Transcript Document

Overview of Underage Alcohol
Use and Problems:
Why It’s Everybody’s Problem
William F. Wieczorek, Ph.D., CRA
Director and Professor
Center for Health and Social Research
Buffalo State College
1300 Elmwood Ave.
Buffalo. NY 14222
Presented at PX2010 Underage Drinking: It’s Everybody’s Problem
Conference, April 28, 2010, Buffalo, NY
Presentation Overview
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Alcohol Basics
Alcohol and Public Health Impact
Underage Drinking Statistics
Health Impact and Costs of Underage
Drinking
• PX2010 Underage Drinking: It’s
Everybody’s Problem Initiative
Beverage Alcohol
• Source of virtually all beverage alcohol
(ethanol/ethyl alcohol) is fermentation (max
content about 14% ethyl alcohol by volume)
• C6H12O6 → 2C2H5OH + 2CO2
– Glucose in aqueous solution with yeast
yields ethanol, gas, and energy (anaerobic
respiration)
• Distillation is necessary for high percent
alcohol by volume liquors.
A Drink Is a Drink!
• Source of alcohol (wine, beer, liquor, wine
cooler, etc) doesn’t matter!
• Biological effect is the same.
• Based on volume of pure ethanol.
• 12 ounces of beer, 5 ounces of wine, one
shot of liquor (straight or in a mixed drink)
all have the same amount of alcohol (about
.6 ounce)
Drinking vs Addiction
• Consumption (sociocultural, pleasurable)
– Alcohol is a central nervous system depressant
(simple anesthetic)
• Alcohol abuse (hazardous/problematic use)
• Alcohol dependence (disorder, compulsion)
– Many more complex effects, especially on the
brain’s pleasure/reinforcement system
(dopaminergic system)
• In addiction, neurotransmitter systems
(especially dopamine) are greatly altered
Addicted vs Non-addicted
Dopamine System
Underage drinkers consume about 17% of all
alcohol in US! Miller, TR, et al. (2006) Journal of Studies on Alcohol, 67(4) 519-528.
Overall Health Impact of
Drinking
• Controversy—much focus on positive
impact of alcohol on cardiovascular disease
• Recognition of negative impacts
– Acute
– Chronic
• How can we assess the overall impact?
Creating a Metric for
Comparative Health Assessment
• Burden of Disease Method-universal
measure of public health of populations
• Disability-adjusted Life Years (DALYS)
– Basic metric in global burden methodology
– (Murray & Lopez, 1996)
• DALYi = YLLi + YLDi
– YLL = Years of life lost
– YLD = Years lived with disability(adjusted for the
severity)
• Allows comparisons across causes!
Alcohol Use: Comparative Analysis as
a Risk Factor for Burden of Disease
• Comparative risk assessment for alcohol
(takes into account all other risk factors)
• Examines DALYS (which includes
premature mortality and current
disease/disability)
Alcohol-related illnesses
Chronic disease:
Cancer: Lip & oropharyngeal cancer, Esophageal cancer,
Stomach cancer, Colon cancer, Rectum cancer, Liver cancer,
Laryngeal cancer, Lung cancer, Female breast cancer, Ovarian
cancer, Prostate cancer
Neuropsychiatric diseases: Alcohol use disorders, unipolar
major depression, epilepsy
Diabetes
Cardiovascular diseases:
Hypertension, coronary heart
disease, cardiac arrhythmias, heart failure, stroke
Gastrointestinal diseases: Esophageal varices, Gastroesophageal hemorrhage, Liver cirrhosis, Cholelithiasis, Acute
pancreatitis, Chronic pancreatitis
Conditions arising during perinatal period: Spontaneous
abortion, Low birth weight, Psoriasis, Prematurity, Intrauterine
growth-retardation
Injury:
Unintentional injury & Intentional injury
Alcohol Attributable DALYS
How does alcohol compare to
other health risks?
• Ezzati et al. (2002) Selected major risk
factors and global and regional burden of
disease. Lancet; 360:1347-60
• Rodgers et al. (2004) Distribution of Major
Health… Plos Medicince Vol 1(1)
(www.plosmedicine.org)
• World Health Report 2002
• Wegman & Said (2007) Chance, 20(3),17-25
• Compare risk by examining predictors of
DALYS
Burden of Disease in Developed
Regions of the World
Burden in North America
Wegman, 2007, Chance)
(Said &
Health Impact of Alcohol
• Alcohol health impact is highly detrimental.
• Ratio of bad health impact to good health
impact is about 30:1
• Tobacco and alcohol are the first and second
leading risk factors for burden of disease in
North America (Said & Wegman, 2007)
• Per capita alcohol consumption is increasing in
the US (about 600 drinks/person/yr)
• Alcohol accounts for over 3 times more disease
burden than do all illicit drugs combined!
Alcohol: Favorite Drug of Teens I
Alcohol: Favorite Drug of Teens II
Adolescents Tend to Drink
To Excess I
Adolescents Tend to Drink
To Excess II
Adolescents Tend to Drink
To Excess III
Underage Drinking Rates
Underage Drinking by Gender
and Ethnicity
Local Underage Drinking by 9th
Graders
Alcohol and Adolescent Health
• Acute health impact of alcohol
disproportionately impacts younger
persons!
– Falls, crashes, violence, suicide among most
frequent causes of death and need for
emergency hospital treatment for youth
• Alcohol use disorders also account for a
substantial health impact
– Neuropsychiatric issues
Main Causes of Death for
Adolescents
Main Cause of Fatal Injuries for
Adolescents
Alcohol and Fatal Crashes (NHTSA,
DOT HS 811 169)
•About 1/3 of fatalities are alcohol-related.
Alcohol Involvement in Other
Adolescent Injury Deaths (National Research
Council and Institute of Medicine(2004). Reducing Underage
Drinking: A Collective Responsibility.)
• About 38% of unintentional injury deaths in
persons under 21 (e.g., drowning, burns,
falls, etc.) related to alcohol use.
• Alcohol involvement in intentional injury
death among those under age 21
– 36% of homicide deaths, 12% of male suicide
deaths, and 8% of female suicide deaths.
– more than 1,500 homicides and 300 suicides in 2000
among persons under 21
Early Drinking & Alcohol
Dependence (Hingson et al. 2006, Arch
Pediatr Adolesc Med. 2006;160:739-746)
•About 1/3 of persons who start drinking before
age 17 will develop alcohol dependence!
Alcohol Dependence Most Prevalent
Among Young People (18-24 yr olds)
More Underage Drinkers Use
Illicit Drugs (OJJDP, 2008. Co-occurrence of
Substance Use Behaviors in Youth)
Underage Drinkers &
Delinquency (OJJDP, 2008. Co-occurrence
of Substance Use Behaviors in Youth)
Underage Drinking and High
School Grades
Alcohol and the Adolescent Brain
(Alcohol Research and Health, 2004/2005 vol26, no. 3)
• Adolescence is time of major brain
development—increases risk
– Development of executive/decision making
function continues into mid-20s
• Risk-taking in general is higher
– Impulsive decisions
• Reactions to Alcohol
– More sensitive to alcohol effect on mood and social
facilitation
– Less sensitive to aversive impact—decreases negative
feedback
• Potential direct impact on brain structure.
Costs of Underage Drinking
(OJJDP www.udetc.org/StateInformation.asp)
• Direct costs alone over $1.1 billion.
Costs by Category
• 80% of costs are violence and injuries.
Underage Drinking Costs in
Erie County
• Estimated cost for each adolescent in
NY is $1802 per year.
• Estimated cost of over $200 million in
Erie County annually!
– 118,486 youth X $1,802 = $213,511,770
– Direct cost of about $72 million
Few Underage Drinkers
Purchase Own Alcohol
Sources of Alcohol Not
Purchased by Underage Drinker
Everybody Influences Adolescents
(Surgeon General’s Call To Action on Underage
Drinking)
Underage Drinking Impacts
Everybody in Our Community
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Adolescent health
Parents/Families
Crime
Addiction
Illicit drug use
Brain function
Health costs
Treatment
Tax payers
• Community
members
• Schools
• Law enforcement
• Alcohol sales
• Other alcohol access
• Impaired Driving
• Violence/homicide
• Suicide
PX2010 Initiative as Erie County
Response to Underage Drinking
• Px20 group http://www.px20.org
– Collaboration of Erie County prevention (PX)
providers
– Erie County Comprehensive Prevention Plan
• PX2010 Underage Drinking: It’s Everybody’s
Problem
– First initiative of the Px20 group
– Alcohol most commonly used drug
– Largest health impact, especially for adolescents
because of acute impact and alcohol dependence
PX2010 Underage Drinking: It’s
Everybody’s Problem
• PX2010 Approach
– Recognition that underage drinking is
everybody’s problem
– Focused on a community-level response
(environmental prevention, universal population
approach)
– Enhance collaboration between law
enforcement, schools, and parents
– Create policy changes, especially in schools
– Change norms and behaviors by providing
information to schools and parents
– Decrease youth access to alcohol
– Measurable outcomes
Thanks for your attention!