Remarks at press conference to launch: The Surgeon General’s Call to Action to Prevent and Reduce Underage Drinking

Tuesday, March 6, 2007
10:00 a.m.
Washington, D.C.

Rear Admiral Kenneth P. Moritsugu, M.D., M.P.H.
     Acting United States Surgeon General
     U.S. Department of Health and Human Services
Mary Easley
Michele Ridge
Koren Zailckas

Dr. Kenneth Moritsugu
Good morning, everyone. My name is Dr. Kenneth Moritsugu; I'm the acting Surgeon General of the United States. I'd like to thank you all for joining us here today. I am here to address a very significant public health and safety problem: alcohol use by America's children and teenagers.

Underage drinking is not just about spring break, and it's not just about parties. 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 at school.

The 2005 National Survey on Drug Use and Health estimates that there are almost 11 million underage drinkers in the United States. We also know that drinking and binge drinking ramp up during the teen years. Nearly 20 percent of 14-year-olds say that they have been drunk at least once. This needs to stop.

Underage drinking is everybody's problem-and its solution is everyone's responsibility. Unfortunately, too many Americans see underage drinking as a rite of passage-kids just being kids. The reality is that our young people are being harmed by underage drinking. That's why this Call to Action is attempting to change the culture and attitudes toward underage drinking in America.

We can no longer ignore what alcohol is doing to our children. The adverse consequences of underage drinking are wide-ranging; they include academic failure, risky sexual behavior, injuries, and even death. In fact, each year, more than 5,000 deaths of people under age 21 are linked to underage drinking. Think of that: entire college campuses wiped clean of the entire student body; every year, the equivalent.

As with every Surgeon General's publication, this Call to Action is grounded in science. The science indicates that underage drinking is putting our children at risk. Recent research shows that the brain continues to develop well beyond childhood and throughout adolescence. This research raises concerns that underage drinking may affect short-term and long-term cognitive functions, and may change the brain in ways that can lead to future alcohol dependence.

Research also shows that young people who start drinking before the age of 15 are five times more likely to have alcohol problems later in life. The bottom line is that research provides more reasons than ever before for parents and other adults to be concerned about the effects of underage drinking on our Nation's children, and to take steps to prevent and to reduce underage drinking. This Call to Action is a call to every American to join with the Surgeon General in a national effort to address underage drinking early, continuously, and in the context of human development.

I want to thank some of the people here today who led the way in developing The Surgeon General's Call to Action to Prevent and Reduce Underage Drinking. Dr. Ting-Kai Li and his staff at the National Institute on Alcohol Abuse and Alcoholism, especially Drs. Vivian Faden and Patricia Powell; Dr. Cline and his staff at the Substance Abuse and Mental Health Services Administration, especially Mark Weber and Steve Wing; Charles Curie, who helped initiate the Call to Action when he was administrator of the Substance Abuse and Mental Health Services Administration; The Interagency Coordinating Committee on the Prevention of Underage Drinking, and in particular a recent retiree, Dr. Ron Schoenfeld, who was our representative to that committee; and finally, but certainly not least, the Leadership to Keep Children Alcohol Free, for their hard work to address the problem of underage drinking and their support for this Call to Action. In particular, I'd like to acknowledge Mrs. Hope Taft, the former First Lady of Ohio, one of the founders of this Leadership to Keep Children Alcohol Free.

This Call to Action identifies six goals that we will be joining with all sectors of society to address. The first goal is that we need to foster changes in society that facilitate healthy adolescent development and that help prevent and reduce underage drinking. The second-to engage parents and schools, communities, all levels of government, all social systems that interface with youth, and youth themselves, in a coordinated national effort to prevent and reduce underage drinking and its consequences. Number three: Promote an understanding of underage alcohol consumption in the context of human development and maturation that takes into account individual adolescent characteristics as well as the environmental, ethnic, cultural, and gender differences. Number four: Conduct additional research on adolescent alcohol use and its relationship to development. Number five: Work to improve public health surveillance on underage drinking and on population-based risk factors for this behavior. And finally, work to ensure that policies at all levels are consistent with the national goal of preventing and reducing underage alcohol consumption.

As many of you know, the Office of the Surgeon General is committed to providing the best scientific information in a way that people can use and understand. By making health information easier to understand, we allow people to actively take steps to increase their health and wellness and to actually prevent disease as a result of healthy choices. In addition to this Call to Action, I will soon release several "Guides to Action" with the science presented in a way that Americans can understand and apply to their individual and their family circumstances. I am confident that the information in this Call to Action, when broadly disseminated and discussed among parents, teachers, community leaders, and young people themselves will literally save lives. I expect to issue the "Guides to Action" at events in States throughout our Nation over the next few months.

Before moving to the next part of our program, I want to specifically recognize the millions of parents who have worked to prevent their children from drinking. You may have often felt that you were fighting this battle alone. You were not and you no longer will be fighting this battle alone. With this 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.

Now, I would like to introduce you to one of the champions of this Call to Action. Mary Easley is the co-chair of the Leadership to Keep Children Alcohol Free. She is also the First Lady of North Carolina. Mrs. Easley…

Mary Easley
Thank you. Thank you and good morning. On behalf of the Leadership to Keep Children Alcohol Free, its 31 current governor spouses and representatives, its 23 emeritus spouses, and on behalf of children and families across America, thank you, Dr. Moritsugu, for issuing this Call to Action to prevent and reduce underage drinking.

A Call to Action issued by the Office of United States Surgeon General provides validation, focus, and encouragement to the many concerned citizens throughout this country who have been working persistently-and, I might add, in ever-increasing numbers-to educate parents, community leaders, and our children about this major public health problem that poses a serious threat to the healthy development of America's youth.

Alcohol is the number one drug of choice for our children, and every year it kills more people-more young people-than all illegal drugs combined. I would like to repeat that because it's a statistic that is really shocking, so you need to take a minute to really let it sink in. Alcohol is the number one drug of choice for children. Every single year, it kills more young people than all illegal drugs combined. Ask any police officer who has dispatched to a fatality along the side of the road in the early morning hours. Talk to any emergency room nurse or physician who has just pumped a stomach. Spend some time at a rape crisis center or with a substance-abuse professional, and they will tell you that alcohol use by our young people is real and widespread with far-reaching impact on every one of us.

In a few minutes, you're going to hear from Koren Zailckas, and as she speaks, her story-keep in mind-is no isolated tale of woe or an aberration of behavior. Her story is a consistent theme of youth alcohol use, and it is something that is a theme that echoes throughout America, whether you come from a small rural town or a major metropolitan area. Hers is the voice of truth and experience and so it should resonate with you as it did with me. But the good news is that in every State and territory in this country there are people who are devoted to educating parents, raising their awareness, raising the awareness and facts available to children and our community leaders with science-based information about the serious health threats associated with the early onset of alcohol use. Coalitions among community leaders, young people, law enforcement, businesses, and educators are reaching into our communities throughout this country and gaining strength while they are raising awareness and providing real strategies for positive change. America is awakening to the need to take action on the National, State, and community levels, and this Call to Action is a valuable tool in that effort.

The Surgeon General's Call to Action to prevent and reduce underage drinking plays a pivotal role in that awakening. It represents a practical, evidence-based approach that defines the problems and the challenges that are presented with the issue of underage drinking, and it also provides a framework for prevention and reduction of alcohol use and alcohol disorders in adolescents. The Surgeon General's Call to Action spotlights youth drinking in a way that will help coordinate all of our individual efforts on a national scale, and that brings important focus and clarity to the discussion.

Dr. Moritsugu, please know that the Leadership to Keep Children Alcohol Free, along with our many partners throughout America, many of whom are represented here today, will take up your call and will use it as a springboard to learn more, to do more, to work harder and smarter than ever before. When the Office of United States Surgeon General speaks on a public health issue, Americans everywhere, parents everywhere, will listen and take note. Your action today as a highly respected national voice to the conversation about youth alcohol use as a major public health problem, it is a voice that will help all of us take this message back to our States and communities with renewed vigor and enthusiasm. This Call to Action represents the facts and the science as we know it today. All of us are grateful to have this tool to use. It's a valuable tool for parents. It's a valuable tool for community leaders as we begin to address this problem nationally and work on it individually. So thank you very much for that, Doctor.

Now I'd like to call to the lectern Michele Ridge, who is the former First Lady of Pennsylvania and one of the original members of the Leadership to Keep Children Alcohol Free. And I would be remiss, however, if I didn't recognize one of my co-chairs, Nancy Freudenthal, who is here, and also Lori Holden, the former First Lady of Missouri, as well as our friend Hope Taft from Ohio. But right now Michele Ridge will come forward, the former First Lady of Pennsylvania, one of our founders of the Leadership to Keep Children Alcohol Free, and a board member of the Leadership to Keep Children Alcohol Free foundation. Michele…

Michele Ridge
Thank you, Mary, and good morning on such an exciting day for those of us across the land who have been working so hard on this issue. I have been a member of the Leadership to Keep Children Alcohol Free since its inception in March of 2000, and working to prevent drinking by children ages 9 to 15 both in Pennsylvania and nationwide. Every day in this country, 7,000 children under the age of 16 take their first drink. As you've heard this morning from Dr. Moritsugu, childhood drinking is associated with a range of consequences, from academic failure to future alcohol dependence. We also know that drinking and binge drinking increase dramatically with age. By the time they are seniors in high school, 75 percent of our young people will report having had a drink. Those are just numbers, but behind the numbers are individual children growing up all over America and their families. It is not just the estimated 5,000 underage drinking-related deaths each year of people under the age of 21, it's how alcohol can interfere with the journey to adulthood, derailing plans, shattering dreams, and compromising futures-but there is hope.

Underage drinking is a preventable problem, one we can solve if each of us does our part. For too long, underage drinking has been fueled by denial, inaction, and acceptance. That changes today. Members of the Leadership to Keep Children Alcohol Free stand ready and willing to do our part. We invite Dr. Moritsugu to join our members across the nation in bringing this Call to Action to their respective States. We will use this Call to Action to guide us as we devote energy and resources to changing the culture around underage drinking. It will serve to galvanize our efforts, elevate the issue, and increase public discourse on this issue, and make us even more effective. We are proud that the Leadership encouraged the Surgeon General's office to develop this Call to Action, and we are so pleased with this document released today. We thank Dr. Moritsugu for making the prevention and reduction of underage drinking a priority, and calling attention to the grave harm that results when our children and adolescents drink. We pledge to use this Call to Action to generate meaningful and positive change. So I thank you for this invitation opportunity to be here. And now, Mary Easley has already given a somewhat introduction to our next speaker, Koren Zailckas, a New York Times best-selling author of Smashed, the story of a drunken girlhood. She will provide her personal insights on the toll underage drinking exacts on the lives of young people. Thank you.

Koren Zailckas
Good morning. I am as excited as a cheerleader on game day to be here in support of this Call to Action. Issues surrounding alcohol abuse and underage drinking have a real personal significance to me; they're really near to my heart. I'm here, quite simply, as mentioned because I wrote a book called Smashed which is about my experiences drinking in high school and in college, and it's my true account. I wrote it for a couple of reasons-one personal, one a little bit more cultural. On a personal level, I was 23 and living in New York and quitting drinking, and I became really preoccupied with this old memory that I had, something I hadn't thought about in a number of years, but suddenly couldn't stop thinking about, which was this night that I had my stomach pumped when I was 16 after night of drinking too much at a friend's weekend party. And, being a writer, somebody who had always processed experiences on paper, I sort of immediately sat down and started to write about it, to write what later became that chapter in my book.

But on a cultural level, during that time, I was hearing so much in the news about girls of my generation and girls of this generation, girls of our generation, and how we were drinking just so much younger and so much more than all the women who'd gone before us, way more than our mothers ever did, sometimes more than our older sisters, and how this had really just happened in the last 10 years, since the 1990s. And I didn't agree with what I was hearing from the sociologists and the psychologists, sometimes the journalists who all seemed to be suggesting that girls like myself were drinking more because we were so liberated and self confident and happy and bursting with girl power. I thought that was a little bit nuts because as I was beginning to reflect on my own experiences I could see I had been drinking in large part as a teenager because it was an expression of my unhappiness or my lack of confidence, especially in social situations. So I had all these experiences, I thought maybe I could offer something like the young person's perspective, the young woman's perspective.

My experience is not all that uncommon in this day and age. Actually, pretty closely mirror sort of some of the big grim statistics that you see in this Call to Action. I had my first drink when I was 14; it was the tail end of eighth grade. I drank throughout high school, had my first close call when I was 16, which was that night that I had my stomach pumped and I was drinking at a friend's party. It was a terrifying experience. It scared the bejeezus out of my parents, scared the heck out of myself, and afterwards I certainly cleaned up my act a little bit, curbed my drinking, until I graduated from high school and went to college, when suddenly my enthusiasm for alcohol was renewed, if not only because, one, it was so accessible on a college campus, but also that parents, teachers sometimes administrators, sort of implicitly expected-and I think accepted-that my peers and I would drink underage and drink to excess. Don't get me wrong, I don't think they were thrilled about the idea that we were drinking ourselves unconscious, but for the time being they were willing to look the other way. They thought it was part of the normal college experience, a life stage behavior that we would eventually outgrow when we graduated and entered the real world. My experiences at college: I saw some of those more horrifying consequences that result from this kind of underage drinking and binge drinking-a lot of alcohol-fueled depression, a lot of blackouts, things like date rape and sexual assaults.

Since I published my book, sort of the most rewarding experience for me has been going out there and opening up a dialog, visiting at high schools across the country, touring colleges and universities, and what I've noticed in these places while I've been talking to young people, to teachers, to administrators, is, one, just the pervasiveness of this problem. It's something that affects all of us really as a culture. I go to colleges on meets and actually it's worth noting on the college level-it's almost half and half; it's almost half-of all college kids are drinking the way that I did. Fortunately the half that aren't are still a little bit higher at this moment in time, but what I notice when I visit is that even the kids who aren't drinking this way come and want to talk to me because maybe they're concerned about their friend, they're wondering what they can do to help them. When I go to high schools and talk to parents, even parents who feel like they're on top of their game-they have the alcohol conversations with their kids, maybe there is a lock on the liquor cabinet and they don't in any way tolerate the idea that it's okay for 15- and 16-year-olds to be drinking-they come to me concerned because maybe their children's friends' parents are still under the impression that underage drinking is okay so long as it's done at home and you confiscate all the kids' car keys.

And, when I go to universities, I talk to administrators who have spent a whole lot of grant dollars, they've done a whole lot of research, they've work really hard to implement these alcohol policies, but they're concerned because just 2 miles off campus there's a whole stretch of bars where ladies drink free and you don't necessarily need a valid ID to get in-maybe a library card will do. So I think maybe this is a problem that affects all of us. And sort of one of the obstacles in terms of dealing with it thus far is we haven't all been on the same page, and that's what I love about this Call to Action. I think it's about getting everyone caught up to speed and giving everyone in our communities the information and education and science that they need to understand these statistics and to change them.

But that's what I want to go back to my own story, just for a moment, because I'm not a sociologist, I'm a memoirist, a girl with a few cautionary tales at first leave. I wanted to just briefly run through a list of things I wish someone had told myself and my parents when I was sort of in the throes of my own underage drinking. And I think there are things that I'm really glad to see incorporated into this Call to Action, one of which is just the importance of prevention. I think in my own mind, it will always be easier to convince that 14-year-old that maybe it's not a great idea to take that first step that will be to convince someone at 16, 18, 20, who is already caught on the little hamster wheel, deep into that cycle of destructive drinking, that there's something wrong with that, or that maybe there's another way to socialize.

I think a lot of it comes back to have to, we have to realize just how young we need to talk to kids. Unfortunately, as uncomfortable as it makes us, kids are taking their first drink in sixth and seventh and eighth grade. So if we're waiting to talk to them until they get to high school, sometimes we're already too late. Likewise, I think, of course, we can't wait until we catch kids drinking, which was something that happened with my parents and I. And we can't just have the conversation once. We can't talk to kids and think, "Hmm, that's done, got it out of the way," and check it off our list. We can't, of course, only talk about it during May, which is when our high schoolers are graduating and having their senior proms, and we can't only talk about it now in March when we're sending kids off to Cancun for spring break. Yes, these are high-risk times of year, and yes, we see a lot of widely publicized underage drinking and binge drinking, but the problem is going on year-round, of course and it's a [inaudible] concern.

Likewise, I think we can't wait for warning signs, which is something that everyone always did for me. You know, our girls especially, we're failing them if we wait for warning signs. Girls are conditioned not to get drunk and act out in ways that get noticed. I never did. We're not going to get into fist fights and end up in hospitals, bloodied where people recognize our problems and get us help. And a lot of us also, some of us will exhibit failing grades, but many of us won't. I didn't, in particular. So if we're teaching parents and kids that they have to wait for falling GPAs, that's not going to work either. There's a real "party hard, think hard" mentality especially that I see on college campuses whereby kids think as long as they are studying as hard as they're drinking, then they're okay, they're on track and nothing is wrong.

But finally, and most importantly, I think it is really important that we rally young people on this issue, that we don't completely focus and get caught up on the one risk that is drinking and driving. It, of course, is devastating, but that one risk tends to eclipse a lot of others. And we know now things we didn't even know 10 years ago when I started drinking about the way alcohol affects the teenage brain, which is hopefully continuing to grow and develop from the time we're 14 to the time we're my age, mid 20s. But, yeah, I think this message will always be more powerful when it comes from one of our own. Being a writer, someone who's preoccupied with words, I just love the phrase, "Call to Action," because here today in this room, this is just the call-right?-and hopefully in the months and years that follow we're going to spring into action. And it always reminds me of that wonderful Mother Theresa quote, if you know the one I'm talking about, where she said there is a light in this world, a healing spirit that comes when ordinary people hear a call and respond in extraordinary ways. So I think we need to get young people on the horn because they're going to surprise us and really respond in extraordinary ways to this issue. But, thank you for your time and I'll turn it back over.

Dr. Moritsugu
Thank you so much, Koren, for your testimony and your sharing with us your own personal story. You know, we can provide you numbers, we can provide you data, but we have to remember that behind every number, behind the data, is a human face; and we have seen one very brave human face here, an individual who is willing to step forward and to share her personal experiences with us so that we would be better motivated to protect our children and our future generations.

I want to thank you again all for being here today. As you are all probably aware, copies of this Call to Action are now available on the Surgeon General's web site, It's downloadable and we will also have hard copies and they should be in your press kits.

Q&A (Various)
[Dr. Moritsugu]: And now I'd like to invite Dr. Li and Dr. Cline, our partners in the development of this Call to Action, to please join me here on the stage for any questions that members of the press may have. And so at this point I'd like to open the floor to questions from the press with the request that before you ask your question you would identify yourself and your affiliation so that we will know who you are. Any questions? Yes, right here in the front. Someone will be bringing you a microphone. Thank you.

[Question #1]: My name is _____ and I'm with Substance Abuse Funding News, and my question for Dr. Cline is: How do you think this Call to Action might carry over into programs at SAMHSA?

[Dr. Moritsugu]: If I might begin, I think that what this Call to Action is really meant to do is to mobilize all segments of our society, not only the Federal Government, not only SAMHSA and NIH, but also going into the communities and all the way down to the family unit and to the individual youth. In order for us to really make a difference, we're going to have to mobilize all segments of society-working together, working in concert, working synergistically-and part of that partnership will be the Federal Government. Dr. Cline.

[Dr. Cline]: Thank you for the question. The Call to Action provides us with an incredible tool, a tool that includes information, science, and best practices, evidence-based practices, so we will be integrating the Call to Action, the information, the guidelines included in the Call to Action to all of our grantees, to prevention specialists across the country. We will be including this information at future town hall meetings. This last year, I think many of you are aware, SAMHSA worked in partnership with many groups to sponsor about 1,400 town halls across the United States with a specific focus and attention to the issue of underage drinking prevention. So this tool for future town halls, this information will be provided to those groups as well as to the participants-every single community last year.

[Dr. Moritsugu]: Thank you for that question. Other questions? If you have a question please raise your hand. In the back there, please.

[Question #2]: I'm _____ from NBC News. In 2003, the National [inaudible] recommended increasing the excise tax on alcohol as one of the ways to reduce underage drinking. Why is this not one of your plans in the Call to Action?

[Dr. Moritsugu]: Thank you for that question. One of the approaches that we have taken is to look at the issue of prevention of underage drinking across the board, and what we have found is that there is science that shows that by increasing the price of alcohol, that that actually does have an impact on reducing the utilization and the demand. Price incorporates many different things. Price may have an impact on whether or not there will be free women's nights at a local tavern, happy hours, increasing prices, not necessarily having sales of alcohol, particularly in areas where our youth would have access to them. Taxes are one of those larger issues-price-that has an impact on price. And rather than drilling down and giving very specific examples, we have elected to look at this from a much broader perspective. But taxes, happy hour prices, pricing at our retail outlets-all of these have an impact upon the accessibility and the utilization of alcohol by everyone, as well as in particular making it less accessible to our underage drinkers.

Closing Remarks (Dr. Kenneth Moritsugu)
Any other questions? Well, I am glad that we have provided you the information that you may need to hopefully carry this message out into the communities. This is a press conference and we look to partnering also with our media to be able to carry this Call to Action out across the country. This is an issue, again, because underage drinking is everybody's problem and its solution is everyone's responsibility. Once again, thank you all for joining us this morning.


Last revised: March 20, 2007