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Using the Minimum Drinking Age As A Vehicle to Educate and Mobilize

Using the Minimum Drinking Age As A Vehicle to Educate and Mobilize. Darlene R. Saunders, PhD PIRE, CPHII, Calverton , MD . Toben F. Nelson, ScD University of Minnesota. Framing the Issue.

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Using the Minimum Drinking Age As A Vehicle to Educate and Mobilize

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  1. Using the Minimum Drinking Age As A Vehicle to Educate and Mobilize Darlene R. Saunders, PhD PIRE, CPHII, Calverton, MD Toben F. Nelson, ScD University of Minnesota

  2. Framing the Issue

  3. Framing Discussions of the Minimum Legal Drinking Age: What is the evidence?Toben F. Nelson, ScDDivision of Epidemiology and Community HealthUniversity of Minnesota

  4. www.epi.umn.edu/alcohol

  5. Toomey TL, Nelson TF, Lenk KM. The age-21 minimum legal drinking age: a case study linking past and current debates. Addiction. 2009 Dec;104(12):1958-65. Wechsler H, Nelson TF. Will making alcohol more available by lowering the minimum legal drinking age decrease drinking and related consequences among youth? American Journal of Public Health, 100(6): 986-992, 2010.

  6. Social Costs of Alcohol • Alcohol - the 3rd leading actual cause of death in the U.S. (McGinnis & Foege, 1993; Mokdad et al., 2004) • 75,000 deaths annually (Stahre et al., 2004) • 17,000 annual deaths in motor-vehicle crashes (NHTSA, 2003) • $184 Billion in annual economic costs (NIAAA, 2003)

  7. RISK FACTOR OUTCOME Injuries Liver disease Violence, Sexual Assault GI cancers, GI disorders Alcohol Misuse Unintended Pregnancies Cardiovascular disease Child Neglect Crime, legal costs Lost productivity, absenteeism Alcohol Use Disorders

  8. Legal Availability Formal Social Controls Public Policy & Institutional Policies/ Structures Individual Risk Factors Drinking Behavior Alcohol-related Problems l Economic Physical Availability Adapted from Wagenaar & Perry, 1994 Integrated theory of drinking behavior Problems that stem from alcohol use are primarily a function of availability

  9. MLDA - Changing Conditions • After Prohibition states regulated drinking age (MDLA)  Most set at 21 • Early 1970s -- MLDA age lowered from 21 to 18 (19 or 20) in US (and Canada)

  10. MLDA - Changing Conditions • Increases in alcohol-related harms in states that lowered their drinking age become evident • Late 1970s -- Drinking age returned to 21 in some states • Patchwork of MLDA creates “blood borders”

  11. July 1984,Ronald Reagan signs national minimum legal drinking age bill “…raising that drinking age is not a fad or an experiment. It's a proven success. Nearly every State that has raised the drinking age to 21 has produced a significant drop in the teenage driving fatalities.” -President Ronald Reagan

  12. Effects of Minimum DrinkingAge Laws Review of 241 published analyses 1960-2000 135 were of high quality • Outcomes • Alcohol consumption (n=33) • Traffic crashes (n=79) • Other (n=23) Wagenaar & Toomey, 2002

  13. Effects of Minimum DrinkingAge Laws Alcohol consumption (n=33) • Higher MDLA – Lower Consumption (n=11; 33%) • Higher MDLA – Higher Consumption (n=1; 3%) Traffic crashes (n=79) • Higher MDLA – Fewer Traffic Crashes (n=46; 58%) • Higher MDLA – More Traffic Crashes (n=0; 0%) Other (n=23) • Higher MDLA – Fewer Alcohol-related problems (n=8; 35%) • Higher MDLA – More Alcohol-related problems (n=0; 0%) Wagenaar & Toomey, 2002

  14. The New Zealand Experience Lowered drinking age from 20 to 18 (1999) • Resulted in increases in: • Presentation to the Emergency Department Intoxicated (Everitt & Jones, 2002) • Alcohol-involved traffic crashes (Kypri et al. 2006) among 15-19 yr olds. They are now considering a reversal.

  15. Estimated 826 lives (ages 18-20) saved by MLDA in 2007 • Total lives saved - more than 25,000 since 1984 Based on an average decline in deaths of 13% when individual states raised the MLDA

  16. Some perspective… What is the weight of the evidence?

  17. Strong Evidence… • Increasing the minimum drinking age • results in a decrease in traffic casualties Source: Preventing Problems Related to Alcohol Availability: Environmental Approaches Practitioners' Guide (1998)

  18. Recommendations for College Student Drinking Evidence of success in general populations Strategy: Increased enforcement of minimum drinking age laws -“most well-studied” and “successful” alcohol control policy Source: NIAAA College Drinking Task Force (2002)

  19. Laws increasing the minimum legal drinking age result in decreases in traffic casualties MLDA results in decreases in alcohol consumption and alcohol-related problems Institute of Medicine Source: National Academy of Sciences (2004)

  20. Approaches for Communities to Reduce Excessive Alcohol Consumption Recommended Enhanced Enforcement of Laws Prohibiting Alcohol Sales to Minors Source: The Community Guide (2007)

  21. Surgeon General’s Recommendations • Enforce all policies and laws against underage drinking and publicize these efforts • Gain public support for enforcing underage drinking laws Source: Office of the US Surgeon General (2007)

  22. Age 21 MLDA iseffective public policy • Preponderance of the evidence • Evaluated by multiple independent investigators and government agencies • Clear, consistent conclusions

  23. What should we expect if the drinking age is lowered? Increases in • Drinking • Alcohol-related harms • Motor vehicles crashes and deaths Among youth ages 18-20 and youth under age 18 We’ve already done this experiment!

  24. Don’t forget where we were before the MLDA…

  25. Debating the Issues

  26. Using the MLDA as A Vehicle to Educate and Mobilize

  27. Should the Minimum Legal Drinking Age Remain at 21? CLASS DEBATE & DISCUSSION Section 0301 Hlth391 Principles of Community Health 2010

  28. MLDA CLASS POLL

  29. Questionnaire • In the past 30 days, have you had any alcohol to drink? This means did you consume, at a minimum, a 12 oz can of beer, a 5 oz glass of wine or a 1.5 oz short of liquor? Yes____ No ______

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