1 The Srgeon General s Call to Action To Prevent and Redce Underage Drinking What It Means to YOU A Gide to Action for Edcators
2 Abot This Srgeon General s Call to Action The Srgeon General, the Nation s top pblic health officer, is appointed by the President of the United States to help protect and promote the health of the Nation. The Srgeon General, a physician, provides the American people with the latest scientific information on how to improve their health and to redce their risk for illness or injry. When a health topic warrants special attention, the Srgeon General may isse a national call to action. The recently pblished Srgeon General s Call to Action To Prevent and Redce Underage Drinking highlights nderage alcohol se as a major pblic health and safety isse. Abot This Gide to Action for Edcators This Gide to Action for Edcators highlights key isses related to nderage drinking fond in the complete Call to Action To Prevent and Redce Underage Drinking. It was developed to provide edcators and other school personnel a gide to what they can do to take action against nderage drinking and why. The Srgeon General believes that, when armed with the knowledge and tools they need to help tackle a significant pblic health problem, parents, edcators, administrators, and policymakers are better able to take action to prevent and redce the problem and the sffering it cases. Sggested Citation: U.S. Department of Health and Hman Services. The Srgeon General s Call to Action To Prevent and Redce Underage Drinking: A Gide to Action for Edcators. U.S. Department of Health and Hman Services, Office of the Srgeon General, All material in this report is in the pblic domain and may be reprodced or copied withot permission from the Federal government. Citation of the sorce is appreciated.
3 TODAY, NEARLY 10.8 MILLION YOUTH, AGES 12-20, ARE UNDERAGE DRINKERS The goal of healthy growth and development for America s yoth a goal shared by parents and teachers, health care providers, and health care policymakers is threatened by nderage drinking. What Is Underage Drinking? Simply pt, nderage drinking is the se of alcohol by a person nder the age of 21, the minimm legal drinking age. With few exceptions, sch as the se of alcohol as part of a religios ceremony, nderage drinking is against the law. Underage drinking is also dangeros; it can have a negative effect on the mind and body of an adolescent in ways many people don t realize. Yet, nderage drinking persists and today, is a serios problem deeply embedded in American cltre. It is time to change that. Tacit acceptance of nderage drinking as a rite of passage mst become nacceptable. It will take repeated work over time in homes and schools, on campses, and in policy arenas. Prevention of nderage drinking mst become a priority an ongoing project for parents, teachers, and other concerned adlts that begins before pberty and contines throghot adolescence. Alcohol is the most widely sed sbstance of abse among America s yoth. A higher percentage of yong people se alcohol than se tobacco or illicit drgs. Past Month Sbstance Use by Grade Percent More adolescents drink than smoke or se drgs. 0 8th 10th 12th Grade Alcohol Cigarettes Marijana Johnston, et al Monitoring the Ftre National Srvey Reslts on Drg Use.
4 THE FACTS As they grow older, the chance that yong people will se alcohol grows. Approximately 10% of 12-year-olds say they have sed alcohol at least once. By age 13 that nmber dobles. And by age 15, approximately 50% have had at least one drink. Yong adlts, ages 18-20, have the highest rate of alcohol dependence in the U.S. poplation, and they are not legally old enogh to drink. Did Yo Know? The start of alcohol se in adolescence is inflenced more by an adolescent s environment than by his or her genetics. Alcohol se by children and adolescents is freqently made possible by adlts. Minors cannot legally obtain alcohol except in special circmstances. FAST FACT Most 6-year-olds know that alcohol is only for adlts. However, between the ages of 9 and 13, yoth begin to think more positively abot alcohol se. That s why it s never too early to start the dialoge abot the dangers of nderage drinking. 2
5 WHAT IS A DRINK, ANYWAY? A drink can come in many forms. It can be a shot of hard liqor or a mixed drink containing vodka, rm, teqila, gin, scotch, etc. It can also be wine, a wine cooler, beer, or malt liqor. A standard drink is any drink that contains abot 14 grams of pre alcohol (abot 0.6 flid onces or 1.2 tablespoons). This is the amont of alcohol sally fond in One 12-once beer One 4- to 5-once glass of wine One 1.5-once shot of 80 proof liqor What s a Standard Drink? Bt not all drinks are standard drinks. In fact, different drinks often have different amonts of alcohol. Mixed drinks may contain more than one shot of liqor, and different beers or wines may not have the same amont of alcohol in them, even when the drinks are the same size. For example, some beers and beer prodcts, like ice beers, and malt liqors, and some wines, have more alcohol than others. Remember, the legal drinking age is 21 and nderage drinking can be a threat to health and development.
6 Why Is Underage Drinking A Problem? So many kids drink. Alcohol is the most widely sed sbstance of abse among America s yoth. By age 18, more than 70% of teens have had at least one drink. Percent of Yoth Who Have Used Alcohol by Age and Gender When kids drink, they drink heavily. Teens drink less freqently than adlts, bt when teens do drink, they drink more than adlts. On average, yoth have abot five drinks on a single occasion. This is the definition of binge drinking, a very dangeros drinking pattern with potentially serios sometimes lethal conseqences. Percent Age male female SAMHSA, 2005 National Srvey on Drg Use & Health (NSDUH) FAST FACT Underage drinkers are at risk for heavy drinking later in life. Adlts who report first sing alcohol before age 15 are five times more likely to also report abse of or dependence on alcohol than are adlts who first sed alcohol at age 21 or older. Approximately 40% of individals who drink before age 15 report having symptoms at some point in their lives that fit a diagnosis of alcohol dependence. This is for times as many as among those who do not drink before age 21. Death and injry rates increase 200% between the early teen years and early adlt life, in large part becase of dangeros activities like nderage drinking. Preventing teen alcohol se saves lives. Alcohol may have a special allre for yoth. Adolescence is a time of adventre, of taking on new challenges, and of striving toward adlthood. It is also a time of sensation-seeking and increased risk-taking. Underage drinking is a risk many teens are willing to take, bt it also is a risk for which teens may be nprepared. They may not anticipate jst how alcohol affects their behavior and their bodies. As a reslt, nderage drinking can have a damaging effect, not only on teens, bt also on families, schools, commnities, and the Nation as a whole. Often the conseqences involve innocent victims.
7 The reslts of nderage drinking can be grave Underage Alcohol Use Is a major case of death from injries among yong people. Each year, approximately 5,000 people nder the age of 21 die as a reslt of nderage drinking; this incldes abot 1,900 deaths from motor vehicle crashes, 1,600 as a reslt of homicides, 300 from sicide, as well as hndreds from other injries sch as falls, brns, and drownings. Increases the risk of carrying ot, or being a victim of, physical or sexal assalt. Can case a range of physical conseqences.physical effects of nderage drinking range from hangovers to death from alcohol poisoning. Is associated with other problems. These may inclde academic failre, legal problems, and drg se. Interferes with an adolescent s ability to jdge risk and make sond decisions. For example, after drinking, a teen may not flly appreciate the risk of driving a car nder the inflence or too fast, the risks of sexal activity, or the risk of aggressive or violent behavior. The reslt of sch behaviors can be life-changing, whether as the reslt of illness or injry, or involvement with the jvenile jstice system. Plays a significant role in risky sexal behavior. This leads to nwanted, nintended, and nprotected sexal activity, and sex with mltiple partners. Sch behavior increases the risk for nplanned pregnancy and sexally transmitted diseases (STDs), inclding infection with HIV, the virs that cases AIDS. Can case changes in the strctre and fnction of the developing brain, especially when kids drink heavily. This is a major concern becase (1) the brain contines to develop into the mid-20s, (2) so many adolescents begin to drink at a yong age, and (3) so many yoth binge when they drink.
8 Adolescence is a Time of Many Changes Adolescence is a time of dramatic physical growth and change. Adolescence is fll of transitions from elementary to middle school and from middle to high school. Peer grops change; responsibilities increase (sch as driving, additional chores, or paying jobs). Adolescents have greater independence from their parents and spend more time with peers and by themselves. They also tend to stay p later and sleep in. Adolescents are increasingly concerned abot social stats, are searching for self-identity, and are experiencing growing romantic and sexal interests. Adolescents experience greater emotional intensity and are particlarly sensitive to their social environment and to highly emotional sitations. Dring adolescence the desire for adventre, excitement, and action increases. So does the potential for greater risk-taking, independence-seeking, and a desire to try new things. These changes are important steps on the road to adlt life. However, these changes also increase the chance that some yong people may trn to alcohol. FAST FACT Factors in an adolescent s environment affect both the appeal of alcohol and its availability. Among these factors are the social systems within which teens fnction and with which they interact. Examples of these social systems are parents, friends, family, schools, and the commnity. The media and the larger social cltre, inclding how alcohol is marketed and portrayed, also contribte to alcohol s appeal to yong people.
9 Why Teens May Choose to Drink An adolescent s decision to se alcohol is inflenced by many factors, some physical, some emotional, and some environmental. These factors also inflence each other. They inclde The social systems in which teens live The increase in risk-taking that sally accompanies adolescence Decreased parental spervision and greater independence Increased time spent alone and with peers Increased stress What adolescents see and hear abot alcohol FAST FACT Yoth with histories of behavior problems (for example, delinqent activity, implsive actions, and difficlty controlling responses) are more likely to se alcohol than are other yong people. The same is tre for yoth who have an nsally strong desire for new experiences and sensations, and for those with histories of family conflict and stress, and/or alcohol problems. 7
10 Underage Drinking Is Everyone s Problem Underage drinking can affect anyone, inclding the teen who doesn t drink. Drinkers and non-drinkers alike can be affected by lod and aggressive behavior, property damage, injries, violence, and even death reslting from nderage alcohol se. Abot 45% of those who die in crashes involving a drinking driver nder age 21 are people other than the driver. These second-hand effects often strike at random, making nderage alcohol se trly everybody s problem. FAST FACT Adolescents matre at different rates. Some grow p faster; others grow p more slowly. Risk and protective factors related to alcohol se shift throghot adolescence. Edcators need to be alert to these changes and se different, developmentally appropriate approaches to help protect yoth from nderage alcohol se. After all, nderage drinking places or Nation s most valable resorce its yoth at risk. 8
11 Preventing and redcing nderage drinking is everyone s responsibility. There is a role for everyone. Everyone needs to work together to change the cltre arond nderage drinking. For yoth themselves, prevention means nderstanding the dangers of alcohol se, changing how they think abot drinking, and obeying the laws against consmption. For edcators, prevention means being aware of how school and other social systems families, stdents peers, the larger commnity, the media, among others can affect stdents risks for nderage drinking. It means taking action in a developmentally sensitive way to help stdents navigate the challenges of adolescence in positive ways, inclding rejecting nderage alcohol consmption. FAST FACT The majority of adolescents who start drinking do so when they are in the 7 th or 8 th grade and are abot years old. That s why parents, caregivers, teachers, and others shold start talking with children abot alcohol se well before the teen years and shold contine talking with them throghot adolescence. It s time to stop accepting teen drinking as a rite of passage and to nderstand the threat it poses to healthy development. It s time to replace an environment that all too often enables nderage alcohol se with an environment that discorages it. 9
12 What edcators can do abot nderage alcohol se Althogh nderage drinking is widespread, nderage alcohol se is not inevitable. Schools and teachers have a significant impact on an adolescent s life. The climate and cohesiveness of a school can play an important role in the development of an adolescent s self-identity. Schools and teachers can help change attitdes abot teen drinking and help replace environments that enable nderage alcohol se with environments that discorage it. Schools and Teachers Can: Help create an environment that can protect yoth from nderage drinking. Encorage stdent involvement in school, a factor in redcing nderage alcohol se. Create an environment that helps stdents explore their talents and follow their passions, whether academic, msical, sports, or social or commnity cases. Provide stdents opportnities for validation and belonging. Increase positive otcomes for adolescents by being a mentor, a valed teacher, or other caring adlt. Provide information to parents on the conseqences of nderage alcohol se, school policies and practices on alcohol se, and local sorces for more information. Recognize that significant social transitions (sch as gradating to middle or high school or getting a driver s license) are accompanied by increasing responsibility, freedom, social pressre, and/or more demanding academic reqirements, all of which may increase the likelihood of alcohol se. At sch times, teachers and staff can be particlarly alert and spportive. Consider making a special effort to connect stdents with an adlt who can serve as a mentor and confidant. Recognize that children who matre earlier or later than the majority of their peers may be at increased risk. Provide and promote mltiple venes where adolescents can get together with their friends. 10
13 Decrease the risk of adolescent alcohol se and the associated negative conseqences. Discorage violation of alcohol rles by consistently enforcing them. Provide stdents with the developmentally appropriate knowledge, skills, and motivation to resist peer and other pressres to drink. Identify and refer stdents sing alcohol for appropriate interventions. Ensre that school nrses are trained to recognize alcohol-related problems, to intervene appropriately when problems are fond, and to be familiar with the referral network. Work with the commnity to ensre that the necessary infrastrctre is in place so stdents in need of services and treatment can be referred to appropriate personnel or health care providers. Establish and enforce strict policies against alcohol se on school property and at school events. Only sponsor interventions that research has confirmed are effective in preventing and redcing nderage alcohol se. Working with Others Teachers can be a positive force in a stdent s life, and that can help prevent nderage drinking. Teachers also need the help and spport of parents and commnities. Schools can work with others to ensre that Families, school colleages, and commnities spport and reward an adolescent s decision not to drink. Protective rles arond adolescent alcohol se are in place, penalties for violations are well known, and enforcement is sre and niform. All laws related to nderage alcohol se are reglarly pblicized and well enforced. Parties and other social events do not allow nderage drinking. 11
14 Advancing the call to action The Srgeon General s Call to Action To Prevent and Redce Underage Drinking was developed to expand pblic knowledge abot nderage drinking and to encorage action by individals and organizations nationwide. Each person in America has a role to play to help prevent and redce nderage alcohol se. This Call to Action is designed to help America rethink nderage drinking as we know it today. It provides the tools to get the word ot in discssions arond the dinner table, in school or camps-based programs, and in commnities. It can also inform local, Tribal, State, and national programs and policies. Teachers, parents, and others who work with children and yoth are better able to protect adolescents from the negative conseqences of alcohol se when they nderstand how nderage drinking affects the development of a child s, or adolescent s body and brain. Teachers and other edcators can more effectively inflence adolescent decisions abot drinking when they recognize, appreciate, and respond to individal characteristics of the adolescent. Finally, teachers and other edcators can help create a more protective environment for adolescents when they work with other edcators, parents, health care professionals, commnities, and policymakers to prevent and redce nderage drinking. This Call to Action is exactly that: a call to every American to join with the Srgeon General in a national effort to address nderage drinking early, continosly, and in the context of hman development. Underage alcohol se is everyone s problem and its soltions are everyone s responsibility. References for A Gide to Action for Edcators The data, facts, and sggestions presented here come primarily from the Srgeon General s Call to Action To Prevent and Redce Underage Drinking, cited on the inside front cover. Other sorces of some data presented in this docment inclde: Grant BF, Dawson DA, Stinson FS, Cho SP, Dfor MC, Pickering RP. The 12-month prevalence and trends in DSM-IV alcohol abse and dependence: United States, and Drg and Alcohol Dependence 74: , Johnston LD, O Malley PM, Bachman JG, Schlenberg JE. (December 21, 2006). Teen drg se contines down in 2006, particlarly among older teens; bt se of prescription-type drgs remains high. University of Michigan News and Information Services: Ann Arbor, MI. [On-line]. Available: accessed 01/03/07. Sbstance Abse and Mental Health Services Administration. Reslts from the 2005 National Srvey on Drg Use and Health: National Findings. Rockville (MD): U.S. Department of Health and Hman Services, Sbstance Abse and Mental Health Services Administration; Available: accessed 01/03/07. 12
15 Acknowledgements This pblic docment was prepared by the U.S. Department of Health and Hman Services (DHHS) nder the direction of the Office of the Srgeon General. Its prpose is to make information contained in the Srgeon General s Call to Action To Prevent and Redce Underage Drinking available in a brief, accessible format to improve pblic knowledge on this topic. Rear Admiral Kenneth P. Moritsg, M.D., M.P.H., Acting Srgeon General, U.S. Pblic Health Service, Office of the Srgeon General, Office of the Secretary, DHHS, Washington, D.C. Richard H. Carmona, M.D., M.P.H., F.A.C.S., former Srgeon General, U.S. Pblic Health Service, Office of the Srgeon General, Office of the Secretary, DHHS, Washington, D.C. Commander Karen A. Near, M.D., M.S., Senior Science Advisor, Office of the Srgeon General, U.S. Pblic Health Service, Office of the Secretary, DHHS, Washington, D.C. Ron Schoenfeld, Ph.D., former Senior Science Advisor, Office of the Srgeon General, U.S. Pblic Health Service, Office of the Secretary, DHHS, Washington, D.C. Ting-Kai Li, M.D., Director, National Institte on Alcohol Abse and Alcoholism, DHHS, Bethesda, MD. Rear Admiral Eric B. Broderick, D.D.S., M.P.H., Acting Depty Administrator, Assistant Srgeon General, Sbstance Abse and Mental Health Services Administration, DHHS, Rockville, MD. Editors and Writers Patricia A. Powell, Ph.D., Senior Scientific Editor, Acting Chief, Science Policy Branch, Office of Science Policy and Commnications, National Institte on Alcohol Abse and Alcoholism, DHHS, Bethesda, MD. Vivian B. Faden, Ph.D., Senior Scientific Editor, Depty Director, Division of Epidemiology and Prevention Research, National Institte on Alcohol Abse and Alcoholism, DHHS, Bethesda, MD. Stephen Wing, M.S.W., Associate Administrator for Alcohol Policy, Sbstance Abse and Mental Health Services Administration, DHHS, Rockville, MD. Science Writers Hamilton Beazley, Ph.D. Scholar-in-Residence, St. Edward s University, Astin, TX. Theodora Fine, M.A., A.B.D., Exective Officer, Fine WordCrafters: Commnications and Editing Alchemy, Ellicott City, MD. 13
16 for more information Underage drinking is a pblic health and safety problem that reslts in serios personal, social, and economic conseqences for adolescents, their families, commnities, and the Nation as a whole. Yor involvement can make a difference. Many free sorces of information are available to help yo take action to prevent and redce nderage drinking. Some of the materials can help yo better edcate yor stdents and their families, yor colleages, and yor commnity abot the dangers of nderage drinking and how to help stop it before it starts. To read the entire Srgeon General s Call to Action To Prevent and Redce Underage Drinking, be sre to log on to the Srgeon General s Web site at For more information abot ways yo can help to prevent and redce nderage drinking in yor commnity, please check ot, a comprehensive portal of Federal resorces for information on nderage drinking and ideas for combating the problem. Another excellent sorce of information is the Web site of the National Institte on Alcohol Abse and Alcoholism at General information abot nderage drinking, its effects on adolescents, families, and commnities, and what yo can do to help stop nderage drinking is available throgh the National Clearinghose on Alcohol and Drg Information (NCADI), on the Internet at or by calling (800) The words and images in this Gide to Action were designed to reach a broad adience. Copies of this booklet and the Srgeon General s Call to Action To Prevent and Redce Underage Drinking can be downloaded from both of the Web sites noted. To order copies by mail, please contact the National Clearinghose on Alcohol and Drg Information (NCADI) or by calling (800)
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