"Improving Public Health by Preventing and Reducing 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

Address to American Public Health Association
Annual Meeting

Tuesday, November 6, 2007
Washington, DC

"Improving Public Health by Preventing and Reducing Underage Drinking"

Thank you, Diana (Session Moderator Diana Conti) for that gracious introduction.

Good morning, ladies and gentlemen.

I am honored to be here today.

Special thanks to Dr. George Benjamin, A-P-H-A's Executive Director, and Bob Vollinger, of the National Cancer Institute, Chair of the A-P-H-A's Alcohol, Tobacco and Other Drugs (A-T-O-D) Section, for extending the invitation and giving me an opportunity to share this time with you.

I would like to recognize also Captain Ann Mahoney, of the Substance Abuse and Mental Health Services Administration (SAMHSA), incoming A-T-O-D Chair.

I commend the APHA membership for your individual and collective commitment to creating a healthier nation and applaud the attendees of this session for recognizing that underage drinking is a serious health concern.

My broad responsibilities as Acting Surgeon General involve serving as our nation's chief "health educator."

My office provides accurate and emerging information on topics related to the health and wellness of all Americans.

Priorities
As many of you may be aware, I am new and still getting "up to speed" in the position of Acting Surgeon General.

I am encouraged by the opportunities I have to improve public health and help individuals and families adopt those practices most likely to result in better personal wellness.

I would like to mention a few top priorities in the Office of the Surgeon General.

The first is Prevention - what each of us can do to make ourselves and our families healthier.

According to the Centers for Disease Control and Prevention (C-D-C):

• More than 90 million Americans live with chronic disease.
• Chronic disease causes seven out of 10 deaths every year.
• And treating people with chronic disease accounts for about 75 percent of the trillion dollars America spends on health care each year.

Right now we have it backwards. Our health system is focused on treatment instead of prevention. We must place more emphasis on prevention.

Keeping people healthier longer reduces the cost of care and can contribute to a longer life.

Five key steps can prevent most chronic diseases:

• Tobacco control,
• Good nutrition,
• Physical activity,
• Maintenance of a healthy weight, and
• Regular health screenings.

We need more Americans to embrace these steps to a healthier life.

Prevention also means stopping drug and alcohol abuse before they start - I don't have to tell you that prevention is the best strategy for reducing the tragic consequences that are associated with substance abuse.

Another priority of my office is Public Health Preparedness.

This includes readiness and the capability of rapid response to all hazards, including hurricanes, earthquakes and pandemics. The third priority which we are especially focused on is Eliminating Health Disparities.

Health literacy - the ability of an individual to access, understand, and use health-related information and services to make sound health decisions - is important.

It's the key to our success in reducing health disparities and promoting disease prevention.

Nearly 9 out of 10 American adults lack the skills needed to take care of their own health, or know how to prevent disease. We know that low health literacy impacts health.

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.

As health care continues to become more complex, the importance of being health literate will increase.

Focus of Address
Many of you know why I am here today.

I'm here to talk about an issue that affects everyone in this room.

We know alcohol use by young people is a serious health and public safety issue.

Each year, approximately 5,000 young people under the age of 21 die 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.

Quite simply, underage drinking places the future well-being and productivity of our kids at stake.

Simply put, it is an issue in which EVERYONE has a stake.

The goals articulated by your Alcohol Tobacco and Other Drugs (A-T-O-D) Section show that the A-P-H-A is well aware of and focused on underage drinking issue.

I am impressed by the description of the A-T-O-D Section's goals:

"... (1) sound research, prevention and treatment practices, and (2) effective communications concerning ATOD issues among A-P-H-A members and with the wider community...

I commend the group for its focus – and I look forward to hearing about its activities in more detail.

I know, of course, that the 1,000 or so members of your A-T-O-D group are greatly concerned about the health and well-being of our young people.

The level of commitment to the subject of youth drinking is also reflected by the fact that 9 of the ATOD Section's 35 sessions and 6 of 29 poster sessions focus on underage drinking - from screening and brief intervention programs to environmental policy strategies that focus on restricting access to and sale of alcohol by geographic area.

The efforts of the Office of the Surgeon General and its partners (like the APHA) to reduce underage drinking are meant to ensure that our children have the greatest opportunity to succeed.

Our goal, as health professionals, providers of care, parents and caring adults, is to provide kids with the tools necessary to make positive and healthy choices... to help them succeed now and later.

Scope of the Problem
As early as ages 8 and 9, our children are confronted with decisions about alcohol on a regular basis in many settings - including at home and in school.

Let's consider what we know:

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 use tobacco or illicit drugs.

The 2006 National Survey on Drug Use and Health (NSDUH) estimated that the rate of current alcohol use among youths aged 12 to 17 was approximately 17 percent in 2006.

In 2006, about 11 million persons aged 12 to 20 reported drinking alcohol in the past month. Approximately 7 million were binge drinkers, and 2 million were heavy drinkers.

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

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

Science confirms that the brain continues to develop well beyond childhood – and through adolescence. This research raises concerns that underage drinking may affect short-term and long-term cognitive functioning, and may even change the brain in ways that lead to future alcohol dependence.

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.

This research provides more reasons than ever for us to be concerned about the effects of underage drinking on our nation's children.

Effects
In people under age 21, alcohol is a leading contributor to "death from injuries" – the main cause of death in that age group.

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.

• Approximately 600,000 students are unintentionally injured while under the influence of alcohol.
• An estimated 700,000 students are assaulted by other students who have been drinking.
• About 100,000 students are victims of alcohol- related sexual assault or date rape .

The data are compelling.

They are evidence-based and science-driven.

Underage drinking is not a harmless "rite of passage."

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

That's why the Call to Action is attempting to change the culture and attitudes toward underage drinking in America.

The Call to Action articulates the Federal commitment to the underage drinking issue but also outlines the need for action on the state and community level.

Its goals include:

• Fostering social changes that contribute to healthy adolescent development and that help prevent and reduce underage drinking.
• Engaging parents, schools, communities, all levels of government, all social systems that interface with youth, and youth themselves in our coordinated national effort to prevent and reduce underage drinking and its consequences.
• Promoting an understanding of underage alcohol consumption in the context of human development and maturation that takes into account individual adolescent characteristics as well as environmental, ethnic, cultural, and gender differences.
• Conducting additional research on adolescent alcohol use and its relationship to development.
• Working to improve public health surveillance on underage drinking and its risk factors.
• Ensuring that policies at all levels are consistent with the national goal of preventing and reducing underage alcohol consumption.

I am confident that - when broadly discussed among parents, teachers, community leaders, and young people themselves - the goals of the Call to Action to Reduce and Prevent Underage Drinking, will be appreciated, embraced and will literally save lives.

The Call to Action alludes to several activities of particular promise:

• 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 university and campus groups that encourage and engage in underage drinking;
• Efforts (like those supported by your A-T-O-D Section) 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.

The Federal policy effort to address underage drinking is coordinated by the Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD). The committee is chaired by the SAMHSA Administrator. The agency's leadership has been exceptional.

The committee's member agencies support a wide range of programs in a comprehensive response to the challenge of preventing underage drinking.

Federal Initiatives
I would like to take a few moments to highlight some of these federal activities.

Through the Enforcing Underage Drinking Laws (EUDL) (pronounced You-dul) initiative, the U.S. Department of Justice devotes dollars to enforcement, to holding young people, parents and communities accountable.

The National Highway Traffic Safety Administration, within the Department of Transportation, partners with Students Against Destructive Decisions (SADD) to develop numerous program materials to address underage drinking and driving.

Concurrently, the Substance Abuse and Mental Health Services Administration (SAMHSA) has reached out to parents, their children, educators and others.

SAMHSA convened more than 1,200 Town Hall Meetings in all 50 states last year.

With collaboration with the Ad Council, SAMHSA has developed an underage drinking prevention campaign directed at parents of 9- to 15-year-olds. Products include four television Public Service Announcements (PSAs) as well as PSAs for radio, print, and Internet.

"Reach Out Now," a unique school-based underage drinking prevention initiative designed specifically for use by fifth- and sixth-grade students, their families, and their teachers, is another SAMHSA project.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA), a component of the National Institutes of Health, has been and remains an invaluable partner in furthering the Call to Action goals.

The Federal effort to prevent youth drinking would not be where it is without NIAAA's guidance and leadership.

The agency is also a co-founder of the Leadership to Keep Children Alcohol Free organization.

The Leadership, a coalition of governors' spouses, Federal agencies, and public and private organizations, is an initiative to prevent the use of alcohol by children ages 9 to 15. It is the only national effort that focuses on alcohol use in this age group.

This group of first spouses has made underage drinking a priority. My predecessor, Rear Admiral Moritsugu, visited a number of states on the invitation of Leadership members to promote and bring attention to the Call to Action.

I look forward to working with the Leadership to continue the momentum the governors' spouses have created since the release of the document.

Guides to Action
Underage drinking is multi-dimensional. To effect change we must approach it from many different levels.

Accordingly, the Office of the Surgeon General has created Guides to Action for Families, Communities, and Educators.

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

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...understand...embrace...and put into action.

By making information about the hazards of underage drinking easier to understand and more accessible, it is easier for individuals and communities to make action. Young people are better positioned and better able to make sound and appropriate choices when the take- home message is clear. Anyone can – and all of us should – send the message.

The message is a simple one: underage drinking is dangerous.

Rather than working separately, we need to "connect the dots" from all sectors of society: federal, state, and local levels. In so doing, we need to continually promote the necessity of parental involvement in the lives of our children.

And by tackling an issue—a public health issue, law enforcement issue, mental health issue—from a group perspective rather than an individual perspective, we can have a greater impact.

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

Unfortunately, a widespread perception exists that young people as a matter of routine, drink alcohol – "no matter what."

Not so. Underage drinking is not a rite of passage.

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 cultural change is possible with underage drinking.

Parents' opinion is actually one of the key reasons young people choose not to drink.

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

Parents must remain involved with their kids' decision-making. They must send our children a clear, unequivocal and consistent message that underage drinking is unhealthy, unsafe, and unacceptable.

When parents do so, they won't be popular. However, they will be responsible parents.

This is tough love.

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. They need to hear and appreciate accurate information about alcohol misuse, underage drinking and the damage it can do.

In talking to their children, parents need to trust them, trust themselves and trust their message.

Closing and Charge
Those of us working to prevent underage drinking are following the evidence where it leads. And it points to the dangers of drinking for young people.

Alcohol's worst consequences are not inevitable, but they are real and can be indelible.

With that in mind, I ask for your help - the assistance of A-P-H-A and every member of the audience today in your capacity as an advocate for better public health - in fostering changes that help prevent and reduce underage drinking.

Get involved and urge others to do so as well.

Reach out to your public health counterparts wherever they are – at community health centers, in local clinics, in state and county and health departments.

Engage them as agents of behavioral and attitudinal change.

We can all connect the dots...create and sustain links...among public health stakeholders and our colleagues in the fields of law enforcement, public safety, public education.

We can do this. We can do this because we care about the health and well-being of our nation.

We care about the health and well-being of our children.

This is how we build a stronger and healthier nation.

Underage drinking diminishes what is otherwise possible...for our kids, what we want for them, what they deserve: healthy bodies, healthy minds, and healthy spirits ... healthy and safe communities!

The good news is that as professionals who care about improving public health, we can make a profound difference.

Each one of us can be an agent of change.

Each one of us can meaningfully act to reduce and prevent underage drinking.

In closing, I invite anyone interested in learning more about the Office of the Surgeon General and our activities to visit our website.

The address is www.surgeongeneral.gov.

I would now like to proceed to the next item, a panel discussion on the issue of underage drinking.

Joining us as panelists today are Steve Wing, SAMHSA's Associate Administrator for Alcohol Prevention and Treatment Policy; Trish Powell from the NIAAA Office of Science Policy and Communications; and Sharie Cantelon from the Department of Justice.

Thank you.

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Last revised: December 30, 2008