Institute of Medicine (IOM)
Reducing Underage Drinking:A Collective Responsibility
Authors:
Richard J. Bonnie and
Mary Ellen O'Connell,
Editors, Committee on Developing a Strategy to Reduce and Prevent Underage Drinking, Board on Children, Youth, and Families, National Research Council
Authoring Organizations
Sept. 9, 2003 News Release
Nationwide Strategy to Combat Underage Drinking Requires Shared Responsibility; Action Also Needed to Improve Compliance With Laws
WASHINGTON -- More young people drink alcohol than use other drugs or smoke tobacco, and underage drinking costs the nation an estimated $53 billion annually in losses stemming from traffic fatalities, violent crime, and other behaviors that threaten the well-being of America's youth. Curbing underage drinking is an uphill battle because alcohol is legal and readily available to adults. To tackle the problem, a new report from the National Research Council and Institute of Medicine of the National Academies offers a comprehensive strategy that requires a deep, shared commitment from many institutions and individuals, including alcohol manufacturers and retail businesses, the entertainment industry, and parents and other adults in local communities.
Federal and state governments should help forge the commitment to curtail alcohol consumption by minors, the report adds. For example, the federal government should do more to educate adults about existing laws and the consequences of underage drinking. Federal and state governments also should provide additional financial assistance and other support to reinforce community-based initiatives, and to research the effectiveness of the proposed strategy itself and related policies.
"All segments of U.S. society should address underage drinking in a serious, coordinated, and sustained manner," said Richard J. Bonnie, John S. Battle Professor of Law and director of the Institute of Law, Psychiatry, and Public Policy at the University of Virginia, Charlottesville, and chair of the committee that wrote the report. "We have to find effective ways to protect our nation's youth while we respect the interests of responsible adult consumers of alcohol. The recommendations in this report attempt to strike the right balance." The congressionally mandated study lays out a strategy that includes heightened adult supervision of children's behavior and calls upon the alcohol and entertainment industries to take stronger steps to shield young people from unsuitable messages about alcohol consumption. Taken as a whole, the plan would have a considerable impact, the committee said, adding that the strategy should be subject to ongoing refinement.
To fund the proposed activities and to help reduce underage consumption, Congress and state legislatures should raise excise tax rates on alcohol – particularly on beer, which studies show is the alcoholic beverage that most young people prefer. Alcohol is much cheaper today, after adjusting for inflation, than it was 30 to 40 years ago. Higher tax rates should be tied to the Consumer Price Index to keep pace with inflation. Increasing the cost of alcohol has well-documented deterrent effects on underage drinkers, the report points out.
A National Wake-Up Call
Most adults express concern about underage drinking and voice support for public policies to curb it. Yet surveys show that youth often obtain alcohol from adults. Studies also show that many parents underestimate both the extent of the problem and their own children's alcohol-consumption habits.
States and localities should use a wide range of educational and enforcement measures to boost compliance with laws that prohibit selling or providing alcohol to children, adolescents, and young adults under the legal drinking age of 21. The aim is to deter adults and youths alike, the report says. Among the recommended steps are increasing the frequency of compliance checks, in which authorities monitor whether businesses are obeying minimum-drinking-age laws and levy fines when necessary, and requiring all sellers and servers of alcohol to complete state-approved training as a condition of employment. Likewise, the federal government should require states to achieve specified rates of retailer compliance with youth-access laws as a condition of receiving federal funds. And states should enhance efforts to prevent and detect the use of false identification by minors who want to purchase alcohol – for example, by issuing driver's licenses and state ID cards that can be electronically scanned.
In addition, states that allow Internet sales and home delivery of alcohol should adopt regulations that require customers to sign statements verifying their identity and age at the time of delivery. At the local level, police, working with community leaders, should create policies for detecting and shutting down underage drinking parties, the report says.
State and local leaders should develop efforts to reduce underage drinking that are tailored to specific circumstances of the problem in their communities, the report says. A broad range of public and private organizations and institutions, including the federal government, should encourage and fund community efforts that have a solid science base.
Likewise, the federal government should fund and actively support the development of a national media campaign to encourage parents and other adults to take steps in their own households and neighborhoods to discourage underage drinking. Officials should carefully craft this activity to make sure that it would reach a diverse audience, the report says.
All intervention and education programs, the committee stressed, should be rigorously evaluated.
Roles for Alcohol and Entertainment Industries
A substantial portion of alcohol advertising reaches an underage audience or is presented in a style that is attractive to youth, the report says. For example, television ads for alcohol often appear during programs where the percentage of underage viewers is greater than their percentage in the overall U.S. population.
The committee recommended that trade associations in the alcohol industry and individual companies strengthen their advertising codes to prohibit placement of commercial messages in venues where a large portion of the audience is underage. These groups also should establish independent, external review boards to investigate complaints about ads and enforce codes. In 1999 the Federal Trade Commission issued similar recommendations urging the industry to toughen its advertising standards for alcoholic beverages. For years, those standards have permitted ad placement in media where adults constitute at least 50 percent of the audience. The industry is expected to soon announce tougher standards that will restrict marketing to audiences with a much larger proportion of adults.
In addition, alcohol companies, advertising firms, and commercial media should refrain from marketing practices -- such as certain product designs or promotion techniques -- that may appeal to young people, the report says.
The alcohol industry also should join with private and public entities to create and fund an independent, nonprofit foundation that is focused solely on preventing and reducing underage drinking, the committee said. The industry currently invests in programs that were established with that stated goal; however, the results of these programs typically are not assessed using rigorous scientific methods.
The entertainment media have key roles to play, too. Officials in the music, television, and film industries should use rating systems and codes to reduce the likelihood that large numbers of young listeners and viewers will be exposed to unsuitable messages about alcohol consumption – even when adults are expected to make up the majority of the audience. The Motion Picture Association of America, for instance, should consider content about alcohol use when rating films, and assign mature ratings for movies that portray drinking in a favorable light, the report says.
The overall goal of the committee's broad strategy is to promote public awareness of the importance of reducing underage drinking, as well as greater accountability in mass communication. To this end, Congress should provide funding for the U.S. Department of Health and Human Services to routinely track youth exposure to alcohol ads by monitoring advertising practices. Likewise, HHS should regularly review representative samples of movies, TV programs, music recordings, and videos offered to audiences that are 15 percent or more underage. Findings from this work should be reported to Congress and the public, the committee said. Moreover, HHS should issue a comprehensive report to Congress each year on trends in underage drinking and progress in reducing the problem.
Larger Government Investments Needed
The use of alcohol among adults is deeply rooted in American culture, and beliefs vary widely about alcohol consumption and expectations for young people. But underage drinking is dangerous, the report emphasizes. It is a significant factor in youth traffic fatalities, and associated with suicide, other violence, and academic failure. When people start drinking in childhood or adolescence, they increase their risk of developing alcohol-related problems as adults.
In the 2002 Monitoring the Future survey, a federally sponsored study, about 72 percent of 12th graders and 39 percent of eighth graders reported that they had consumed some alcohol in the past year. That study also showed that more than a quarter of high school seniors had consumed five or more drinks in a row in the previous two weeks.
Federal and state excise taxes are potentially important tools for preventing and reducing underage drinking and its harmful consequences, the committee concluded. Extensive research indicates that even small changes in these tax rates can decrease the prevalence of drinking among youths, who tend to have limited discretionary income. Current federal excise tax rates of $2.14 per 750-ml. bottle of 80-proof spirits, 33 cents per six pack of beer, and 21 cents per bottle of wine represent a long downward slide in the value of these taxes.
Further, the federal government needs to enhance and better organize research in this area, the report says. A federal, interagency coordinating committee should be formed, with the secretary of HHS serving as chair, to provide national leadership on the topic. HHS should create a National Training and Research Center on Underage Drinking, and collect more detailed data on the problem -- gathering information on regional trends and on brands of alcohol that are popular among young people, for instance. HHS also should issue annual reports on progress in implementing the proposed strategy.
State policy-makers should designate an agency to spearhead and coordinate their activities and programs in this area, the report says. Also, residential colleges and universities, which face serious alcohol-related problems among students under 21, should develop, adopt, and evaluate comprehensive prevention approaches in partnership with local communities.
The report was sponsored by the U.S. Department of Health and Human Services. The National Research Council and the Institute of Medicine are private, nonprofit institutions that provide science and health policy advice under a congressional charter. The Research Council is the principal operating arm of the National Academy of Sciences and the National Academy of Engineering. A committee roster follows.
Committee on Developing a Strategy to Reduce and Prevent Underage Drinking
Richard J. Bonnie, LL.B (chair)
John S. Battle Professor of Law;
Professor of Psychiatric Medicine; and
Director
Institute of Law, Psychiatry, and Public Policy
University of Virginia
Charlottesville
Marilyn Aguirre-Molina, Ph.D.
Professor of Population and Family Health
Mailman School of Public Health
Columbia University
New York City
Philip J. Cook, Ph.D.
ITT and Terry Sanford Distinguished Professor of
Public Policy Studies;
Professor of Economics; and
Professor of Sociology
Duke University
Durham, N.C.
Judy Cushing
President and CEO
Oregon Partnership
Portland
Joel W. Grube, Ph.D.
Director
Prevention Research Center
Pacific Institute for Research and Evaluation
Berkeley, Calif.
Bonnie L. Halpern-Felsher, Ph.D.
Associate Professor
Division of Adolescent Medicine
Department of Pediatrics
University of California
San Francisco
William B. Hansen, Ph.D.
President
Tanglewood Research Inc.
Greensboro, N.C.
Denise Herd, Ph.D.
Associate Professor of Behavioral Sciences
Division of Health and Social Behavior
School of Public Health
University of California
Berkeley
Robert Hornik, Ph.D.
Wilbur Schramm Professor of
Communication and Health Policy
Annenberg School for Communication
University of Pennsylvania
Philadelphia
Jan Jacobs, Ph.D.
Vice Provost
Undergraduate Education and International Programs, and
Professor
Human Development and Family Studies, and
Department of Psychology
Pennsylvania State University
University Park
Mark H. Moore, Ph.D.
Guggenheim Professor of Criminal Justice Policy and Management, and
Director
Hauser Center for Non-Profit Organizations
John F. Kennedy School of Government
Cambridge, Mass.
Daniel Trujillo, Ph.D.
Associate Dean
Community Development and Substance Abuse
Massachusetts Institute of Technology
Cambridge
INSTITUTE STAFF
Mary Ellen O'Connell, M.M.H.S.
Study Director
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