Transcript Document

Underage Drinking in Michigan
Hannah Jary, MPH
CDC/CSTE Applied Epidemiology Fellow- Alcohol
Michigan Department of Community Health
Underage Drinking Prevention Plan Workgroup Meeting
January 22, 2015
MDCH Alcohol Epidemiology
Program
• Our Mission:
– To strengthen the scientific foundation for
preventing excessive alcohol consumption.
• Our Goals:
– Improve public health surveillance
– Translate applied public health research
– Support public health activities to prevent
excessive drinking
2
Population Level Strategies to Reduce &
Prevent Excessive Alcohol Use
Outcomes
Factors that
Affect
Drinking
Motor Vehicle
Crashes
Price
Retailer
Serving
Practices
Binge Drinking
Underage
Drinking
Violent Crime
Assaults
Homicide
Suicide
Domestic
Violence
Days of Sale
Hours of Sale
Overconsumption
Location &
Density of
Retailers
Alcohol
Poisonings
Injuries
STIs
Unplanned
Pregnancies
3
Youth Risk Behavior Survey, 2013
UNDERAGE DRINKING TRENDS
4
Any Drinking in the Past 30 Days
40
Percent
30
Age 18-20
20
High School
10
0
2011
2012
Age 18-20 Source: MiBRFSS, High School Source: MI YRBS
2013
5
Binge Drinking in the Past 30 Days
30
25
Percent
20
Age 18-20
15
High School
10
5
0
2011
2012
Age 18-20 Source: MiBRFSS, High School Source: MI YRBS
2013
6
Usual Source of Alcohol, Past 30
days
60
Nonbinge Drinker
50
Binge Drinker
Percent
40
30
20
10
0
Someone gave Gave someone Some other
to me
money
way
Source: Michigan Youth Risk Behavior Survey, 2013
Took from
store/family
Bought at
store,
restaurant or
public event
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Substance Use Patterns, 2013
100
90
80
No marijuana or illicit drugs
Illicit drugs only
0.3
5.4
0.9
27.3
Marijuana only
Marijuana and illicit drugs
2.1
11.3
1.4
2.4
Percent
70
47.3
60
50
93.5
40
69.2
30
20
39.0
10
0
Nondrinker
Nonbinge drinker
Source: Michigan Youth Risk Behavior Survey, 2013
Binge drinker
8
Youth Tobacco Survey, 2011
YOUTH DRINKING PREFERENCES
9
Frequency of Consumption, past
30 days
90
Non-binge drinker
Binge Drinker
80
70
Percent
60
50
40
30
20
10
0
1-2 days
Source: Youth Tobacco Survey, 2011
3-5 days
6-9 days
10+ days
10
Largest number of drinks
consumed, past 30 days, by sex
70
Female
Male
60
Percent
50
40
30
20
10
0
1-3 drinks
Source: Youth Tobacco Survey, 2011
4-5 drinks
6-9 drinks
10+ drinks
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Usual Alcohol Type Consumed,
by sex
70
Female
Male
60
Percent
50
40
30
20
10
0
Liquor
Beer
FABs
Source: Youth Tobacco Survey, 2011
No Usual
Type
Wine
Other Type Cordials
12
80
Usual Alcohol Type Consumed,
by grade
Liquor
70
Beer
FABs
60
Percent
50
40
30
20
10
0
9th
Source: Youth Tobacco Survey, 2011
10th
Grade
11th
12th
13
Usual Liquor Type Consumed, by
sex
70
Female
Male
60
Percent
50
40
30
20
10
0
Vodka
Rum
Source: Youth Tobacco Survey, 2011
Whiskey
No usual Other type
type
Tequila
Cordials
14
Prevalence of Mixing Energy
Drinks & Alcohol
60
52.2
50
Percent
40
30
20
20.1
10
0
Non-binge drinkers
Source: Youth Tobacco Survey, 2011
Binge drinkers
15
Conclusions
• Liquor dominates youth preferences
– Vodka most popular liquor type
– Other usual alcohol types:
• Beer (males)
• Flavored alcoholic beverages (females)
• A large proportion of binge drinkers
report hazardous drinking behaviors
– Drinking more often
– Mixing energy drinks & alcohol
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Michigan Liquor Control Commission
LIQUOR LICENSES
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Liquor Licenses
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Available at: www.michigan.gov/lcc
Liquor License Availability
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Available at: https://www.michigan.gov/lara/0,4601,7-154-35299_10570_12905---,00.html
Liquor License Availability
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Liquor License Lists
21
Available at: https://www.michigan.gov/lara/0,4601,7-154-35299_10570_12905---,00.html
Liquor License Query
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Available at: http://www2.dleg.state.mi.us/llist/
Active Wayne
County Liquor Licenses
23
Available at: http://www2.dleg.state.mi.us/llist/
Active Wayne
County Liquor Licenses
24
Available at: http://www2.dleg.state.mi.us/llist/
Violation Information
for Liquor Licenses
Available at: http://www2.dleg.state.mi.us/llist/
25
Liquor License Considerations
• Potential for geospatial
analysis
• Updated frequently
• Types of licenses
– Incomplete
• Bars vs. restaurants
• Special or temporary
• Violation history
available
• Establish partnerships
with retailers
26
The Community Guide
PREVENTION
27
Binge Drinking by High School
Students and Adults Closely Related
Source: Nelson, DE et al. American Journal of Preventive Medicine, 2009.
28
Alcohol Policy Impacts Youth
Local Alcohol
Environment
Adolescent Drinking
Alcohol-Related Beliefs
Source: Paschall, MJ, et al. Effects of the local alcohol environment on adolescents’ drinking behaviors
and beliefs. Addiction, 109 (2013) 407-416.
29
Population Level Strategies to Reduce &
Prevent Excessive Alcohol Use
Environmental
Strategies
Increase
Alcohol Excise
Taxes
Outcomes
Factors that
Affect
Drinking
Motor Vehicle
Crashes
Price
Commercial
Host Liability
Retailer
Serving
Practices
Maintaining
Limits on Days
of Sale
Days of Sale
Binge Drinking
Underage
Drinking
Violent Crime
Assaults
Homicide
Suicide
Domestic
Violence
Hours of Sale
Maintaining
Limits on
Hours of Sale
Regulating
Alcohol Outlet
Density
Overconsumption
Location &
Density of
Retailers
Alcohol
Poisonings
Injuries
STIs
Unplanned
Pregnancies
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Reframing Intervention Impact
Health Behavior
Education,
Social Norming
SBIRT,
Naltrexone
Excise taxes
Dram shop liability,
Limiting hours &
days of sale,
.08 BAC Laws
Frieden, TR. A Framework for Public Health Action: The Health Impact Pyramid. Am J Public Health 2010; 100(4):590-5.
31
The Community
Guide Recommendations
• Enhanced Enforcement of Laws
Prohibiting Sales to Minors
• Regulation of Alcohol Outlet Density
• Commercial Host Liability
• Increasing Alcohol Taxes
• Electronic Screening and Brief
Intervention (e-SBI)
• Maintaining Limits on Days of Sale
• Maintaining Limits on Hours of Sale
Source: The Community Guide, Preventing Excessive Alcohol Consumption
32
Enhanced Enforcement of Laws
Prohibiting Sales to Minors
• Retailer compliance checks/ “sting
operations”
– 42% decrease in sales to decoys
• Effective in:
– Bars and liquor stores
– Rural and urban communities
– Different ethnic and socioeconomic groups
• Part of multicomponent, communitybased efforts
Source: The Community Guide, Preventing Excessive Alcohol Consumption
33
Regulation of Alcohol Outlet Density
• Applying regulatory authority to reduce
density of alcohol outlets
• Increased alcohol outlet density resulted
in:
– Increased excessive alcohol consumption
– Increased related harms
• For a typical census tract in LA with 5 offpremise outlets, closing 1 outlet was
associated with 42 fewer gonorrhea cases
per 100,0001
1Cohen,
DA, et al. Alcohol outlets, gonorrhea, and the Los Angeles civil unrest: A
longitudinal analysis. Social Science & Medicine 62 (2006) 3062–3071.
34
OnPremise
Alcohol
Outlet
Density
35
Prevention Status Report- Density
Available at: http://www.cdc.gov/psr/alcohol/2013/MI-alcohol.pdf
36
Commercial Host Liability
• Owner/server held legally responsible for
harms inflicted by an intoxicated or
underage customer
– E.g. Death, injury, damage from alcoholrelated car crash
– MI does not have any major limitations
• All-cause motor vehicle fatalities among
underage drinkers was reduced between
2.2% and 13.0%
Source: The Community Guide, Preventing Excessive Alcohol Consumption
37
Prevention Status ReportCommercial Host Liability
38
Increasing Alcohol Taxes
• Increase the price of alcohol
– Reduce harms, raise revenue, or both
– 10% increase in price of beer would decrease beer
consumption by about 5%
• Based on volume sold
– MI beer tax since 1966 = $0.20/gallon
• Would be $1.32/gallon if kept up with inflation
• Among adolescents
– Younger drinkers more price sensitive than older
– Heavier drinkers more price sensitive than light
Source: Xu X, Chaloupka FJ. The effects of prices on alcohol use and its consequences. Alcohol Research and Health. 34(2).
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Increasing Alcohol Taxes- Example
• Illinois alcohol excise tax increase, 2009
– Beer increased $0.046/gal ($0.185 $0.231)
– Wine increased $0.66/gal ($0.730$1.39)
– Spirits increased $4.05/gal ($4.50$8.55)
• Net effect, among ages 15-19:
– Gonorrhea rates decreased 14% for whites
and 26% for blacks
– Chlamydia rates decreased 6% for whites and
7% for blacks
Source: Jernigan DH. Social and health effects of changes in alcohol prices: findings of a research
collaborative. The Center of Alcohol Marketing and Youth.
40
Prevention Status Report- Taxes
41
Screening and Brief Intervention
• Screening: Assess patient drinking
patterns
• Brief Intervention: Personalized feedback
about risks, referral if necessary
• E-SBI uses electronic devices to deliver
the SBI
• Studies showed decreases in all types of
alcohol consumption after using e-SBI
42
Alcohol Screening
and Brief
Intervention
Resource for Youth
Source: Alcohol screening and brief intervention for youth: a practitioner’s guide. National Institute on Alcohol Abuse and Alcoholism.
43
Maintaining Limits on Days and
Hours of Sale
• Removing limits on days of sale:
– Increases in consumption
– Increases in motor vehicle-related harm
• Increasing hours of sale by 2+ hours:
– Increases in vehicle crashes injuries
– Increases in ED admissions
– Increased alcohol-related assault & injury
44
Conclusions
• Underage drinking in is prevalent in
Michigan
• Underage drinking is related to adult
drinking and the alcohol environment
• Evidence-based policies and
interventions can be implemented on a
variety of levels to prevent underage
drinking and related harms
45
Contact Information
Hannah Jary, MPH
[email protected]
517-373-7048
Michigan.gov/substanceabuseepi
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