Underage Drinking: A Challenge to Every Population

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

Address to Intergovernmental Tribal Training and Technical Assistance Conference

Billings, MT
August 21, 2008

Thank you, Rick (Erick Broderick, Deputy Administrator, SAMHSA) for that gracious introduction.

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

Conferences like this one are especially important: In the broadest sense, this gathering is an opportunity to promote the concept of wellness and discuss how an emphasis on prevention and wellness are improving personal and community health.

Beyond the specific training and technical assistance provided here, this event is an excellent venue for information-sharing, consultation, learning and strategic planning; each is vital to sustaining progress in addressing issues like underage drinking.

Since arriving in Montana, I have spent time in Helena with Montana’s First Lady, Nancy Schweitzer, and a number of state officials and policymakers. 

I’ve discussed the underage drinking issue and learned about grass roots activities underway in Butte and in Bozeman at Montana State University.

My impression certainly is that your own desire to reduce and prevent underage drinking is shared at the highest levels and throughout the entire state. 

I commend Mrs. Schweitzer 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.

Governor and Mrs. Schweitzer 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 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 federal Call to Action to Prevent and Reduce Underage Drinking.”

First, however, I am pleased to note that a principal theme of this training and technical assistance conference is “...Tribal Justice, Safety, and Wellness.”

The theme confirms that our cause is a common one.

I say this because 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.

Before discussing my primary topic in detail, I want to mention certain of my priorities as the Acting Surgeon General.

First: My Priorities

First, a topic a just alluded to – 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.

Another priority 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.

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. 

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 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 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:

Unfortunately, health disparities among tribal communities and Native Americans elsewhere - an estimated 60 percent of American Indians live off the reservation - remain profound.

We know that American Indian/Alaska Native adults are 1.2 times as likely as White adults to have heart disease (HHS Office of Minority Health).

We know that American Indian/Alaska Native adults are 1.6 times as likely as white adults to be obese (OMH).

American Indian/Alaska Native adults are 1.3 times as likely as White adults to have high blood pressure (OMH).

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 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.

Every one of us, 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. 

I am sure you may have often felt that you were fighting this battle alone.

Not so.

Community and tribal leaders across the land are collaborating with young people, government agencies, as well as justice and social systems to proactively address youth access to alcohol.

Underage drinking does not threaten only Native American youth.

Everyone needs to pay attention to alcohol use among young people; make no mistake: all population groups are vulnerable to the acute consequences of underage drinking.

I want to specifically recognize the countless numbers of parents and community leaders, here and across America, who have worked to prevent their children from drinking. 

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.

Our children deserve nothing less.

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.
• 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.

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 Montana totaling $104 million in sales. (Fact Sheet, the Pacific Institute for Research and Evaluation (PIRE), October 2006).

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

• 78% had at least one drink of alcohol on one or more days during their life.
• 28% had their first drink of alcohol, other than a few sips, before age 13.
• 49% had at least one drink of alcohol on one or more occasion in the past 30 days.
• 34% had five or more drinks of alcohol in a row (i.e., binge drinking) in the past 30 days.

We also know that Montana ranked 5th 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 “Call to Action to Prevent and Reduce Underage Drinking.”

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

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.

For its part, SAMHSA uses a variety of approaches to reach out to parents, their children, educators and others. 

This past March, SAMHSA convened the first of some 1,600 town meetings scheduled to be convened this year in communities throughout the 50 states.

Among that number were underage drinking town hall meetings in more than 20 Montana cities and towns.

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.

The study was funded by the Substance Abuse Policy Research Program (SAPRP) of the Robert Wood Johnson Foundation.

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.   

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. 

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. 

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.

Together, we are agents of achievable societal change.

As I mentioned earlier, the 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

Today, I want to ask for your continued support and leadership at the tribal and community level to help reduce and prevent underage drinking. 

I know that together, and by bringing together strong and growing partnership in service of our common commitment, we can ensure the futures and protect the health of young people.

Next, I look forward - as I am sure you do - to hearing the address by Dr. Mark Willenbring, Director of the National Institute of Alcohol Abuse and Alcoholism (NIAAA). 

Thank you.