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Reducing Underage Alcohol Consumption

  • Date: Nov 09 2004
  • Policy Number: 20041

Key Words: Alcohol

Recognizing that considerable new research has emerged regarding health consequences of alcohol consumption by youth as well as changing trends in the marketing of alcohol to youth under the legal age of 21 since the adoption of APHA Policy 9409 (Limiting Youth Access to Alcohol);1 and 

Recognizing that alcohol still continues to play an important role in unintentional injuries, homicides and suicides which are the leading causes of death among youth;2,3 and

Recognizing that children who consume alcohol before age 15 are four times more likely to develop alcohol dependence at some point in their lives versus children who abstain from alcohol until they are 21, and over 40 percent of those who began drinking before age 14 become alcohol dependent;4 and

Recognizing the Youth Risk Behavior Surveillance Survey found that, in 2003, 44.9 percent of high school students reported using alcohol in the preceding month, 30.2 percent of high school students reported riding with a driver who had been drinking, and 28.3 percent of high school students had five or more drinks on one or more occasions in the preceding month,5 and that the CDC found "point-of-purchase," or on-site, alcohol marketing in 94 percent of the nearly 4,000 convenience stores, grocery stores and gas stations it studied, having selected types of retail outlets that are frequented by underage youth;6 and

Recognizing that alcohol use is implicated in at least one-third of sexual assault and acquaintance or "date" rape cases among teens and college students;7 and

Nearly a quarter of the alcohol advertising on television was more likely to be seen by youth ages 12-20 than by adults of legal drinking age,8 and that

Reports by the Center on Alcohol Marketing and Youth revealed that underage youth are heavily exposed to alcohol advertising on radio,9 in magazines,10 and on the Internet;11 and

Acknowledging, that approaches vary in their effectiveness and that a World Health Organization metanalysis has shown that excise tax or age limits are singly more effective than others such as alcohol education;12 and

Recognizing the current voluntary guidelines of the Beer Institute and the Distilled Spirits Council of the U.S. allow alcohol advertising to reach a great number of youth, and since the 2004 report by the National Research Council and Institute of Medicine13 gives 40 recommendations for combating underage drinking,

THEREFORE BE IT RESOLVED that the American Public Health Association urges the support and implementation of the following recommendations of the National Research Council and Institute of Medicine’s report entitled Reducing Underage Drinking: A Collective Responsibility by:13

  1. Urging the federal government to fund and actively support the development of a national media effort to reduce underage drinking (similar to successful anti-tobacco campaigns);14,15
  2. Advocating that Congress appropriate funding for U.S. Department of Health and Human Services (USDHHS) to monitor underage exposure to alcohol advertising;
  3. Urging Congress to fund the USDHHS to enable them to conduct periodic reviews of movies, television, and music to ascertain the influence they have on youth alcohol consumption;
  4. Requesting the federal government to require states to achieve designated rates of retailer compliance related to youth access to alcohol similar to the Synar Amendment’s requirements for tobacco sales to youth;
  5. Urging USDHHS to fund only evidence-based education interventions;
  6. Advocating that the National Institute on Alcohol Abuse and Alcoholism and the Substance Abuse and Mental Health Services Administration continue to fund evaluations of college-based interventions;
  7. Recommending that USDHHS expand the availability of effective clinical services for diagnosing and treating underage youth who have alcohol abuse problems;
  8. Supporting the establishment of a federal interagency coordinating committee on prevention of underage drinking, chaired by the Secretary of USDHHS;
  9. Supporting the establishment of a National Training and Research Center on underage drinking within the USDHHS;
  10. Requesting that the secretary of USDHHS issue an annual report to Congress on underage drinking;
  11. Urging the Monitoring the Future Survey and the National Survey on Drug Use and Health to revise their surveys to elicit more precise information on the quantity of alcohol consumed and to ascertain brand preferences of youth;
  12.  Advocating that Congress raise excise taxes on alcoholic beverages to support prevention and treatment programs; and
  13. Requesting that USDHHS and the U.S. Department of Education fund both development and evaluation of programs for all underage populations.
  14. BE IT FURTHER RESOLVED that the American Public Health Association state affiliates and sections urge state and local government leaders to support and implement any of the appropriate 40 recommendations for their jurisdictions, of the National Research Council and Institute of Medicine’s report titled Reducing Underage Drinking: A Collective Responsibility.13 


  1. American Public Health Association Policy Statement 9409: Limiting Youth Access to Alcohol. APHA Policy Statements, 1948-present, cumulative. Washington, DC: APHA current volume.
  2. Arias E, Anderson RN, Kung HC, Murphy SL, Kochanek KS. Deaths: final data for 2001. Natl Vital Stat Rep 2003;52(3):1-100; 
  3. Mokhdad A, Marks JS, Stroup DF Gerberding JL. Actual causes of death in the US. JAMA 2004;291(10):1263-4.
  4. Grant, BF and Dawson, DA. Age at onset of alcohol use and its association with DSM-IV alcohol abuse and dependence: Results from the National Longitudinal Alcohol Epidemiologic Survey. J Substance Abuse 1997;9:103-110. 
  5. Grunbaum JA, Kann L, Kinchen S, et al. Youth risk behavior surveillance--United States, 2003. MMWR 2004;53(SS-2):4,12-13. 
  6. Point-of-Purchase Alcohol Marketing and Promotion by Store Type — United States, 2000-2001. MMWR. April 11, 2003;52(14);310-313
  7. Office of Inspector General, U.S. Department of Health and Human Services, "Youth and Alcohol: Dangerous and Deadly Consequences," Washington, D.C., April 1992.
  8. Center on Alcohol Marketing and Youth, Television: Alcohol’s Vast Adland. December 18, 2002. Washington, DC.
  9. Center on Alcohol Marketing and Youth, Alcohol Ads Tune in Underage Youth. April 2, 2003. Washington, DC.
  10. Center on Alcohol Marketing and Youth, OverExposed: Youth a Target of Alcohol Advertising in Magazines, September 2002, Washington, DC.
  11. Center on Alcohol Marketing and Youth, Clicking with Kids: Alcohol Marketing and Youth on the Internet, March 2004, Washington, DC
  12. Babor T.F. et al., (2003) Alcohol–No Ordinary Commodity. Research and Public Policy. London: Oxford University Press.
  13. National Research Council and Institute of Medicine, Reducing Underage Drinking: A Collective Responsibility. Committee on Developing a Strategy to Reduce and Prevent Underage Drinking, Bonnie, RJ, O’Connell ME, eds. Board on Children, Youth and Families, Division of Behavioral and Social Sciences and Education. Washington, DC, National Academies Press, 2004.
  14. Siegel M. The effectiveness of state-level tobacco control interventions: a review of program implementation and behavioral outcomes. Ann Rev Public Health 2002;23:45-71. 
  15. Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs—August 1999. Atlanta GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, August 1999.

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