objectives and Strategic Plans
Combine Education and Law Enforcement
Include screening and early interventions
- Use Data to Plan and Evaluate
Involve Private Citizens – Be Inclusive
Involve Youth

15. Successful Comprehensive Community Interventions
Saving Lives Program, Hingson (1996)
Project Northland, Perry (1996)
Communities Mobilizing for Change, Wagenaar (2002)
Community Trials, Holder (2000)
A Matter of Degree, Weitzman (2004)
Fighting Back, Hingson (2005)
Sacramento Neighborhood Prevention, Treno, (2007)
State Coalitions to Reduce Underage Drinking, Wagenaar (2007)
Neighborhoods Engaging with Students (NEST), Saltz (2009)
College community program, McCartt et al. (2009)
Communities That Care, Hawkins et al. (2009)
Safer California Universities, Saltz et al. (2010)
Study to Prevent Alcohol Related Consequences (SPARC), Wolfson et al. (2011)

16. Conclusions
Research indicates reductions in underage and college age drinking and related problems can be achieved with interventions that focus on
- Individuals
- Families
- Schools
- Environmental Changes/Legislation
- Community
Interventions targeting multiple levels are more effective

17. Number of Alcohol- vs. Non-Alcohol-Related Traffic Fatalities, Ages 16-20, Massachusetts, 1982-2015
U.S. MLDA Age 21 law
MLDA 21 in all 50 states
107 (Rate/100K=20.1)
Alcohol-Related ↓ 93% in Rate/100K
50 (Rate/100K=9.4)
14 (Rate/100K=2.9)
Non-Alcohol-Related ↓ 70% in Rate/100k
2015
7 (Rate/100K=1.5)
Sources: U.S. Fatality Analysis Reporting System, 2016; U.S. Census Bureau, 2016