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Magnitude and Prevention of Underage and College Drinking Problems

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  1. Magnitude and Prevention of Underage and College Drinking Problems Ralph Hingson, ScD National Institute on Alcohol Abuse and Alcoholism CADCA National Conference Washington, DC February 15, 2006

  2. Underage Drinking and Prevention U.S.A.

  3. Alcohol is the Drug of Choice Among Adolescents Percent Using in Past Month Grade Source: Monitoring the Future, 2004

  4. Adolescents Drink Less Frequently Than Adults, But Drink More Per Occasion Underage 12-17 Adult 26 and older 9.06 4.61 4.65 2.65 Drinking days/ month Usual # drinks/ occasion Source: SAMHSA National Survey on Drug Use and Health 2003

  5. CDC Youth Risk Behavior Survey2003 N= 15,240 School Response 81%, Student Response 83% U.S. Student Pop. Grades 9-12 15,267,000 • 28% of high school students start to drink before age 13 • By age 17 they are 7 times more likely to binge frequently (5 or more drinks/ 6 or more times per month) • There are over 1 million frequent bingers in high school • Over 2 million age 12-20 are frequent binge drinkers (NHSDUH 2003)

  6. Youth Risk Behavior Survey2003 Frequent binge drinkers compared to abstainers in high school were much more likely in the past 30 days to Ride with a drinking driver 80% vs. 13% Drive after Drinking 61% vs. 0% Never wear safety belts 18% vs. 5% Carry weapon 45% vs. 10% Carry gun 24% vs. 3% Be injured in a fight 17% vs. 2% Be injured in a suicidal attempt 10% vs. 1%

  7. Youth Risk Behavior Survey2003 Frequent binge drinkers compared to abstainers in high school were much more likely to Be forced to have sex 22% vs. 5% Had sex with 6 or more partners 32% vs. 3% Use condoms last time had sex 56% vs. 65% Been or gotten someone pregnant 13% vs. 2%

  8. Youth Risk Behavior Survey2003 Frequent binge drinkers compared to abstainers in high school were much more likely to have in the past month Used marijuana 71% vs. 6% Used cocaine 26% vs. <1% Ever injected drugs 15% vs. <1%

  9. 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

  10. United States 2002Underage Drinking Related Injury Deaths Persons Under 21 1735 Traffic crash deaths* 1,143 drinking drivers under 21 592 other persons under 21 483 persons older than 21 1921 Other unintentional injury deaths** 1900 alcohol related homicides/suicides _____ 35% of homicides 11% of suicides*** 5,555 * NHTSA ** CDC 33% alcohol related *** Percentage Reported by Levy et al. Cost of Underage Drinking OJJ DP, 1999

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

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

  13. Data Sources Examined • Fatality Analysis Reporting System (FARS, NHTSA) • Mortality Statistics (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 • National Household Survey on Drug Abuse 1999, 2002 • Harvard School of Public HealthCollege Alcohol Survey (CAS) 1999, 2001

  14. Change in percent binge drinking and driving under the influence among 18-24 year olds Persons ages 18-24 1999 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

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

  16. 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

  17. Alcohol Related Behaviors and Consequences of 18-24 Year Olds in the U.S. 2001

  18. 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

  19. 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

  20. Interventions • Individually oriented • Family • School • Environmental • Comprehensive Community Interventions

  21. Brief Motivational Alcohol Intervention in a Trauma Center • 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 Source: Gentilello Annals of Surgery, 1999

  22. Brief Motivational Alcohol Intervention in a Trauma Center Results: • 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 Source: Gentilello Annals of Surgery, 1999

  23. Brief Alcohol Intervention for Older Adolescents • 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 Results at six months: • Brief intervention group had • ¼ drinking and driving occasions • Fewer moving violations 3% vs. 23% • ¼ alcohol related injuries Source: Monti et al. J. Consulting and Clinical Psychology (1999)

  24. 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 • Borsari and Carey (in press) • Labrie 2002 • Gregory 2001 • LaChance 2004 • Murphy et al. 2001 • Murphy et al. 2004 Source: Larimer and Cronce (2002, 2005 In Review)

  25. Implementation Gap • Fewer than • ½ of pediatricians screen all adolescents for use of alcohol and drugs • ¼ screen for drinking and driving. • Pediatric Medical Care Providers considerably underdiagnose alcohol use, abuse, and dependence among patients ages 14-18. • 1.5 million 12-17 year olds need alcohol treatment • Only 216,000 14% received treatment Sources: American Academy of Pediatrics, 1997; Wilson, Sheritt, Gates, Knight Pediatrics, 2004; National Household Survey on Drug Use and Health, 2003

  26. 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

  27. 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

  28. Family Interventions Iowa Strengthening Families Program Goals: • Improve parent/child relations • Strengthen family communication skills • Increase child coping skills Implementation: • 7 sessions at school • 13 hours total • Parent and child separately and together

  29. Family Interventions A randomized controlled trial with families of 6th graders: • Iowa Strengthening Families Program (ISFP) (206 families) • Preparing for Drug Free Years Program (PDFYP) (221 families) • Control (221 families) Lifetime Drunkenness Through 6 Years Past Baseline: Logistic Growth Curve Trajectory for ISFP Condition Trajectory for Control Condition 72 0 6 18 30 48 Months Source: Spoth, Redmond, Shin J Consulting Clinical Psychology (2001, 2004)

  30. School Based Programs • Programs that rely primarily on increasing knowledge about consequences of drinking are not effective. • Effective Programs : • Are based on social influence models • Include norm setting • Address social pressures to drink and teach resistance skills • Include developmentally appropriate information • Include peer-led components • Provide teacher training • Are interactive • School only program effects are generally small • Less effective with students who initiate drinking prior to grades 5 or 6 Source: NIAAA, Alcohol and Development in Youth: A Multidisciplinary Overview

  31. School Based Life Skills Program Junior High- 30 sessions, most in Year 1 Curricula: Drug Information Alcohol/Drug Resistance Skills Self Management Skills General Social Skills Results: Beneficial Effects Alcohol & Tobacco Use Through High School, Not After Sources: Botvin et al. J. Consulting and Clinical Psychology (1990); JAMA (1995); Addictive Behaviors (2000)

  32. Combined Family Interventions& School Based Life skills Program Randomized controlled trial of 7th graders from 36 rural schools: • ISFP Plus Life Skills Training (n=549) • Life Skills Training Only (n=517) • Control (n=453) • Results: 2 ½ Years Later • Weekly drunkenness rate among intervention students 1/3 lower • Strengthening Family plus Life Skills (p=.03) • Life Skills Training (p=.08) Conclusion: Family and school interventions combined are more effective than school interventions only Source: Spoth, et al Psychology of Addictive Behaviors (2005)

  33. Environmental Approaches

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

  35. 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

  36. 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

  37. 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

  38. Legal Drinking Age Changes • CDC reviewed 49 studies published in scientific journals • Alcohol-Related Traffic Crashes: - Increased 10% when the drinking age was lowered - Decreased 16% when the drinking age was raised Source: Shults et al., American Journal of Preventive Medicine, 2001

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

  40. 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

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

  42. Purpose To 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

  43. Micheal Timothy Wilder

  44. 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