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Recent Trends and Findings Regarding the Magnitude and Prevention of College and Underage Drinking Problems

Recent Trends and Findings Regarding the Magnitude and Prevention of College and Underage Drinking Problems. Ralph Hingson, Sc.D., M.P.H. Director, Division of Epidemiology and Prevention Research National Institute on Alcohol Abuse and Alcoholism

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Recent Trends and Findings Regarding the Magnitude and Prevention of College and Underage Drinking Problems

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  1. Recent Trends and Findings Regarding the Magnitude and Prevention of College and Underage Drinking Problems • Ralph Hingson, Sc.D., M.P.H. • Director, Division of Epidemiology and Prevention Research • National Institute on Alcohol Abuse and Alcoholism • WV Collegiate Initiative to Address High Risk Alcohol Use Training Institute: • Promoting Healthy Campus Environments • Davis & Elkins College • Elkins, WV • May 18, 2011

  2. Alcohol Attributable Deaths in the United States, Annual Average, 2001-2005 • 79,696 • 3rd leading cause of preventable deaths • Injury (including poisoning): 43,731 • Chronic disease: 35,915 • 9,625 alcohol attributable deaths are ages 25 or younger • Nearly 5,000 injury deaths attributable to underage drinking Sources: CDC, ARDI, 2009; U.S. Surgeon General’s Call to Action to Prevent and Reduce Underage Drinking, 2007

  3. Alcohol Attributable Deaths: Acute Conditions 43,731 Source: CDC: ARDI, 2009

  4. Low-Risk Drinking Limits Source: NIAAA, Rethinking Drinking: Alcohol and Your Health, 2009

  5. Youth Ages 18-24 Are Most Likely to Exceed Low-Risk Drinking Limits • 9% of population age 18+ exceeds both daily and weekly limits (20 million) • 25% of people age 18-24 exceed both limits (7 million) Sources: NIAAA, Rethinking Drinking: Alcohol and Your Health, 2009; National Epidemiologic Survey on Alcohol and Related Conditions

  6. Youth Ages 18-24 Are Most Likely to Experience Alcohol Dependence • 4% of the adult U.S. population met alcohol dependence criteria in the past year, representing 7.9 million people • Youth are most affected • 12.5% of persons ages 18-20 (1.6 million) • 11% of persons ages 21-24 (1.8 million) • Total ages 18-24 (3.4 million) • Youth 18-24 are: • 16% of the population age 18 and older • 43% of that population who met alcohol dependence criteria in the past year Source: NIAAA, NESARC, 2002

  7. Magnitude of Alcohol Problems on U.S. College Campuses Dr. Margaret Jonathan Travis Moore Levy Stedman Hingson et al. (2002) J. Studies on Alcohol

  8. Key Findings: Trends in Alcohol-Related Mortality and Morbidity Among U.S. College Students, 1998-2007 • Among college students ages 18-24: • Unintentional alcohol-related injury deaths per 100,000 increase d 1% from 1,440 to 1,870 • The proportion who: • Drank 5+ drinks per occasion increased 3% (41.7%-43%) • Drove under the influence decreased 1% (26.1%-25.2%) • The highest proportions engaging in these behaviors are among 21-24 year olds, not 18-20 year olds

  9. Alcohol: Trends in 2-Week Prevalence of 5 or More Drinks in a Row among College Students vs. Others 1-4 Years Beyond HS Federal 21 Drinking Age Drinking Age 21 in all states Full-time College Students Other 1-4 Yrs. Past HS 12th Graders Source: Monitoring the Future, 2007

  10. Percentage Binge Drinking, Ages 18-20 & 21-25 in College and Not in College Ages 21-25 college Ages 21-25 Not college Ages 18-20 college Ages 18-20 not college National Household Survey on Drug Use and Health, 2007

  11. Percentage Drove Under the Influence of Alcohol, Ages 18-20 & 21-25 in College and Not in College Ages 21-25 college Ages 21-25 Not college Ages 18-20 college Ages 18-20 not college National Household Survey on Drug Use and Health, 2007

  12. Consumption of 10+ Drinks or More or 21+ Drinks on an Occasion in Past Year by U.S. 18-20 and 21-24 Year Olds, 1991-92 vs. 2001-02 10+ drinks Ages 21-24 10+ drinks Ages 21-24 Ages 18-20 Percent Ages 18-20 21+ drinks Ages 21-24 21+ drinks Ages 18-20 Ages 18-20 Ages 21-24 Not In College In College

  13. Alcohol-Related Traffic Fatalities, Rate per 100,000, Ages 18-20 vs. 21-24, United States, 1982-2007 U.S. MLDA Age 21 law MLDA 21 in all 50 states Data in initial NIAAA college report 30.25 (n=3,867) Ages 21-24 ↓44% 27.35 (n=4,733) 15.33 (n=2,583) 11.97 (n=1,520) Ages 18-20 ↓60% Source: U.S. Fatality Analysis Reporting System, 2009; U.S. Census Bureau, 2009

  14. Alcohol-Related Non-Traffic Unintentional Injury Deaths Among 18-24 Year Olds, 1998 vs. 2007

  15. Alcohol Related Behaviors and Consequences of 18-24 Year Olds in the U.S. 2007 (Estimates)

  16. College Alcohol Study The younger college students were when first drunk, the more likely they will experience in college: • Alcohol Dependence • Drive after drinking • Alcohol related injury • Unplanned and unprotected sex after drinking Source: Hingson, Heeren, Winter. J. Studies on Alcohol 2003, Pediatrics 2003

  17. Youth Risk Behavior Survey2009 • Nearly 1 million high school students and nearly 2 million 12-20 year olds consume 5 or more drinks 6 or more times per month. They are much more likely to • Ride with a drinking driver • Drive after Drinking • Never wear safety belts • Carry weapons/guns • Be bullied • Be injured in a fight • Be injured in a suicide attempt • Be forced to have sex • Had sex with 6 or more partner • Have unprotected sex • Use Marijuana/cocaine • Ever injected drugs

  18. Youth Risk Behavior Survey2009 • Frequent binge drinkers compared to abstainers in high school were much more likely in the past month to: Drink at school 32% vs. 0% Use marijuana at school 24% vs. 1% Earned mostly D’s and F’s in 14% vs. 4% school within the past year

  19. Squeglia et al., Psychology of Addictive Behaviors, 2009 • Prospective research indicates moderate to heavy alcohol use predicts changes in neuropsychological functioning for adolescent girls and boys • Examined 75 persons ages 12-14 before drinking began • 25 transitioned into heavy drinking (11 girls, 14 boys) • Controlled for tobacco and other drug use, family history density of alcohol use disorder, socioeconomic status, education, and occupation

  20. Squeglia et al. (cont.) • Results: • Girls: More drinking days (12+) per month predicted reduction in visuospatial task performance (could affect driving and figural reasoning • Boys: Greater past-year hangover symptoms predicted worsened sustained attention

  21. Conclusion • In the U.S. there is an urgent need to expand and improve prevention, screening and treatment programs and policies to reduce alcohol related harm • Persons under 21 • Among college students • Persons of similar ages not in college

  22. Conclusion • There is an important need to improve surveillance of alcohol-attributable mortality • Mortality data need college identifiers • All injury and poisoning deaths should be tested for alcohol

  23. Need to test all injury deaths under age 21 for alcohol

  24. Interventions • Individually oriented • Family • School • Environmental • Comprehensive Community Interventions

  25. GentilelloBrief Motivational Alcohol Intervention in a Trauma Center; Annals of Surgery, 1999 • 46% of injured trauma center patients age 18 and older screened positive for alcohol problems. • Half (N=336) randomly allocated to receive 30 minute brief intervention to reduce risky drinking and offers links to alcohol treatment

  26. GentilelloBrief Motivational Alcohol Intervention in a Trauma Center; Annals of Surgery, 1999 • Reduced alcohol consumption by an average 21 drinks per week at 1 year follow up • 47% reduction in new injuries requiring treatment in ED • 48% reduction in hospital admissions for injury over 3 years • 23% fewer drunk driving arrests

  27. Systematic Review of Randomized Trials of Brief Interventions from 1992-2004(Solberg et al., Am. J. Prev. Med, 2008) • “Results make alcohol screening and counseling one of the highest ranking preventive services among 25 effective services.” • Similar score as screening for -hypertension -colorectal cancer -vision for adults age 65 and older

  28. Tripodi et al. Interventions for Reducing Adolescent Alcohol Abuse. Arch Pediatr Adolesc Med, 2010 • Methods: • First meta-analysis to examine individual and family oriented interventions aimed at reducing adolescent alcohol consumption • Reviewed scientific literature from 1960-2008 (11 different research article data bases) • 16 studies of interventions to reduce alcohol use targeted adolescents ages 12-19 (published 1994-2008) • Outcomes (alcohol abstinence, frequency and quantity of drinking, alcohol problems) compared to control group, wait list, other treatment

  29. Tripodi et al. (cont.) • Results: • All tested interventions yielded reductions in alcohol use • Large effects found for: • Brief motivational interventions active with after care • Brief intervention with adolescent and parent • Brief intervention with adolescent • Cognitive behavioral therapy with 12-step approach • Multi-Dimensional family therapy • Conclusion: • More research needed to determine whether individually oriented vs. family therapies produce greater benefits • While effects declined over time, both individual and family-based approaches produced significant reductions in alcohol use at 12 months post treatment

  30. Strong Support for Individual Level Interventions Among College Students • Reduce drinking and related problems • Larimer, Addictive Behaviors, 2007 • Review of 18 experimental studies of brief interventions • Carey et al., Addictive Behaviors, 2007 • Meta-analysis of 62 controlled studies • Face-to-face interventions most effective • Motivational interview • Personalized normative feedback

  31. Implementation Gap • 19% of College Students 18-24 met DSM IV Alcohol Abuse or Dependence Criteria • 5% of them sought treatment in the past year • 1.5 million 12-17 year olds need treatment • Only 14% have received treatment Source: National Epidemiologic Study of Alcohol Related Conditions 2002; National Household Survey of Drug Use and Health, 2005

  32. Barriers to Screening • Time to ask questions • Time to respond to questions • Lack of training • Lack of treatment centers for referral • Reimbursement issues

  33. Insurers' Liability for Health/ Sickness Losses Due to Intoxication ("UPPL") as of January 1, 2010

  34. Screening and Brief Alcohol Intervention at College Health Center • Screened all students at health service for at-risk drinkers • Past 2 weeks • 5+ per occasion for men • 4+ per occasion for women • Excluded and referred for treatment • BAC>0.35 • Drank 200+ in past 30 days Source: Schaus et al., J. Stud. Alcohol Drug, Suppl. No. 16, 2009

  35. Screening and Brief Alcohol Intervention (cont.) • Interventions Based on 2 brief motivational interventions (MI) (20 minute sessions) • Patient-Centered MI (Miller & Rollnick, 2002) • NIAAA curriculum to reduce high risk drinking in college students (Fleming, 2002) • Brief alcohol screening and intervention for college student BASICS (DiMeff, 1999) • Results • 3 months • Reduction in typical and peak BAC • Peak drinks/setting • Drinks/week • Foolish risk-taking • 6 + 9 months • Lower scores (Rutgers Alcohol Problem Index (RAPI)) Source: Schaus et al., J. Stud. Alcohol Drug, Suppl. No. 16, 2009

  36. Fleming et al. Brief Physician Advice for Heavy Drinking College Students, Journal of Studies on Alcohol and Drugs, 2010 • Brief intervention studied at5 college student health services • Similar results as Schaus

  37. Social Norms Interventions to Reduce Alcohol Misuse Among College Students • Methods • Review of Medline, EMBASE, PsyInfo, CINAHL (up to March 2008) • Identified 22 randomized trials RTC or cluster RTCs (N=7,275 participants) • Studied effects of: • Web/Computer feedback • Individual face-to-face feedback • Group face-to-face feedback • Mailed feedback • Social marketing Source: Moreira et al., Cochrane Reviews, 2009

  38. Social Norms Interventions (cont.) • Group face-to-face feedback • Reduced at 3 months: • Quantity of drinking • Binge drinking • Mailed feedback • No effects • Social Norms Marketing • Mixed results - only 2 experimental studies (DeJong, 2006; DeJong, 2008) • Results • Web/Computer Feedback • Reduced at 3 months, 4-16 months: • Alcohol problems • Peak BAC • Frequency of drinking • Quantity of drinking • Binge drinking • Individual face-to-face feedback • Reduced at 3 months: • Frequency of drinking • Binge drinking • Reduced at 4-6 months: • Alcohol-Related problems • Frequency of drinking • Reduced at 17+ months: • Alcohol-Related problems Source: Moreira et al., Cochrane Reviews, 2009

  39. School Based Programs • Programs that rely primarily on increasing knowledge about consequences of drinking are not effective. • School only program effects are generally small • Most Effective Programs : • Address social pressures to drink and teach resistance skills • Include developmentally appropriate information • Include peer-led components • Provide teacher training • Are interactive • Include community and family components (e.g. Pentz, 1989; Perry et al., 1996, 2002; Spoth et al., 2001, 2004) Sources: NIAAA, Alcohol and Development in Youth: A Multidisciplinary Overview, 2005; Spoth et al., Pediatrics, 2008

  40. Family Influences on Youth Drinking 12-20 • Children of parents who binge, compared with abstainers, are twice as likely to • Binge (20% vs. 10%) • Meet alcohol dependence/abuse criteria (10% vs. 5%) Source: SAMHSA, Findings From the 2002-2006 National Surveys on Drug Use and Health, 2008

  41. Studies Indicating a Statistically Significant Association Between Parents Providing Alcohol at Home to Their Children and Subsequent Alcohol Use or Problems Among Those Children • Home Availability Linked to Heavier Childhood Drinking: • McMorris et al., J Stud Alcohol Drugs 72: 418-428, 2011 • Van Den Eijnden et al., J Stud Alcohol Drugs 72: 408-417, 2011 • Van der Vorst, J Stud Alcohol Drugs 71: 105-114, 2010 • Livingston et al., Addict Behav35(12): 1105-1112, 2010 • Komro et al., Addiction 102: 1597–1608, 2008 • Lundborg, Vulnerable Child Youth Stud 2(1): 60-70, 2007 • Foley et al., J Adol Health 34(5): e17-e26, 2004 • Jackson et al., J Stud Alcohol 60: 362-367, 1999 • Dielman et al., J Sch Health 59(6): 255-263, 1989

  42. Studies Showing Adult Provision at Home was Protective • Home Availability Protective: • Bellis et al., Subst Abuse Treat Prev Policy 2: 15, 2007 • Foley et al., J Adol Health 34(5): e17-e26, 2004

  43. McMorris et al., Parental Supervised Alcohol Use, JSAD, 2011 • Methods: • N= 961 students in Washington State • N=984 in Victoria, Australia • Surveyed in school in 7th and again in 8th and 9th grades • Results: • By 7th grade, 59% of Australian and 39% of Washington State youth had consumed alcohol • By 8th grade, 2/3 of Australian and 35% of Washington State youth reported drinking in adult-supervised settings • Both consumption of alcohol by 7th grade and adult-supervised drinking by 8th grade independently predicted more frequent drinking and higher alcohol problems experience scores in 9th grade independent of student perception of their parents’ attitudes towards alcohol.

  44. Family Interventions Iowa Strengthening Families Program Goals: • Improve parent/child relations • Strengthen family communication skills • Increase child coping skills Implementation: • 7 sessions at school • 13 hours total • Parent and child separately and together Spoth et al., J Consulting Clinical Psychology (2001, 2004)

  45. Family Interventions A randomized controlled trial with families of 6th graders: • Iowa Strengthening Families Program (ISFP) (206 families) • Preparing for Drug Free Years Program (PDFYP) (221 families) • Control (221 families) Lifetime Drunkenness Through 6 Years Past Baseline: Logistic Growth Curve Trajectory for ISFP Condition Trajectory for Control Condition 0 6 18 30 48 72 Months • Results Persist at age 21 (Spoth, 2009) Source: Spoth, Redmond, Shin J Consulting Clinical Psychology (2001, 2004, 2009)

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