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Prevention of Underage and College Drinking Problems

Prevention of Underage and College Drinking Problems. Ralph Hingson, Sc.D. US Department of Education National Meeting on Alcohol and Other Drug Abuse, and Violence Prevention Indianapolis, IN October 5, 2005. Purpose.

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Prevention of Underage and College Drinking Problems

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  1. Prevention of Underage and College Drinking Problems Ralph Hingson, Sc.D. US Department of Education National Meeting on Alcohol and Other Drug Abuse, and Violence Prevention Indianapolis, IN October 5, 2005

  2. Purpose • Assess magnitude of alcohol related health problems among college students • Drunk driving • Heavy drinking • Alcohol-related traffic deaths • Unintentional non-traffic deaths • Other health problems • Examine research on interventions to reduce college drinking problems

  3. Magnitude of Alcohol Problems on U.S. College Campuses Hingson et al. (2002) J. Studies on Alcohol Dr. Margaret Jonathan Travis Moore Levy Stedman

  4. Annual Review of Public Health Brad McCue www.brad21.org

  5. Data Sources Examined • Fatality Analysis Reporting System (FARS) • National Highway Transportation and Safety Administration (NHTSA) • Mortality Statistics Centers for Disease Control (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

  6. National Surveys • National Household Survey on Drug Abuse 1999, 2002 • Harvard School of Public HealthCollege Alcohol Survey (CAS) 1999, 2001 • CDC National College Youth Risk Behavior Survey (1995)

  7. Change in percent binge drinking and driving under the influence among 18-24 year olds1999-2002 Persons ages 18-241999 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

  8. Changes in Alcohol Related Injury Deaths college and non-college 18-24 year olds 1998-2001 Source: FARS, CDC, Smith et al. 1995

  9. Change in Numbers of College Students 18-24 Experiencing Alcohol Problems1999-2001 19992001 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 97,000Full 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

  10. Alcohol Related Behaviors and Consequences of 18-24 Year Olds in the U.S. 2001 College 3.8 million 2.8 million 1,700 Non College 7.6 million 4.5 million 3,700 Total 11.4 million 7.3 million 5,400 • Drank 5+ on an occasion past month • Past year drove under the influence of alcohol • Died of alcohol-related unintentional injury

  11. 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

  12. CDC Youth RiskBehavior Survey 2003 • 28% of high school students start to drink before age 13. • They are 7 times more likely by age 17 to binge frequently (5 or more drinks/6 or more times per month). • There are over 1 million frequent bingers in high school.

  13. Youth Risk Behavior Survey2003 • Frequent binge drinkers compared to abstainers in high school were much more likely to: • Ride with a drinking driver • Drive after Drinking • Never wear safety belts • Carry weapon • Carry gun • Be injured in a fight • Be injured in a suicide attempt • Be forced to have sex • Had sex with 6 or more partner • Have unprotected sex • Been or gotten someone pregnant • Use Marijuana • Used Cocaine • Ever injected drugs

  14. Youth Risk Behavior Survey2003 • 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

  15. 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

  16. Interventions • Individually oriented • Environmental • Comprehensive Campus/ Community Interventions

  17. GentilelloBrief Motivational Alcohol Intervention in a Trauma CenterAnnals of Surgery, 1999 • 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

  18. GentilelloBrief Motivational Alcohol Intervention in a Trauma CenterAnnals of Surgery, 1999 • 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

  19. Brief Alcohol Intervention for Older Adolescents J. Consulting and Clinical Psychology Monti et al. (1999) • 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

  20. 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 • Boresian et al. In Press • Labrie 2002 • Gregory 2001 • LaChance 2004 • Murphy and Colleagues 2001 • Murphy and Colleagues 2004 Source: Larimer and Cronce (2002, In Review)

  21. 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

  22. Insurers’ Liability for Losses Due to IntoxicationAs of January 1, 2004 28 States and DC allow with holding of medical reimbursement if injured under the influence

  23. Environmental Approaches

  24. Drinking Trends AmongHigh School Seniors, 1975-2003 Federal 21 drinking age Drinking age 21 in all States Source: Monitoring the Future, 2004

  25. 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 5,244 Non Alcohol Related Fatalities ↑38% 3,781 2,738 2,115 Alcohol Related Fatalities ↓60% Source: U.S. Fatality Analysis Reporting System

  26. 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

  27. 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

  28. Legal Drinking Age Changes • CDC reviewed 49 studies published in scientific journals • Alcohol-Related Traffic Crashes: - Increased10% when the drinking age was lowered - Decreased 16% when the drinking age was raised Source: Shults et al., American Journal of Preventive Medicine, 2001

  29. Cumulative Estimated Number of Lives Saved by the Minimum Drinking Age Laws, 1975-2003 Source: National Highway Traffic Safety Administration

  30. 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 10 Reasons for Legal Drinking Age of 21

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

  32. PurposeTo 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

  33. Micheal Timothy Wilder

  34. Figure 2: Ever in a Physical Fight While or After Drinking According to Age of Drinking Onset, National Longitudinal Alcohol Epidemiologic Survey Odds Ratio and Confidence Intervals Age Started Drinking P<.001 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

  35. Why Are These Findings Important? Injuries are the leading cause of death among youth 1-34 • Unintentional injuries #1 1-44 • Intentional injuries #2 8-34 Source: CDC

  36. Why Are These Findings Important? Alcohol is involved over 50,000 injury deaths annually Over half under age 44 Source G. Smith et. al 1999

  37. Legislation to Reduce AlcoholRelated Traffic Deaths: • Legal drinking age of 21 All States • Criminal per se laws All States • Administrative license revocation 40 States • Mandatory assessment and treatment 32 States • Primary enforcement safety belt 21 States • Zero tolerance for drivers under 21 All States • .08% Criminal per se BAC level All States

  38. 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 • Key driving functions are impaired at levels as low as .02-.04%. Source: National Highway Traffic Safety Administration

  39. Relative Risk of Fatal CrashDrivers Age 16-19 and 20+ As a function of BAC 16-19 y.o. 20+ y.o. • The risk of fatal crash increases more with each drink among young drivers than drivers age 20 and older. Source: Simpson, H. 1989

  40. Increased Risk of Driver Single Vehicle Crash Death at Blood Alcohol Concentration of .08% - .10% Relative to Sober Drivers Source: (Zador P., Krawchuck S., Voas R., J. Studies on Alcohol, 2000)

  41. Proportion of Teen Fatal Crashes Involving Single Vehicles at Night Before and After Zero Tolerance Laws for Youth Comparison Zero Tolerance Percent Before After Before After 1% 21% SVNF 143910791150 717 Fatal Crashes 4597 3400 3637 2851 Conclusion: If all states adopted Zero Tolerance laws there would be 375-400 fewer fatal crashes each year involving drivers under 21. Source: Hingson, Heeren, Winter, 1994

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