Opening Statement
by

Richard J. Bonnie

John S. Battle Professor of Law, Professor of Psychiatric Medicine, and
Director of the Institute of Law, Psychiatry, and Public Policy
University of Virginia, Charlottesville 
and
Chair, Committee on Developing a Strategy to Reduce and Prevent Underage Drinking Good morning. I am Richard Bonnie, chair of the Committee on Developing a Strategy to Reduce and Prevent Underage Drinking. I welcome everyone participating today in this public briefing. It is a pleasure for me, along with three of my fellow committee members, to present this important report, which reflects a longstanding and continuing interest in youth development issues at the National Academies.

In response to a congressional request, the committee reviewed a wide variety of government and private programs for the purpose of developing a comprehensive national strategy to reduce and prevent underage drinking. 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 establishing 21 as the minimum legal drinking age. 

Alcohol use by young people is dangerous -- because of the risks associated with acute impairment, and because it threatens their long-term development. Traffic crashes are perhaps the most visible consequences of this danger. But underage drinking is also linked with violence, suicide, academic failure, and other harmful behaviors. Many more of the nation's youth drink alcohol than smoke tobacco or use other drugs. Especially disturbing is the fact that young people tend to drink more heavily than adults, thereby exacerbating the dangers to themselves and people around them. In the 2002 Monitoring the Future survey, a federally sponsored study, more than a quarter of high school seniors reported that they had consumed five or more drinks in a row in the preceding two weeks. The social cost of underage drinking has been estimated at $53 billion each year, including $19 billion from traffic crashes alone. 

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 preventing illegal drug use by young people than on preventing 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 attitudes toward alcohol use. Others tend to focus on changing the marketing practices of the alcohol industry to reduce young people's exposure to messages that 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 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. We believe that a broad, multifaceted effort is urgently needed. 

The primary goal of our recommended strategy is to create and sustain a strong societal commitment to reduce underage drinking. To be perfectly frank, focusing on youth alone will not have much impact on the problem. Acting in concert, all of us -- 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. 

Adults must be the primary targets of this national campaign to reduce underage drinking. Most adults express concern about this behavior 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. 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 – people who are now 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; decrease adult conduct that tends to facilitate it; 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 multipronged 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 should focus on both retail outlets and social channels though which underage drinkers obtain 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 in 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 try to buy alcohol. 

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 community initiatives that have been shown to work. 

The committee also supports specific intervention and education programs aimed at young people; these programs should be science-based and rigorously evaluated. A good start in identifying evidence-based school programs has already been made by the U.S. Department of Education and the Substance Abuse Mental Health Services Administration in the U.S. 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.

We accept the alcohol industry's declared commitment to the goal of reducing underage drinking and its willingness to be part of the solution. We think, however, that opportunities for cooperation are being overlooked. Indeed, there is much common ground. The committee calls on the alcohol industry to become a partner in a collaborative national effort to implement the proposed strategy, and we recommend two concrete steps. First, the alcohol industry should join with private and public entities to create and fund an independent, nonprofit 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 have rarely been scientifically evaluated, and the overall level of industry investment in such initiatives 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 as part of a genuine national partnership to reduce underage drinking. 

Second, we urge changes in alcohol advertising, while recognizing that the issue of advertising is a particularly sensitive one. A substantial portion of alcohol advertising reaches an underage audience or is presented in a style that tends to appeal to 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 a 1999 report by the Federal Trade Commission, we urge the industry's 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 years, those codes permitted ad placement in media where adults were at least 50 percent of the audience. Earlier today, the FTC announced that the beer and distilled spirits trade associations have joined the wine industry to revise the threshold to 70 percent for the minimum proportion of adults in an audience. This is a step in the right direction, but the committee believes that the industry threshold for adult viewers or listeners should be raised even further. 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 -- such as certain product designs -- that have particular appeal to young people – regardless of whether they are intentionally targeted.

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 an audience. 

The federal government should routinely 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 in 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 on trends in underage drinking, and summarize progress in reducing the problem and implementing the proposed strategy. 

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 shows that even small 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 price fluctuations. 

In summary, we propose 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 our country can do much more than it is now doing. We need to develop and implement effective ways to protect young people from the dangers of drinking while we also respect the interests of responsible adult consumers of alcohol. Our report attempts to strike the right balance.

Thank you for your interest and attention. My colleagues and I will now take questions from audience members in the room and those of you listening to the webcast. We ask those of you in the room to please step to one of the floor microphones. And we ask everyone to please identify yourselves by name and organization before asking your questions.