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IOM Report

Reducing Underage Drinking: A Collective Responsibility
A Report by the National Research Council and Institute of Medicine of the National Academies of Science

In 2002, Congress allocated $500,000 to the Institute of Medicine (IOM) of the National Academy of Sciences to create a strategy to reduce and prevent underage drinking. Underage drinking costs the nation an estimated $53 billion annually, due in part to losses stemming from traffic fatalities and violent crime. The legislation called for a review of existing federal and state alcohol prevention programs to establish a more effective underage drinking campaign housed in the Department of Health and Human Services.

In September, 2003, the IOM released a comprehensive strategy to address underage drinking. The report, “Reducing Underage Drinking: A Collective Responsibility,” calls for a collective effort to address the problem from many constituencies, including alcohol manufacturers and retail businesses, the entertainment industry, and parents and other adults in local communities.

The report advises state and local leaders to develop activities and programs tailored to specific circumstances of underage drinking in their communities. For instance, because youth often obtain alcohol from adults, the report recommends that states and localities should use educational and enforcement measures to boost compliance with laws that prohibit selling or providing alcohol to children and underage youth. Among the recommended steps are increasing the frequency of compliance checks, in which authorities monitor whether businesses are obeying minimum-drinking-age laws and levy fines when necessary.

The report also states that federal and state governments should help forge the commitment to curtail alcohol consumption by minors, educating adults about existing laws and the consequences of underage drinking, and provide additional financial assistance and other support to reinforce community-based prevention initiatives.

The report advises that the federal government fund and actively support the development of a national media campaign to encourage parents and other adults to take steps in their own households and neighborhoods to discourage underage drinking. Television ads for alcohol often appear during programs where the percentage of underage viewers is greater than their percentage in the overall U.S. population. The committee recommended that trade associations in the alcohol industry and individual companies strengthen their advertising codes to prohibit placement of commercial messages in venues where a large portion of the audience is underage. These groups also should establish independent, external review boards to investigate complaints about ads and enforce codes. In addition, alcohol companies, advertising firms, and commercial media should refrain from marketing practices -- such as certain product designs or promotion techniques -- that may appeal to young people, the report says.

To fund the proposed activities and to help reduce underage consumption, the report proposes that Congress and state legislatures raise excise tax rates on alcohol – particularly on beer, which studies show is the alcoholic beverage that most young people prefer. Alcohol is much cheaper today, after adjusting for inflation, than it was 30 to 40 years ago. According to the report, higher tax rates should be tied to the Consumer Price Index to keep pace with inflation. Increasing the cost of alcohol has well-documented deterrent effects on underage drinkers, the report points out.

Key findings from the report:

  • Patterns and consequences of underage drinking are closely related to the overall extent and patterns of drinking in society and are affected by the same factors that affect adult consumption.
  • Underage drinking cannot be successfully addressed by focusing on youth alone. Efforts to reduce and prevent underage drinking need to focus on parents and other adults and include strategies that engage the society at large.
  • Alcoholic beverages are far cheaper today than they were in the 1960s and 1970s.

  • (Source: Institute of Medicine, Reducing Underage Drinking - A Collective Responsibility, September 2003)

Key recommendations from the report:

  • Multiple components must be implemented that include science-based programs, research, and evaluation.
  • Congress and state legislators should raise alcohol taxes. Top priority should be given to raising beer taxes, and excise taxes on all alcoholic beverages should be indexed to the consumer price index to keep pace with inflation.
  • Public and private funders should support community mobilization to reduce underage drinking. Community leaders should assess their local underage drinking problem and consider effective approaches such as community organizing, coalition building and strategic use of mass media.
  • States and communities should implement a system requiring registration of beer kegs that records information on purchaser’s identity.
  • Residential colleges and universities should adopt comprehensive prevention approaches including environmental changes that limit underage access to alcohol.
  • Local police, working with community leaders, should adopt and announce policies for deterring and terminating underage drinking parties.
  • States and localities should implement enforcement programs to deter adults from purchasing alcohol for minors.
    (Source: Institute of Medicine, Reducing Underage Drinking - A Collective Responsibility, September 2003)

General statistics on underage drinking:

  • More than 10 million underage youth drink, over half of whom are binge drinkers.
    (Source: Summary of Findings from the 1998 National Household Survey on Drug Abuse, U.S. Department of Health and Human Services, 1999)
  • Illegal alcohol consumption by underage youth accounts for up to $22 billion a year in alcohol sales.
    (Source: Alcohol Consumption and Expenditures for Underage Drinking and Adult Excessive Drinking, National Center on Addiction and Substance Abuse, Columbia University, published in JAMA, 2003)
  • In a survey of Americans age 12-17, the average person took their first drink before age 13.
    (Source: National Household Survey on Drug Abuse: Main Findings 1996. U.S. Department of Health and Human Services, 1998)
  • Youth who use alcohol before 15 are four times more likely to be alcohol dependent than adults whose first drink is at the legal age of 21.
    (Source: Grant & Dawson. Age at Onset of Alcohol Use and its Association with DSM-IV Alcohol Abuse and Dependence, Journal of Substance Abuse, Volume 9, pages 103-110, 1997)
  • The consequences of underage drinking are a tremendous expense to the U.S. economy and total more than $53 billion per year, by far the most costly of all drug problems.
    (Source: Institute of Medicine, Reducing Underage Drinking - A Collective Responsibility, September 2003)

The IOM Report was welcomed by many advocates for alcohol prevention, among them:

  • Center on Alcohol Marketing and Youth (CAMY)
  • Mothers Against Drunk Driving (MADD)
  • Center for Science in the Public Interest (CSPI)
  • Governors Highway Safety Association (GHSA)
  • The National Center on Addiction and Substance Abuse (CASA)
  • The American Medical Association (AMA)
  • Community Anti-Drug Coalitions of America (CADCA)
  • The National Council on Alcoholism and Drug Dependence (NCADD)

Copies of Reducing Underage Drinking: A Collective Responsibility are available from the National Academies Press. FACE – Truth and Clarity on Alcohol developed an executive summary of the report. The reprint booklet can be ordered at their Web site.

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