"The Risks and Challenge of Underage Drinking"

Remarks as prepared; not a transcript.

RADM Steven K. Galson, M.D., MPH
Acting Surgeon General
U.S. Department of Health and Human Services

Remarks at a Prevention of Underage Drinking Event in Lincoln, Nebraska

April 14, 2008
Lincoln, NE

"The Risks and Challenge of Underage Drinking"

Thank you, Sally (Nebraska First Lady Sally Ganem), for that gracious introduction.

Good evening ladies and gentlemen.

I am honored to be here today - and I applaud your commitment to protect the health and preserve the futures of Nebraska’s young people.

My bosses, Department of Heath and Human Services Secretary Mike Leavitt, and Dr. Joxel Garcia, the Assistant Secretary for Health, have asked me to bring you their best wishes.

I want first to thank your state’s first lady for her longstanding commitment to promoting the education, health and well-being of young people.

I commend Ms. Ganem’s involvement with the Leadership to Keep Children Alcohol Free, an organization of current and former First Spouses that serves as a catalyst to create momentum for change. The Leadership’s mission is to prevent the use of alcohol by children ages 9 to 15.

Gov. Heineman and Ms. Ganem have for several years supported without reservation federal and community efforts to reduce and prevent underage drinking.

I applaud them both for all they have done.

I would like to also recognize another friend, and former first lady of Ohio, who has worked extensively to reduce underage drinking -- Mrs. Hope Taft. Mrs. Taft serves now as the Executive Director for the Leadership to Keep Children Alcohol Free Foundation.

I also want to thank Stephen Wing from the Substance Abuse and Mental Health Services Administration, for joining us.

Steve was one of our editors of the Surgeon General’s Call to Action to Prevent and Reduce Underage Drinking.

And I salute you, my audience, as well.

What you have been doing - or what you plan to do after leaving this meeting - to address the problem of underage drinking makes a real difference.

As public officials, civic leaders, parents and people who care, you are positioned and prepared to bring about attitudinal change as it relates to underage drinking.

Whatever your individual role, you can help make sure young people understand the risks and consequences of drug and alcohol misuse - and trying to prevent them.

Your interest, your focus, and your activism will reach across communities. You will promote productivity, employment, healthy families and healthy communities.

And you are motivated by the knowledge that underage drinking and can be reduced if we intervene early with the best information and services available.

Before moving to my primary topic, I first want to talk to you today about my role and quickly run through my Priorities as the Acting Surgeon General

First: My Priorities

As Acting Surgeon General, I serve as our nation’s chief “health educator” - responsible for giving Americans the best scientific information available on how to improve their health and reduce the risk of illness and injury.

My top priorities are:

First, Disease Prevention - we spend the vast proportion of our health care dollars in this country treating preventable diseases. Yet, a modest increase in investment in preventing these diseases will save lives and precious health dollars.

Prevention is the cornerstone of what we do in my office. Our emphasis on prevention is premised on the understanding that we need to change the way we think about health care in America.

H-H-S Secretary Leavitt has long talked this…

…about the critical need for change in American health care…how important it is that we have a system which is value driven.. As the Secretary says, “…consumers know more about the quality of their television than about the quality of their health care.”

Today, providers cannot offer the best care they are capable of and consumers do not have the ability to consider value when they make their health care purchasing decisions.

At H-H-S, the Secretary is leading an effort to bring about a future in which consumers:

…are able to find out which hospital in their area has the highest success rate for the procedure they need

…can compare doctors, not just on what they charge, but also in the quality of the care they give, and

…approach health care they way they would any other major purchase - by consulting an impartial source of information on quality and cost.

This is part of a broader vision, one which involves systemic change… from a treatment-oriented and value driven framework of care - where too little time, money and effort are invented tin preventing disease - to a prevention-centered society.

My next priority is Public Health Preparedness - we must be prepared to meet and overcome challenges to our health and safety, whether caused by nature or humans.

Preparedness must involve planning by every level of society, including every family.

One important area that we continue to work on - even as the media buzz has died down - is pandemic flu preparedness.

Frankly, we must prepare as if the pandemic strikes tomorrow. This way, we do everything we can, everyday, to be ready. And, our job is never done; we can always do more.

For pandemic flu, we have preparedness checklists on our website. These include checklists for individuals, families, schools, businesses, hospitals, long term care and child care providers, and community organizations.

Yet our need to prepare doesn’t stop there.

That is why the President has requested $507 million in his fiscal year 2009 budget to achieve the goals of his pandemic flu preparedness plan and another $313 million for ongoing pandemic flu preparedness efforts across H-H-S.

“Bird Flu” may have slipped from the headlines but the threat remains real.

Our work to prepare the country for a possible flu pandemic is just as focused today as it was when the President released the National Pandemic Plan more than two years ago.

Pandemic planning is a shared responsibility among all levels of government, the health care community, schools, businesses, faith-based and community based organization, and families and individuals.

There’s a role for everyone and that’s why we created a program called Pandemic Flu: Take the Lead.

The purpose of this program - now being tested in 9 communities - is to help community leaders learn more about pandemic flu and how they can help citizens take a few steps now to prepare.

We’ve created resources and tools for community leaders such as faith leaders, doctors and nurses, and business leaders to help them raise awareness of pandemic planning within their community.

Eliminating Health Disparities - While, overall, our nation's health has improved, not all populations have benefited equally - and too many Americans in minority groups still suffer from illnesses at a disproportionate rate.

For instance:

• African Americans are 1.5 times as likely as non-Hispanic whites to have high blood pressure.
• Cancer is the second leading cause of death for most racial and ethnic minorities in the United States.
• For Asians and Pacific Islanders, cancer is the number one killer.
• Hispanics were 1.5 times as likely as non-Hispanic Whites to die from diabetes; Hispanic men and women have higher incidence and mortality rates for stomach and liver cancer than non-Hispanics.

Regrettably, we also know that American Indians and Alaska Natives suffer disproportionately from substance use disorders compared with other racial groups in the United States. (Source: Office of Applied Studies. (2006). Results from the 2005 National Survey on Drug Use and Health: National findings).

The statistics that reflect health disparities that exist among minority populations, unfortunately, go on and on.

This is simply unacceptable.

It is imperative that things change, and we need to work collaboratively to improve health care access.

The last priority I want to share with you is Improving Health Literacy.

We need to steadily improve the ability of an individual to access, understand, and use information and services to make appropriate health decisions.

People with low health literacy are less likely to know how to navigate the health care system, understand basic health information, or get preventive health care services.

When a patient does not understand that certain factors increase his or her risk for a disease...that is a problem.

When a student does not understand the reality of alcohol poisoning…that is a problem.

We won’t make improvements in health care and prevention without our messages being understood through language and education barriers that exist in this country.

All of us, any public health professional, indeed anyone in the audience today - can become an ambassador for health literacy.

The Purpose of Your Visit

As you know, the main reason I am here today is to talk with you about underage drinking.

We all want our children to have the greatest opportunity to succeed.

And we want to provide our kids with the tools that enable them to make positive and healthy choices.

The data supports the acute need that young people have for accurate information about underage drinking.

The scope of the underage drinking problem is highlighted by a new SAMHSA report that found:

• 28.3 percent of 12-20 year olds (10.8 million people) are current alcohol drinkers.
• This same group drank on an average of 5.9 days in the past month and consumed an average of 4.9 drinks per day.

On the days they drank, they drink more heavily than adults aged 21 or older.

The challenge before us to prevent underage drinking is substantial and real.

Most of you already know that alcohol is the most widely used and abused substance among our Nation’s youth: a higher percentage of young people between the ages of 12 and 20 use alcohol than tobacco or illicit drugs.

Scope of the Problem

Nationally, approximately 5,000 young people under the age of 21 die every year as a result of underage drinking; this includes about 1,900 deaths from motor vehicle crashes,

• 1,600 as a result of homicides,
• 300 from suicide, as well as hundreds from other injuries such as falls, burns, and drowning.

In people under age 21, alcohol is a leading contributor to “death from injuries” - the main cause of death in that age group.

What a terrible, terrible waste.

Closer to home:

In 2005, underage drinkers consumed nearly 22 percent of all alcohol sold in Nebraska totaling $154 million in sales. (Fact Sheet, the Pacific Institute for Research and Evaluation (PIRE), October 2006).

In 2005, according to self-reports by Nebraska students in grades 9-12:

• 73% had at least one drink of alcohol on one or more days during their life.
• 24% had their first drink of alcohol, other than a few sips, before age 13.
• 43% had at least one drink of alcohol on one or more occasion in the past 30 days.
• 30% had five or more drinks of alcohol in a row (i.e., binge drinking) in the past 30 days.

We also know that Nebraska ranked 10th highest among the 50 states for the cost-per-youth of underage drinking in 2005 (Fact Sheet, the Pacific Institute for Research and Evaluation (PIRE), October 2006).

Findings like these are one reason we released the "Surgeon General’s Call to Action to Prevent and Reduce Underage Drinking" last year.

Science makes clear that the effects on young people can be profound.

Alcohol use during adolescence is pervasive and it ramps up dramatically between the ages of 12 and 21.

Research also shows that young people who start drinking before age 15 are five times more likely to have alcohol-related problems later in life suggesting that alcohol may change the brain in ways that lead to future alcohol dependence.

Secondhand Effects

Alcohol also plays a significant role in risky sexual behavior including unwanted, unintended and unprotected sexual activity.

It increases the risks of physical and sexual assault.

• Each year, approximately 600,000 college students are unintentionally injured while under the influence of alcohol (Hingson et al. 2005).
• Each year an estimated 700,000 college students are assaulted by other students who have been drinking (Hingson et al. 2005).
• Each year about 100,000 college students are victims of alcohol- related sexual assault or date rape (Hingson et al. 2005).

The data are compelling.

They confirm what everyone here knows: Underage drinking is not a harmless “rite of passage.”

The reality is our young people are being harmed by underage drinking.

The Call to Action articulates the Federal commitment to underage drinking prevention and outlines the need for action.

Some of the strategies in the Call to Action include encouraging states and communities to:

• Value, encourage, and reward an adolescent’s commitment not to drink
• Invest in alcohol-free, youth-friendly programs and environments
• Widely publicize all policies and laws that prohibit underage drinking use

and

• Pay attention to what children see and hear, for example urge the alcohol industry to voluntarily reduce outdoor alcohol advertising.

Consider what ideas you can take back to your friends and neighbors to help combat this growing problem. And most importantly, act on it.

The H-H-S federal Substance Abuse and Mental Health Services Administration (SAMHSA) uses a variety of approaches to reach out to parents, their children, educators and others. In 2006, SAMHSA convened more than 1,200 Town Hall Meetings in all 50 states

This year over 1600 town hall meetings are being convened across the nation by SAMHSA, including meetings in 17 meetings in Nebraska cities and towns alone

In particular, one will take place here in Lincoln on April 23.

We are also working with the Ad Council on a nation-wide public service announcement campaign on preventing underage drinking - in the last 18 months of this campaign over 75 million dollars in donated media space has been used to convey the message to parents - they need to start talking with their children about underage drinking.

For more information on the Ad Council Campaign and a complete list of town hall meeting sites, visit: www.stopalcoholabuse.gov

In the meantime, I would like to tell you about some of the resources that we have available to help any and all who are interested in curbing underage drinking.

Publications

To effect change we must approach underage drinking from many different levels; the more information we share, and the more people we reach, the more successful we will be in reducing underage drinking.

To facilitate this process, the Office of the Surgeon General has created Guides to Action for Families, Communities, and Educators.

They empower families, communities, and educators with the knowledge and tools useful in delivering the underage drinking message in a way that is easy to hear and understand - they promote the health literacy we so badly need.

These plain-language guides help people understand what the Call to Action says and what it means to them.

Collaboration

A perception exists that young people, adolescents, will as a matter of routine drink alcohol - “no matter what.”

Not so.

When the American people rejected the use of tobacco and illicit drugs as a culturally acceptable behavior, the use of those substances declined, and the culture of acceptance shifted to disapproval.

The same change is possible with underage drinking.

Anyone, from policymakers to parents, guidance counselors, coaches, mentors, and prevention professionals, can benefit from hearing the message.

Parental opinion is actually one of the reasons young people choose not to drink.

Parents must talk to and with their children - early and often.

Parents need to become involved and remain involved with their kids’ decision-making.

…And they must send a clear and consistent message that underage drinking is unhealthy, unsafe, and unacceptable. Period.

When parents do so, they won’t be popular. But it’s the only responsible thing to do.

I know this, because I have three teenagers of my own. I know talking to your children can sometimes be uncomfortable and challenging, but:

It is never too early to talk to kids about alcohol, to give them accurate information about drinking, to answer the questions, even those they do not ask.

In the federal government, we are following the evidence where it leads. And it points to the very real and unacceptable risks of drinking for young people.

I strongly encourage each of you to redouble your efforts to reach out to your friends and neighbors - to connect the dots in every way possible - because together we can accomplish more than we can alone.

And remember, alcohol use by young people transcends borders, boundaries, and economic status.

Underage drinking is everybody’s problem, and its solution is everyone’s responsibility.

Accordingly, I look forward to working “side by side as one” with Nebraska officials and your allies in every sector of society - including kids themselves - to discourage underage drinking.

Together, we are agents of achievable societal change.

Our cause is a common one. Alcohol’s worst consequences are not what we want as a society, as a culture, as a nation.

They diminish what is otherwise possible…for our kids, what we want for them, what they deserve: healthy bodies, healthy minds, and healthy spirits ...leading to healthy and safe communities!

Closing and Charge

Thank you once again for your interest and for your commitment to improving the health of all Americans.

Today, I want to ask for your continued support and leadership at the community level to bring about changes in society that help prevent and reduce underage drinking.

Looking around this room, I know that through your efforts, and by bringing together all of our strong and growing partnerships and networks across the Nation, we can ensure better health and safety for all Americans.

I look forward to working with you during this meeting and beyond.

Thank you for your dedication and your commitment to improving the health and well being of people everywhere.

Next, I look forward to hearing from you and to learning from you. I’m happy to take a few questions.

- END -

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Last revised: December 30, 2008