1. William F. Wieczorek, Ph.D., CRA Director and Professor Center for Health and Social Research Buffalo State College 1300 Elmwood Ave. Buffalo. NY 14222 Overview of Underage Alcohol Use and Problems: Why It’s Everybody’s Problem Presented at PX2010 Underage Drinking: It’s Everybody’s Problem Conference, April 28, 2010, Buffalo, NY

2. Presentation Overview 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

3. Beverage Alcohol Source of virtually all beverage alcohol (ethanol/ethyl alcohol) is fermentation (max content about 14% ethyl alcohol by volume) C 6 H 12 O 6 → 2C 2 H 5 OH + 2CO 2 –Glucose in aqueous solution with yeast yields ethanol, gas, and energy (anaerobic respiration) Distillation is necessary for high percent alcohol by volume liquors.

4. 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)

6. 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

7. Addicted vs Non-addicted Dopamine System

8. Underage drinkers consume about 17% of all alcohol in US! Miller, TR, et al. (2006) Journal of Studies on Alcohol, 67(4) 519-528.

9. 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?

10. 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) DALY i = YLL i + YLD i –YLL = Years of life lost –YLD = Years lived with disability(adjusted for the severity) Allows comparisons across causes!

11. 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)

12. 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, Gastro- esophageal 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

13. Alcohol Attributable DALYS

14. 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)www.plosmedicine.org World Health Report 2002 Wegman & Said (2007) Chance, 20(3),17-25 Compare risk by examining predictors of DALYS

15. Burden of Disease in Developed Regions of the World

16. Burden in North America (Said & Wegman, 2007, Chance)

17. 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!

18. Alcohol: Favorite Drug of Teens I

19. Alcohol: Favorite Drug of Teens II

20. Adolescents Tend to Drink To Excess I

21. Adolescents Tend to Drink To Excess II

22. Adolescents Tend to Drink To Excess III

23. Underage Drinking Rates

24. Underage Drinking by Gender and Ethnicity

25. Local Underage Drinking by 9 th Graders

26. 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 Alcohol and Adolescent Health

27. Main Causes of Death for Adolescents

28. Main Cause of Fatal Injuries for Adolescents

29. Alcohol and Fatal Crashes (NHTSA, DOT HS 811 169) About 1/3 of fatalities are alcohol-related.

30. 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

31. 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!

32. Alcohol Dependence Most Prevalent Among Young People (18-24 yr olds)

33. More Underage Drinkers Use Illicit Drugs (OJJDP, 2008. Co-occurrence of Substance Use Behaviors in Youth)

34. Underage Drinkers & Delinquency (OJJDP, 2008. Co-occurrence of Substance Use Behaviors in Youth)

35. Underage Drinking and High School Grades

36. 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.

37. Costs of Underage Drinking (OJJDP www.udetc.org/StateInformation.asp) Direct costs alone over $1.1 billion.

38. Costs by Category 80% of costs are violence and injuries.

39. 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

40. Few Underage Drinkers Purchase Own Alcohol

41. Sources of Alcohol Not Purchased by Underage Drinker

42. Everybody Influences Adolescents (Surgeon General’s Call To Action on Underage Drinking)

43. Underage Drinking Impacts Everybody in Our Community 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

44. PX2010 Initiative as Erie County Response to Underage Drinking Px20 group http://www.px20.orghttp://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

45. 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

46. Thanks for your attention!