Preventing Underage Drinking: Difficult, Yet Achievable

Remarks as prepared; not a transcript.

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

Keynote Address to Mothers Against Drunk Driving Underage Drinking Symposium

November 6, 2008

Washington, DC

“Preventing Underage Drinking: Difficult, Yet Achievable”

Thank you, gentlemen [Peter Folkemer, Board Chair and Bill Windsor, Associate Vice President of Safety, Mothers Against Drunk Driving (MADD)] for the kind words and gracious introduction.

Good morning to all of you.  I am honored to be here today.

What great energy we have here today!

I want to start by commending MADD leaders and members for all you have done, for so many years, to heighten public appreciation of alcohol’s worst consequences and the very real toll they exact on individuals and families.

MADD is truly a pioneer in this work.

MADD has been and remains a model: for yours is a grassroots coalition unlike any other.

MADD was among the first to demonstrate to others how to turn pain and tragedy into concerted action.

MADD richly deserves great thanks from your fellow citizens everywhere - because since your inception your work has saved lives. 

And in 1999, MADD moved proactively and before most others to make preventing underage drinking a formal part of your mission.

This same mission guides the organization today:

Many of you know I and previous Surgeons General have been working hard to prevent underage drinking.

We’ve been working closely with the Leadership to Keep Children Alcohol Free Foundation.

The Leadership is an organization of current and former First Spouses that serves as a catalyst to create momentum for change. Directed by Ms. Hope Taft, former First Lady of Ohio, the Leadership’s mission is to prevent the use of alcohol by children ages 9 to 15.

I know that Patricia Kempthorne, former First Lady of Idaho, and a prominent member of the Leadership, is scheduled to discuss childhood drinking during a panel discussion this afternoon.

 I want to take a moment to thank Stephen Wing from the Substance Abuse and Mental Health Services Administration and Trish Powell of the National Institute on Alcohol Abuse and Alcoholism for joining us.

SAMHSA and NIAAA have been instrumental in working with me and with partners like those represented here today to implement the Surgeon General’ Call to Action to Prevent and Reduce Underage Drinking.”

Before discussing the CTA in further detail, I would like to talk for a moment about what I do and what we do at the federal Department of Health and Human Services (HHS).

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.

And creating a culture of health and wellness, emphasizing preventive care and encouraging healthy decisions is what my office is all about.

Indeed, Disease Prevention is one of my major priorities.

Today, 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. 

HHS Secretary Leavitt has long talked about 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 HHS, 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 in preventing disease - to a prevention-centered society.

Another of my priorities is 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.

Eliminating Health Disparities is another of my main priorities.

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:

• In 2004, African American men were 30 percent more likely to die from heart disease, as compared to non-Hispanic white men; African Americans are also 50 percent more likely than non-Hispanic whites to have high blood pressure.
• Hispanics are 50 percent more likely than non-Hispanic whites to die from diabetes.
• In American Indian and Alaska Native populations, the infant mortality rate is 51 percent higher than in non-Hispanic whites. American Indian/Alaska Natives Sudden Infant Death Syndrome (SIDS) rate is 1.9 times the mortality among non-Hispanic whites.

This is simply unacceptable. And these are just a few examples.

It is imperative that this change and we need to work collaboratively to ensure that it does.

The last priority I want to share with you is 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.

In 2003, an estimated 77 million American adults, about 36 percent of the population, were reported to be at or below basic health literacy levels (Source: National Center for Education Statistics, Institute for Education Sciences).

We cannot make improvements in health care and prevention if our messages aren’t being understood.

The Purpose of Your Visit

As you know, the main reason I am here today is to talk with you about the Office of the Surgeon General’s Call to Action to prevent and reduce 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. 

Everyone needs to pay attention to alcohol use among young people; everyone needs to recognize how vulnerable our kids are to the acute consequences of underage drinking.

Through the Surgeon General’s Call to Action, I am asking every American to join in a national effort to change attitudes and behaviors regarding underage drinking.

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

Scope of the Problem

The scope of the underage drinking problem is highlighted by a SAMHSA report released earlier this year.  The report revealed:

- 28.3 percent of 12-20 year olds (10.8 million people) are current alcohol drinkers.

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 waste.

Findings like these are one reason we released the “Call to Action.”

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 problems later in life - suggesting that alcohol may change the brain in ways that lead to future alcohol dependence. 

Secondhand Effects

I know you are aware that 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.” 

Rather, it is a dangerous and potentially lethal practice.

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

It casts a wide net. Consider its reach.

Think again of the spike in violent crime, suicides, injuries, and traffic fatalities directly attributable to underage alcohol use; the increased numbers of young people taken into custody, incarcerated; the costs of addiction treatment; families and lives disrupted; futures of young people lost.

We need to do a better job of making connections between public health-to law enforcement-to public safety-to public education-to parental involvement - and of course, to the children.

College and university administrators also play a key role in the fight against underage drinking.

They can systematically foster a culture in which alcohol does not play a central role in college life or the college experience.

Working together, all of us can accomplish more.

The Call to Action identifies strategies that parents, universities, grass-roots coalitions and communities anywhere can use.

Among them:

• Efforts directed toward the establishment of parent "safe home" type coalitions that involve pledges not to serve alcohol to youth and to host only alcohol-free parties;
• Youth involvement with underage drinking law enforcement activities;
• Enforcement of all existing underage drinking laws and widespread publicity of these enforcement efforts;
• Community-based efforts to hold accountable groups that encourage and engage in underage drinking;
• Community-based efforts to reduce easy access to alcohol around college campuses and military bases, including efforts addressing outlet density, low-price drinks, and alcohol promotions; and
• Efforts to restrict drinking in public places.

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.

At the federal level, SAMHSA, for its part, uses a variety of approaches to reach out to parents, their children, educators and others. 

SAMHSA convened some 1,600 town hall meetings this year in communities throughout the 50 states to share information about underage drinking and its consequences.

We are also working with the Ad Council on a nation-wide public service announcement campaign on preventing underage drinking.

I can report that in a span covering 18 months of this campaign, more than 75 million dollars in donated media space was used to convey the message to parents that they need to start talking with their children about underage drinking.

And there is some new promising news.

A new study published in the July 2008 issue of the journal Accident Analysis and Prevention found that laws making it illegal to possess or purchase alcohol by anyone under the age of 21 had led to an 11 percent drop in alcohol-related traffic deaths among youth; secondly, they found that states with strong laws against fake IDs reported 7 percent fewer alcohol-related fatalities among drivers under the age of 21.

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.

These three documents mirror the science found in the Call to Action while being written in a more “user-friendly” way.

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.   

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.

However, 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. 

Trust them. Trust yourselves. Trust your message.

Be honest…

Give information…

Discuss underage drinking’s risks and consequences, even if kids do not ask the questions.

Think about it: you are following the evidence where it leads.  And it points to the very real and unacceptable risks of drinking for young people. 

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

Closing and Charge

As I close, I salute you again for influencing the dialogue in such a profound way.

Because of MADD and your dedicated leadership, thousands of young people and others have made and will continue to make the appropriate choices when it comes to alcohol.

Your organization is, really, an irreplaceable ally.

I look forward to working with all of you as we build bridges in our fight to end underage drinking.

Alcohol’s human consequences, its lasting damage, are antithetical to what we all want  ... healthy and safe communities, where our youth can grow and thrive! 

Young people deserve nothing less.

By reaching out, by creating and expanding coalitions, by working collaboratively, our common effort to curtail underage drinking will have a steadily wider reach.

I am asking you to redouble your efforts - then watch the results!!!!!!

Thank you.

I’ll now be happy to take a few questions.