Transcript Underage Drinking: A South Carolina Priority

Underage Drinking:
A South Carolina Priority
November 16, 2010
CAST Training
State Epidemiological Outcomes
Workgroup (SEOW)



SEOW is a subcommittee of Gov. Council
Began meeting in 2006
Determined four state priorities, approved by
GC in 2008
Underage Drinking
 Alcohol-Related Traffic Crashes
 Youth Tobacco Use (including smokeless tobacco)
 Substance Use During Pregnancy

Strategic Prevention Framework
Consequences
Consumption
Causal Factors
South Carolina Community Action for a Safer Tomorrow (CAST)
Environmental Logic Model: Underage Drinking
Underage
Drinking
Risk Factors & Underlying
Conditions
Social norms accepting and/or
encouraging use
Social event monitoring &
enforcement
Insufficient enforcement of laws
Adjudication systems
enhancement
Easy social access
Easy retail access
•35% of SC high
school students drink
•18% of SC high
school students drank
5 or more drinks on
one occasion in the
past two week
•1 in 10 SC high
school students drove
after drinking in the
past month
Last updated 8/6/10
Environmental
Strategies
Inappropriate promotion of use
Low or discount pricing
Insufficient laws and policies
Community media advocacy
Consumption
Pattern
High-visibility best practice
enforcement operations
Merchant education
Alcohol advertising restrictions
Increase product price
Community mobilization for
policy change
Insufficient enforcement of
school policies
Model school policies w/
enforcement
Lack of identification of early
problem behaviors
Improved screening &
referral systems
Consequences
Death
 Traffic Crashes
 Homicide
 Suicide
 Violent Crime

Injuries/Assaults
Dependence
 Teen Pregnancy
 Academic Failure
 Cost

Death
5,000 people under age 21 in the U.S.
die each year from alcohol-related
injuries
Motor Vehicle
Crashes 38%
Homicides 32%
Suicide 6%
Other 24%
Using 2001-2005 data, CDC estimates 84 alcoholrelated SC deaths for those under 21 annually.
SC Crash Statistics 2005
Youth Alcohol Use & Crashes
# of Fatalities & Injuries in Alcohol-Related Crashes
with an “At Fault” Underage Driver
2006
2007
2008
2009
Fatalities
45
63
55
51
Injuries
422
408
427
347
DAODAS/PIRE Analysis of Office of Highway Safety Crash Data
High School Students
Driving after Drinking (past month)
US
South Carolina
30
Percent
20
10
0
1995
1997
Source: Youth Risk Behavior Survellance System
1999
2001
2003
Year
2005
2007
2009
High School Students
Riding with Drinking Driver (past month)
US
South Carolina
50
Percent
40
30
20
10
0
1995
1997
Source: Youth Risk Behavior Survellance System
1999
2001
2003
Year
2005
2007
2009
Homicide
 Estimated
47% of homicides are
alcohol-related (all ages)
 SC:
7.7 deaths per 100,000
 31%
higher than US
SC Homicide Deaths per 1,000
Rate (per 1000 population)
0.15
0.10
SC
US
0.05
0.00
1990
1991
1992
1993
Source: National Vital Statistics System
1994
1995
1996
1997
Year
1998
1999
2000
2001
2002
2003
2004
Homicides by Age, SC 2004
Rate (per 100,000 population)
15
10
SC
US
5
0
5-14
15-24
Source: National Vital Statistics System
25-34
35-44
45-54
55-64
65-74
75-84
85+
Age Group
15- to 24-year olds: 2nd highest homicide death rates
Suicide
 SC:
11.3 deaths per 100,000
 SC rates similar to US
 Estimated 23% of suicides are alcoholrelated
 Means
103 alcohol-related suicide deaths
per year in SC
 SC
high school drinker twice as likely as
non-drinker to have attempted (13% in
past year)
(2007 YRBS)
Suicide Deaths per 100,000
Rate (per 1000 population)
0.15
0.10
SC
US
0.05
0.00
1990
1991
1992
1993
Source: National Vital Statistics System
1994
1995
1996
1997
Year
1998
1999
2000
2001
2002
2003
2004
Suicides by Age, SC 2004
20
Rate (per 100,000 population)
15
SC
10
US
5
0
5-14
15-24
Source: National Vital Statistics System
25-34
35-44
45-54
55-64
65-74
75-84
85+
Age Group
Comparatively low rates among 15- to 24-year olds.
Violent Crime
7.7
reported offenses per
1,000 residents
64% higher than US
Violent Crime Reports per 1,000
12
Rate (per 1000 population)
10
8
SC
6
US
4
2
0
1995
1996
1997
Source: Uniform Crime Reporting Program
1998
1999
2000
2001
Year
2002
2003
2004
2005
2006
Injuries/Assaults among
Young Adults, US




599,000 18-24 year old students are
unintentionally injured under the influence of
alcohol
696,000 18-24 year old students are assaulted by
another student who has been drinking
97,000 18-24 year old students are victims of
alcohol-related sexual assault or date rape
SC: High school drinker twice as likely to have
been forced to have sex (14%) than non-drinker
Sources: The Surgeon General’s Call to Action to Prevent and Reduce Underage Drinking
2007 and SC YRBS 2007
Teen Pregnancy
 In
2004, there were 52.1 live births per
1,000 women ages 15 to 19 in SC
 41.1
 SC
per 1,000 women in the US
27% higher than US
Teen Sex and Alcohol/Drug Use

19% of SC high school students report alcohol
or drug use before the last time they had sex
(2009 YRBS)

22% nationally
Alcohol Dependence
Dependence/Abuse
(DSM-IV Criteria)
Percent of Persons Age 12 to 17 and 18 to 25 Meeting DSM-IV Criteria
For Alcohol Dependence or Abuse in the Past Year,
South Carolina and US, 2002-2006
25
Percent
20
15
Ages 18 to 25
SC
US
10
5
Ages 12 to 17
0
2002-2003
2003-2004
2004-2005
Year
2005-2006
% o f s tu d e n ts w ith s p e c if ic g ra d e s w h o
e n g a g e in b e h a v io r
Academic Failure
100
Mostly As
80
Mostly Bs
Mostly Cs
60
40
51
37
Mostly D/Fs
42
42
29
18
20
37
32
22
16
18
22
0
Current Alcohol Use
Drank Alcohol Before Age 13
Binge Drinking
Grades Mostly Received by Students Reporting Alcohol Use (Using 2007
YRBS)
Other Drug Use

High school drinkers, compared to nondrinkers, are . . .
Seven times more likely to use smokeless
tobacco or ecstasy
 Eight times more likely to use steroids
 Nine times more likely to use marijuana
 Eleven times more likely to smoke
 Twelve times more likely to use cocaine

DAODAS/PIRE Analysis Using 2007 YRBS Data
Other Correlations

High school drinkers, compared to nondrinkers, are . . .
Twice as likely to have been in a fight
 Twice as likely to have had sex
 Three times as likely to be in a gang
 Three times as likely to carry a weapon
 Four times as likely to ride in a car with a
drinking driver

Underage Drinking is a $1.1 Billion a
Year Problem in South Carolina.
Total Cost
of Underage
Alcohol Use
in SC for 2007:
$1.1 billion
US Total Cost:
Medical Care:
$121 million
Pain & Lost
Quality of Life:
$684 million
Work Loss &
Other Costs:
$263 million
$68 billion
$2,428 per year per youth
PIRE 2008
Costs of Underage Drinking by
Problem, South Carolina 2005
Problem
Total Costs
(in millions)
Youth Violence
$693.2
Youth Traffic Crashes
$168.1
High-Risk Sex, Ages 14-20
$58.4
Youth Property Crime
$55.6
Youth Injury
$32.4
Poisonings and Psychoses
$3.8
FAS Among Mothers Age 15-20
$17.0
Youth Alcohol Treatment
$38.8
Total
$1,067.3
Consumption Patterns
SC Middle School
Use
 SC Adult Use
 SC College Use
 Age of First Use


SC High School
Use
 How much they
drink
 What they drink
 Where they drink
SC Alcohol Use Across Lifespan
Note: This timeline uses a variety of data sources with different methodologies and samples and should not suggest
a “clean” timeline. For general information only. Middle School = 2009 MS YRBS; High School = 2009 HS
YRBS; College = 2009 weighted Core Data from 10 SC colleges; Adult = 2009 BRFSS (18 & older)
2009 South Carolina Middle School YRBS
Percentage of students who ever had a drink of alcohol, other than a few sips
100
80
53.0
60
42.1
41.7
45.4
42.5
41.6
41.9
40
25.0
20
0
Total
Male
Female
QN25 - Weighted Data
*Non-Hispanic.
Missing bars indicate less than 100 students in the subgroup.
6th
7th
8th
Black*
Hispanic/
Latino
White*
Alcohol & Other Drug Use Among HS Students,
2009 YRBS
Alcohol & Other Drug Use Among HS Students,
2009 YRBS
HS Alcohol Use Over Time
Current (Past 30-Day) Alcohol Use among Youths in Grades 9 through 12,
South Carolina and US, 1995 to 2009
US
South Carolina
70
60
Percent
50
40
30
20
10
0
1995
1997
Source: Youth Risk Behavior Survellance System
1999
2001
2003
Year
2005
2007
2009
High School Use (2009 YRBS)
69% had at least one drink of alcohol on
one or more days during their life.
 35% of SC high school students drink;
down 19% from 2005!
 18% engaged in binge drinking in past
month; down 22% from 2005!
 31% of drinkers had their first drink of
alcohol, other than a few sips, before age 13.

SC High School Drinkers
60
50
Percent
40
30
20
10
0
Male
Female
Grade 9
Source: 2007 Youth Risk Behavior Surveillance System
Grade 10
Grade 11
Grade 12
White
Black
Total
Past-Month Drinking: 12 to 25
70
60
Percent
50
A ge 18 to 25
40
SC
US
30
20
10
A ge 12 to 17
0
2002-2003
2003-2004
2004-2005
2005-2006
Year
NSDUH
Initiation Before Age 13, SC
US
South Carolina
50
Percent
40
30
20
10
0
1995
1997
Source: Youth Risk Behavior Survellance System
1999
2001
2003
Year
2005
2007
2009
Past-Month HS Binge Drinking
US
South Carolina
50
Percent
40
30
20
10
0
1995
1997
Source: Youth Risk Behavior Survellance System
1999
2001
2003
Year
2005
2007
2009
High School Binge Drinking
50
40
Percent
30
20
10
0
Male
Female
Grade 9
Source: 2007 Youth Risk Behavior Surveillance System
Grade 10
Grade 11
Grade 12
White
Black
Total
*Defined as five or more drinks on a single occasion
Consumption Amounts (US)

Adults average 2.6 drinks per occasion

Youth average 4.6 drinks per occasion

96% of alcohol consumed by ages 15-20
is done while binge drinking
Frequency and Volume of Use
Adults drink more often, but youth drink more when they drink.
Binge Drinking
WHO USES ALCOHOL MORE
IN HIGH SCHOOL—THOSE
GOING TO COLLEGE OR
NOT?
WHO USES ALCOHOL MORE
IN “COLLEGE-AGE” YEARS,
THOSE IN COLLEGE OR NOT?
“The College Effect”

In HS, those not going to college drink more

A year later, those at college drink more than
non-college peers
US College Drinking

Recent CASA Study

No decline in proportion of college students
who drink or binge drink from 1993-2005
Proportion of students who “frequently” binge
drink is up 16%
Who drink on 10 or more occasions in a month
up 25%
Those who get drunk at least 3 times/month is
up 26%
Who drink to get drunk up 21%




But . . .

“Outside The Classroom” says data they’ve
reviewed from past 3 years show % of
Freshman abstainers is rising for first time in
many years
Core Survey

National survey taken by 10 SC
colleges/universities in 2009
Random sample at each
 N ranged from 223 to 1,062
 Total: 6,119

Prevalence

85% drank in past year



74% drank in past month



Range: 61% to 90%
National (Core Institute ’06): 84%
Range: 39% to 80%
National: 72%
51% engaged in binge drinking in past 2 weeks


Range: 23% to 61%
National: 55%
Comparison by Institution
90
80
70
60
Drinkers
50
40
Bingers
30
Hurt/Injured
20
10
0
A
B
C
D
E
F
G
H
I
J
SC Core Survey Data, 2009
Average Drinks Per Week

Students average 6.4 drinks per week
Range: 1.9 to 8.4
 National: 5.4


If exclude non-drinkers, 9.5 drinks per
week

Range: 5.3 to 11.0
Underage vs. Legal Age Drinking
Avg. Drinks/Week by School
12
10
8
6
Under 21
4
21 and
Over
2
0
A
B
C
D
E
F
G
H
I
J
SC Core Survey Data, 2009
Exploring Drinking—
Drinks/week


Multiple Regression based on # of drinks per
week (if >0)
Significant Factors
Biggest: Gender (males: 12.9; females: 6.3)
 Smaller: Greek (more), religious group (less)
affiliation
 Smallest, but significant: off campus (more), “year”
(Freshmen higher), athletic participation (slightly
higher)
 Not significant: institution, race/ethnicity

Exploring Drinking—Underage
Drinking


Logistic Regression on underage drinkers
Significant Factors
Year (63% Freshmen, 69% Soph, 71% Jr.)
 Race/Ethnicity: (White 71%, AA 46%)
 Residency (off-campus 72%, on 64%)
 Greek (not 60%, attend 80%, leader 87%)
 Religious group (not involved 74%, attended 67%,
active 52%)


Not significant: Gender, Athletics
Exploring Drinking—Binge
Drinking


Logistic Regression on underage drinkers
All Were Significant Factors







Year (46% Fr., 49% Soph., 53% Jr., 55% Sr.)
Race/Ethnicity: (White 55%, AA 26%)
Residency (off-campus 56%, on 44%)
Greek (not 44%, attend 66%, leader 71%)
Religious group (not involved 57%, attended 51%, active
37%)
Athletes (non-athlete 50%, active 52%)
Gender (male 57%, female 45%)
Drinking and Driving (SC Core)

31% drove after drinking in past year
Range: 12% to 37%
 National: 27%


1.1% arrested for DUI
Range: 0.2% to 1.4%
 National: 1.5%

Academic Impact (SC Core)
Average Number of Drinks Per Week by GPA
(Drinkers Only)
12
10
8
6
4
2
0
A
B
C
SC Core Survey Data, 2009
Academic Impact

26% performed poorly on test/project due to
drinking/drug use
Range: 10% to 34%
 National: 22%


36% missed class due to drinking/drugs
Range: 16% to 45%
 National: 30%


25% of U.S. college students have alcoholrelated academic problems (Dept. of Education, 2008)
Getting in Trouble (SC Core)

14% have been in trouble with police or other
authorities due to drinking/drug use
Range: 4% to 22%
 National: 14%

Arguments/Fights (SC Core)

35% have been in argument/fight due to
drinking/drug use
Range: 17% to 42%
 National: 32%


5% involved in physical violence, 74% of
incidents after consuming alcohol/drugs*

*Range: 25% to 81%
Unwanted Sexual Activity
(SC Core)

9.5% of females have been taken advantage of
sexually when alcohol/drugs involved

Range: 4% to 13%
Injury (SC Core)

16% hurt/injured due to drinking/drug use
Range: 7% to 21%
 National: 16%

Addiction (SC Core)

10.5% thought they have a drinking/drug
problem
Range: 3% to 15%
 National: 11%


5% tried unsuccessfully to stop using
alcohol/drugs
Range: 2% to 8%
 National: 5%

What is the drink of
choice for SC high school
students?
Drink of Choice (2009 SC CTC)
Type
Beer
Alcopops
Alcohol Energy
Drinks
Wine Coolers
Wine
Liquor
Other
Overall
23.8%
14.3%
7.4%
Male
28.5%
10.1%
6.9%
Female
19.4%
18.5%
7.5%
3.1%
15.1%
29.7%
6.6%
2.6%
14.7%
31.6%
5.6%
3.6%
16.2%
27.7%
7.2%
ALCOPOPS
Production of Alcopops





A liquid is derived from malt
It is filtered to remove most or all taste, odor
and alcohol
“Flavoring” is added to the liquid, which
includes distilled alcohol
Product distributed as malt beverage (most or all
brewed alcohol is removed – distilled alcohol
only)
Beer classification
Why the Classification?

Advantages – Beer is:
 Advertised
on electronic media
 Taxed at substantially lower tax rates
 Available in a greater # of retail locations,
particularly those likely to be frequented by
underage drinkers
Examples of Alcopops




Bacardi Silver
Mike’s Hard Lemonade
Smirnoff Ice
Smirnoff Raw Tea
The “New” Kid on the Block
Alcoholic
Energy
Drinks
South Carolina 2009 YRBS
Percentage of students who drank premixed alcoholic energy drinks, such as Sparks, Tilt, Rockstar 21, or
Liquid Charge, on one or more of the past 30 days
100
80
60
40
20
12.0
11.5
Total
Male
12.4
9.7
11.1
14.8
13.2
12.1
9.2
0
Female
QN90 - Weighted Data
*Non-Hispanic.
Missing bars indicate less than 100 students in the subgroup.
9th
10th
11th
12th
Black*
Hispanic/
Latino
White*
And where are they getting it?




1.
2.
3.
4.
Someone gave it to me: 37%
Gave someone $ to buy it: 25%
Took it from store or family: 8%
Retail (store/restaurant/event): 11%
Other: 19%
Underage Alcohol Sales in SC





Local compliance checks sale rate (FY’10):
14.5%
Dropping since ‘07 (20.3%)
In 2007, SC underage drinkers consumed 10%
of all alcohol sold in SC.
This accounted for $224 million in sales of
alcohol in SC.
These sales provided profits of $110 million to
the alcohol industry.
Risk Factors & Underlying Conditions









Social norms accepting and/or encouraging use
Insufficient enforcement of laws
Easy social access
Easy retail access
Inappropriate promotion of use
Low or discount pricing
Insufficient laws and policies
Insufficient enforcement of school policies
Lack of identification of early problem behaviors
Social Norms

17,001 alcohol licenses in the state




about 1 per 250 people
AET enforcement operations decreased in FY
‘10, largely due to funding cuts
19% of HS students said they thought their
parents would think it is “not wrong at all” or “a
little big wrong” if they drank (SC CTC)
60% of HS students said alcohol is “very easy”
or “sort of easy” to get (SC CTC)
Social Norms: College

57% of SC college students think the campus
environment promotes alcohol use
Insufficient Enforcement of Laws


AETs have greatly increased enforcement in
many areas, though decreases are happening
All AETs do compliance checks, but party
dispersals, fake ID checks, public safety
checkpoints more sporadic
23 counties w/ dispersals
 32 counties w/ safety checkpoints


Many barriers to getting substantial
administrative penalties against license holders

Local enforcement normally cannot do this
Social Access

SC YRBS: Almost 2/3 of the time, alcohol
provided by adult (non-retail)
Retail Access





In FY ’08, “new” counties to receive local
enforcement had higher rates (22.3% vs. 18.7%)
FY ’10, 6,438 alcohol and 1,088 tobacco
compliance checks (local)
SLED has dropped back to inspections based
on complaints only
Liquor sold more frequently in checks
Youngest clerks most likely to sell
Retail Sales by Outlet Type
Type of Business
Convenience Store/Gas Station
N
(Alcohol
Purchase
Attempts)
% Sales
Completed
(Alcohol)
4,479
13.6
Bar
277
26.0
Restaurant
282
22.7
Liquor Store
456
18.2
Small Grocery
44
18.2
Large Grocery
636
10.8
Drug Store
143
4.9
Inappropriate Promotion




Income from underage drinking = $22
Billion/year (mostly from beer) (IOM, 2003).
Total spent on alcohol advertising = $4.8 billion
Many ads work to “normalize” drinking alcohol
Happy Hour laws reported to be confusing to
law enforcement and retailers
 Rarely enforced
Low or Discount Pricing

SC alcohol sales tax rates:
spirits tax = $4.97;
 table wine tax = $1.08;
 beer tax = $.77.



SC ranked 21st, 11th, and 3rd in the nation for
sales tax rates, respectively,
Meaning: SC has close to an average sales tax on
spirits, a high tax on wine, and a very high tax
on beer.
Pricing



Alcopops taxed as beer
Beer tax unchanged for 30+ years but is still one
of highest in US
Happy Hour laws reported to be confusing to
law enforcement and retailers

Rarely enforced
Insufficient Laws & Policies



Underage drinking laws greatly strengthened in
2007 (PUDAAA)
Communities have very little ability to regulate
alcohol sale issues (power lies with state)
Department of Revenue and SLED alcohol
sections not staffed as they once were
Insufficient Enforcement of
School Policies

Many school policies address penalties but not
referral protocol or responsibility to provide
prevention efforts
Lack of Identification of Early
Problem Behaviors

Many systems that could identify problematic
early alcohol use are not taking full opportunity
to do so:
Schools
 Physicians
 People working with youth
 Parents
 Prevention specialists

Action Steps


Presented by Risk Factor/Underlying Condition
Items listed as “Being Done” and “Could be
Done” are simply examples
Strengths/Weaknesses can be debated
 Not suggesting any planned or future courses of
action or advocacy by DAODAS, CAST, or any
other group

Social Norms
Being Done




Some areas using social
norms campaigns
Active AET enforcement
Media advocacy (getting
better)
Parents Who Host, Lose
the Most
Could Be Done


Working on community
event alcohol sale
policies
Develop local advocacy
groups (youth/adults)
Insufficient Enforcement
Being Done



AETs increased all types
of enforcement, but
dipped
New underage drinking
laws (2007)
Hundreds of officers
trained in laws
Could Be Done




Increased use of
operations targeted
towards consequences,
sources
Sustainability for AETs
Increased EUDL training
at Academy
Better coordination
regarding diversion
programs
Social Access
Being Done



Some AETs doing party
patrols, source
investigations
Parents Who Host
campaign (currently
suspended at state level)
Publicity around transfer
cases
Could Be Done



Social host law
Felony transfer law
Make source
investigations standard
procedure, uniformly
collected
Retail Access
Being Done



Local compliance
enforcement
Increased number of
merchants in education
programs (PREP)
Increased fines,
mandated program for
selling
Could Be Done





Mandated merchant
education in some form
Increased local control
on administrative
enforcement
Stiffer, swifter penalties
for multiple
administrative violations
Felony sale law
Increased promotion of
merchant education
Promotion
Being Done
 Increased attention
to youth-friendly
products
Could Be Done




Remove alcohol
sponsorship from
community events
Enforcement of Happy
Hour violations
Controls on alcohol
advertising
Restrict availability of
youth-friendly products
Pricing
Being Done


Maintain high tax rates
Implement keg
registration
Could Be Done


Classify alcopops as
liquor
Educate law
enforcement on Happy
Hour enforcement
Insufficient Laws/Policies
Being Done

Enhanced laws in 2007
Could Be Done




Restrict alcohol outlet
density
Pass social host
laws/ordinances
Improve Happy Hour
laws
Enhance graduated
drivers license laws
School Policies
Being Done

Educate SROs on
underage drinking trends
Could Be Done


Work with schools on
implementing model
policies
Increase enforcement at
school events
Screening & Referral Systems
Being Done


Educate enforcement,
prevention, parents on
youth alcohol trends
Alcohol Education
Program
Could Be Done


Increase medical
providers use of
screening/brief
interventions
Increase training on
“signs” of underage
drinking