REDUCING UNDERAGE DRINKING: A COLLECTIVE RESPONSIBILITY
Richard J. Bonnie
Chair of the
Committee on Developing a Strategy to Reduce and Prevent Underage Drinking
National Research Council and Institute of Medicine
John S. Battle Professor of Law
Director, Institute of Law, Psychiatry, and Public Policy
University of Virginia
Subcommittee on Substance Abuse and Mental Health Services
Committee on Health, Education, Labor and Pensions
SEPTEMBER 30, 2003
Good morning, Mr. Chairman and members of the Subcommittee. My name is Richard Bonnie. I am the John S. Battle Professor of Law and Director of the Institute of Law, Psychiatry and Public Policy at the University of Virginia. I served as chair of the Committee on Developing a Strategy to Reduce and Prevent Underage Drinking of the National Research Council and the Institute of Medicine. The National Research Council is the operating arm of the National Academy of Sciences, National Academy of Engineering and the Institute of Medicine, chartered by Congress in 1863 to advise the government on matters of science and technology.
The report of this committee was produced in response to a Congressional request to develop a strategy to reduce and prevent underage drinking. The committee reviewed a wide variety of government and private programs for the purpose of developing a comprehensive national strategy. We relied on the available scientific literature, commissioned papers, testimony and submissions from the public, and the expertise of committee members in public policy, public health, youth interventions, and substance abuse. Our starting point was the current national policy setting 21 as the minimum legal-drinking age.
Alcohol use by young people is an endemic problem that is not likely to improve in the absence of significant new interventions. Many more of the nation’s youth drink than smoke cigarettes or use other drugs. And, young people tend to drink more heavily than adults, exacerbating the dangers to themselves and people around them. In the 2002 Monitoring the Future survey, a federally sponsored study, nearly one in five eighth graders and almost half of twelfth graders reported drinking in the last month. More than a quarter of high school seniors reported that they had five or more drinks in a row in the last two weeks. One-in-eight eighth graders reported the same thing. These underlying rates have remained basically unchanged for a decade. The social cost of underage drinking has been estimated at $53 billion each year, including $19 billion from traffic crashes alone. While traffic crashes are perhaps the most visible consequences of this problem, underage drinking is also linked with violence, suicide, academic failure, and other harmful behaviors. Heavy drinking also threatens youth’s long-term development.
Although the public is generally aware of the problems associated with underage drinking, the nation’s social response has not been commensurate with the magnitude and seriousness of the problem. This disparity is evident not only in the fact that the federal government spends 25 times more on prevention of illicit drug use by young people than on prevention of underage drinking, but also in the lack of sustained and comprehensive grassroots efforts to address the problem in most communities.
Some people think that the key to reducing underage drinking lies in finding the right messages to send to young people to instill negative beliefs and attitudes toward alcohol use. Others tend to focus on changing the marketing practices of the alcohol industry in order to reduce young people’s exposure to messages designed to promote drinking. However, the problem is much more complicated than either of these positions would suggest because alcohol use is deeply embedded in the economic and cultural fabric of life in the United States. Annual revenues in the alcohol industry amount to $116 billion. The challenge, then, is how to reduce underage drinking in a context where adult drinking is widespread and commonly accepted and where billions of gallons of alcohol are in the stream of commerce. We believe that will require a broad, multifaceted effort.
The primary goal of the committee’s recommended strategy is to create and sustain a strong societal commitment to reduce underage drinking. All of us, acting in concert—including parents and other adults, alcohol producers, wholesalers and retail outlets, entertainment media, and community groups–must take the necessary steps to reduce the availability of alcohol to underage drinkers, to reduce the attractiveness of alcohol to young people, and to reduce opportunities for youthful drinking. Underage drinking prevention is everybody’s business.
The report emphasizes that adults must be the primary targets of this national campaign to reduce underage drinking. Most adults express concern about underage drinking and voice support for public policies to curb it. Yet behind the concern lies a paradox: Youth often get their alcohol from adults. And many parents downplay the extent of the problem or are unaware of their own kids' drinking habits. Thirty percent of parents whose kids reported drinking heavily within the last thirty days, think their kids do not drink at all. The sad truth is that many adults facilitate and condone underage drinking. We need to change the behavior of well-meaning adults in communities all over the nation – including people who are holding drinking parties for kids in their homes in violation of the law.
As the centerpiece of the committee’s adult-oriented strategy, our report calls on the federal government to fund and actively support the development of a national media campaign designed to create a broad societal commitment to reduce underage drinking, to decrease adult conduct that tends to facilitate underage drinking, and to encourage parents and other adults to take specific steps in their own households, neighborhoods and businesses to discourage underage drinking.
The comprehensive strategy we suggest also includes a multi-pronged plan for boosting compliance with laws that prohibit selling or providing alcohol to young people under the legal drinking age of 21. Efforts to increase compliance need to focus on both retail outlets and social channels though which underage drinkers obtain their alcohol. For example, we urge state authorities to require all sellers and servers of alcohol to complete state-approved training as a condition of employment, and to increase the frequency of staged underage purchases by which they monitor retailer compliance with minimum drinking-age laws. The federal government should require states to achieve specified rates of retailer compliance with youth-access laws as a condition of receiving federal funds. And states should beef up efforts to prevent and detect the use of fake IDs by minors who want to buy alcohol.
The committee also supports specific intervention and education programs aimed at young people as long as those programs have been evaluated and found to be effective. A good start in identifying evidence-based school programs has already been made by the Department of Education and the Substance Abuse Mental Health Services Administration in the Department of Health and Human Services. A recent report sponsored by the National Institute on Alcohol Abuse and Alcoholism has done the same for programs aimed at college students.
Community leaders need to mobilize the energy, resources and attention of local organizations and businesses to develop and implement programs for preventing and reducing underage drinking. These efforts should be tailored to specific circumstances of the problem in their communities. The federal government as well as public and private organizations should encourage and help pay for relevant community initiatives that have been shown to work.
The alcohol industry also has a vitally important role to play in the strategy we have proposed. The committee acknowledges the industry’s declared commitment to the goal of reducing underage drinking and its willingness to be part of the solution. We believe that there is much common ground, and that opportunities for cooperation are now being overlooked. Specifically, we urge the alcohol industry to join with private and public entities to create and fund an independent, non-profit foundation that focuses solely on designing, evaluating, and implementing evidence-based programs for preventing and reducing underage drinking. Although the industry currently invests in programs that were set up with that stated goal, the results of these programs have rarely been scientifically evaluated, and the overall level of industry investment is modest in relation to the revenues generated by the underage market. We think it is reasonable to expect the industry to do more than it is now doing, and to join with others to form a genuine national partnership to reduce underage drinking.
We also urge greater self-restraint in alcohol advertising. We recognize, of course, that advertising is a particularly sensitive issue. However, a substantial portion of alcohol advertising reaches an underage audience or is presented in a style that tends to attract youth. For example, alcohol ads on TV often appear during programs where the percentage of underage viewers is greater than their percentage in the overall U.S. population. Building on an important 1999 report by the Federal Trade Commission, the committee’s report urges industry trade associations to strengthen their advertising codes to prohibit placement of commercial messages in venues where a large portion of the audience is underage. For many years, the industry trade association codes permitted ad placements in media where adults were at least 50 percent of the audience. The FTC recently announced that the beer and distilled spirits trade associations have joined the wine industry to increase the threshold to 70 percent for the minimum proportion of adults in the viewing audience. This is a step in the right direction, but the committee believes that the industry should continue to move toward a higher threshold of adult viewers. In addition, trade associations and alcohol companies should create independent, external review boards to investigate complaints about ads and enforce codes. Furthermore, alcohol companies, advertising firms, and commercial media should refrain from marketing practices that have particular appeal to young people, regardless of whether they are intentionally targeted at youth audiences.
Companies and trade associations in the entertainment sector also have a responsibility to join in the collective effort to reduce underage drinking, and to exercise greater restraint in disseminating images and lyrics that promote or glorify alcohol use in venues with significant underage audiences. Officials in the music, TV, and film industries should use rating systems and codes similar to those used by some industries for drug abuse to reduce the likelihood that large numbers of young listeners and viewers will be exposed to unsuitable messages about alcohol consumption – even when adults are expected to make up the majority of the audience.
The federal government should periodically monitor advertising practices in the alcohol industry and review representative samples of movies, television programs, music recordings, and videos that are offered at times or venues likely to have significant underage audiences. This work should be conducted by the U.S. Department of Health and Human Services, and reported to Congress and the general public on a regular basis. The department also should issue a comprehensive report to Congress each year summarizing trends in underage drinking, and reporting on progress in implementing the proposed strategy and in reducing the problem. A federal interagency coordinating committee, chaired by the Secretary of HHS, should be formed to provide national leadership and to better organize the multiple federal activities in this area. HHS also should create a National Training and Research Center on Underage Drinking and collect more detailed data, including data on brands preferred by youth. State policy-makers should designate an agency to spearhead and coordinate their activities.
To help pay for the proposed public programs and to help reduce underage consumption, Congress and state legislatures should raise excise tax rates on alcohol – especially on beer, which is the alcoholic beverage that young people drink most often. Alcohol is much cheaper today, after adjusting for inflation, than it was 30 to 40 years ago. Higher tax rates should be tied to the Consumer Price Index to keep pace with inflation. Research indicates that changes in these tax rates can decrease the prevalence and harmful effects of drinking among youths, who tend to have limited discretionary income and are especially sensitive to changes in price.
In summary, we've proposed a comprehensive strategy that, taken as a whole, would foster a deep, unequivocal societal commitment to curtail underage drinking. As a national community, we need to focus our attention on this serious problem and accept a collective responsibility to address it. This is an admittedly difficult challenge, but the committee believes that our country can do much more than it is now doing. The nation needs to develop and implement effective ways to protect young people from the dangers of early drinking while respecting the interests of responsible adult consumers of alcohol. The committee’s report attempts to strike the right balance.
Thank you for your interest and the opportunity to testify to the subcommittee. I’d be happy to answer any questions you may have about the committee’s report.