1. Underage Drinking in Michigan Hannah Jary, MPH CDC/CSTE Applied Epidemiology Fellow- Alcohol Michigan Department of Community Health Underage Drinking Prevention Plan Workgroup Meeting January 22, 2015

2. MDCH Alcohol Epidemiology Program Our Mission: –To strengthen the scientific foundation for preventing excessive alcohol consumption. Our Goals: –Improve public health surveillance –Translate applied public health research –Support public health activities to prevent excessive drinking 2

3. Population Level Strategies to Reduce & Prevent Excessive Alcohol Use Increase Alcohol Excise Taxes Commercial Host Liability Maintaining Limits on Days of Sale Maintaining Limits on Hours of Sale Regulating Alcohol Outlet Density Motor Vehicle Crashes Violent Crime Assaults Homicide Suicide Domestic Violence Alcohol Poisonings Injuries STIs Unplanned Pregnancies Overconsumption Binge Drinking Underage Drinking Price Retailer Serving Practices Days of Sale Hours of Sale Location & Density of Retailers Environmental Strategies Factors that Affect Drinking Outcomes 3

4. UNDERAGE DRINKING TRENDS Youth Risk Behavior Survey, 2013 4

5. Any Drinking in the Past 30 Days 5 Age 18-20 Source: MiBRFSS, High School Source: MI YRBSMiBRFSSMI YRBS

6. Binge Drinking in the Past 30 Days 6 Age 18-20 Source: MiBRFSS, High School Source: MI YRBSMiBRFSSMI YRBS

7. Usual Source of Alcohol, Past 30 days 7 Source: Michigan Youth Risk Behavior Survey, 2013

8. Substance Use Patterns, 2013 8 Source: Michigan Youth Risk Behavior Survey, 2013

9. YOUTH DRINKING PREFERENCES Youth Tobacco Survey, 2011 9

10. Frequency of Consumption, past 30 days Source: Youth Tobacco Survey, 2011 10

11. Largest number of drinks consumed, past 30 days, by sex Source: Youth Tobacco Survey, 2011 11

12. Usual Alcohol Type Consumed, by sex 12 Source: Youth Tobacco Survey, 2011

13. Usual Alcohol Type Consumed, by grade Source: Youth Tobacco Survey, 2011 13

14. Usual Liquor Type Consumed, by sex Source: Youth Tobacco Survey, 2011 14

15. Prevalence of Mixing Energy Drinks & Alcohol Source: Youth Tobacco Survey, 2011 15

16. Conclusions Liquor dominates youth preferences –Vodka most popular liquor type –Other usual alcohol types: Beer (males) Flavored alcoholic beverages (females) A large proportion of binge drinkers report hazardous drinking behaviors –Drinking more often –Mixing energy drinks & alcohol 16

17. LIQUOR LICENSES Michigan Liquor Control Commission 17

18. Liquor Licenses Available at: www.michigan.gov/lcc 18

19. Liquor License Availability Available at: https://www.michigan.gov/lara/0,4601,7-154-35299_10570_12905---,00.html 19

20. Liquor License Availability 20

21. Liquor License Lists Available at: https://www.michigan.gov/lara/0,4601,7-154-35299_10570_12905---,00.html 21

22. Liquor License Query Available at: http://www2.dleg.state.mi.us/llist/ 22

23. Active Wayne County Liquor Licenses Available at: http://www2.dleg.state.mi.us/llist/ 23

24. Active Wayne County Liquor Licenses Available at: http://www2.dleg.state.mi.us/llist/ 24

25. Violation Information for Liquor Licenses Available at: http://www2.dleg.state.mi.us/llist/ 25

26. Liquor License Considerations Potential for geospatial analysis Updated frequently Types of licenses –Incomplete Bars vs. restaurants Special or temporary Violation history available Establish partnerships with retailers 26

27. PREVENTION The Community Guide 27

28. Binge Drinking by High School Students and Adults Closely Related 28 Source: Nelson, DE et al. American Journal of Preventive Medicine, 2009.

29. Alcohol Policy Impacts Youth 29 Source: Paschall, MJ, et al. Effects of the local alcohol environment on adolescents’ drinking behaviors and beliefs. Addiction, 109 (2013) 407-416. Adolescent Drinking Local Alcohol Environment Alcohol-Related Beliefs

30. Population Level Strategies to Reduce & Prevent Excessive Alcohol Use Increase Alcohol Excise Taxes Commercial Host Liability Maintaining Limits on Days of Sale Maintaining Limits on Hours of Sale Regulating Alcohol Outlet Density Motor Vehicle Crashes Violent Crime Assaults Homicide Suicide Domestic Violence Alcohol Poisonings Injuries STIs Unplanned Pregnancies Overconsumption Binge Drinking Underage Drinking Price Retailer Serving Practices Days of Sale Hours of Sale Location & Density of Retailers Environmental Strategies Factors that Affect Drinking Outcomes 30

31. Reframing Intervention Impact Health Behavior Education, Social Norming Frieden, TR. A Framework for Public Health Action: The Health Impact Pyramid. Am J Public Health 2010; 100(4):590-5. Dram shop liability, Limiting hours & days of sale,.08 BAC Laws Excise taxes SBIRT, Naltrexone 31

32. The Community Guide Recommendations Enhanced Enforcement of Laws Prohibiting Sales to Minors Regulation of Alcohol Outlet Density Commercial Host Liability Increasing Alcohol Taxes Electronic Screening and Brief Intervention (e-SBI) Maintaining Limits on Days of Sale Maintaining Limits on Hours of Sale 32 Source: The Community Guide, Preventing Excessive Alcohol Consumption

33. Enhanced Enforcement of Laws Prohibiting Sales to Minors Retailer compliance checks/ “sting operations” –42% decrease in sales to decoys Effective in: –Bars and liquor stores –Rural and urban communities –Different ethnic and socioeconomic groups Part of multicomponent, community- based efforts 33 Source: The Community Guide, Preventing Excessive Alcohol Consumption

34. Regulation of Alcohol Outlet Density Applying regulatory authority to reduce density of alcohol outlets Increased alcohol outlet density resulted in: –Increased excessive alcohol consumption –Increased related harms For a typical census tract in LA with 5 off- premise outlets, closing 1 outlet was associated with 42 fewer gonorrhea cases per 100,000 1 34 1 Cohen, DA, et al. Alcohol outlets, gonorrhea, and the Los Angeles civil unrest: A longitudinal analysis. Social Science & Medicine 62 (2006) 3062–3071.

35. On- Premise Alcohol Outlet Density 35

36. Prevention Status Report- Density 36 Available at: http://www.cdc.gov/psr/alcohol/2013/MI-alcohol.pdf

37. Commercial Host Liability Owner/server held legally responsible for harms inflicted by an intoxicated or underage customer –E.g. Death, injury, damage from alcohol- related car crash –MI does not have any major limitations All-cause motor vehicle fatalities among underage drinkers was reduced between 2.2% and 13.0% 37 Source: The Community Guide, Preventing Excessive Alcohol Consumption

38. Prevention Status Report- Commercial Host Liability 38

39. Increasing Alcohol Taxes Increase the price of alcohol –Reduce harms, raise revenue, or both –10% increase in price of beer would decrease beer consumption by about 5% Based on volume sold –MI beer tax since 1966 = $0.20/gallon Would be $1.32/gallon if kept up with inflation Among adolescents –Younger drinkers more price sensitive than older –Heavier drinkers more price sensitive than light 39 Source: Xu X, Chaloupka FJ. The effects of prices on alcohol use and its consequences. Alcohol Research and Health. 34(2).

40. Increasing Alcohol Taxes- Example Illinois alcohol excise tax increase, 2009 –Beer increased $0.046/gal ($0.185  $0.231) –Wine increased $0.66/gal ($0.730  $1.39) –Spirits increased $4.05/gal ($4.50  $8.55) Net effect, among ages 15-19: –Gonorrhea rates decreased 14% for whites and 26% for blacks –Chlamydia rates decreased 6% for whites and 7% for blacks 40 Source: Jernigan DH. Social and health effects of changes in alcohol prices: findings of a research collaborative. The Center of Alcohol Marketing and Youth.

41. Prevention Status Report- Taxes 41

42. Screening and Brief Intervention Screening: Assess patient drinking patterns Brief Intervention: Personalized feedback about risks, referral if necessary E-SBI uses electronic devices to deliver the SBI Studies showed decreases in all types of alcohol consumption after using e-SBI 42

43. Alcohol Screening and Brief Intervention Resource for Youth 43 Source: Alcohol screening and brief intervention for youth: a practitioner’s guide. National Institute on Alcohol Abuse and Alcoholism.

44. Maintaining Limits on Days and Hours of Sale Removing limits on days of sale: –Increases in consumption –Increases in motor vehicle-related harm Increasing hours of sale by 2+ hours: –Increases in vehicle crashes injuries –Increases in ED admissions –Increased alcohol-related assault & injury 44

45. Conclusions Underage drinking in is prevalent in Michigan Underage drinking is related to adult drinking and the alcohol environment Evidence-based policies and interventions can be implemented on a variety of levels to prevent underage drinking and related harms 45

46. Contact Information Hannah Jary, MPH jaryh@michigan.gov 517-373-7048 Michigan.gov/substanceabuseepi 46