Reducing underage drinking: Surgeon general issues Call for Action

Spring breaks are coming to a close, and prom nights and graduation parties are just around the corner. These times are full of celebration and fun. Unfortunately, they also are often soaked in alcohol, sometimes with tragic endings.

When such things happen, the TV news reports are haunting, showing footage of young, tear-stained faces looking in shock at accident scenes or clutching photos of schoolmates lost. And the headlines trigger a heightened awareness of this danger. But a Call to Action issued last month by the surgeon general -- the first ever to address the health concern of youth alcohol use and abuse -- makes clear that this reaction is not enough. Preventing and reducing underage drinking is a public health imperative that requires attention and involvement all year round from all levels of society.

This effort by the surgeon general is both right and timely. One must only look at the numbers to grasp the problem's pervasive and persistent nature. While young people's use of tobacco and illicit drugs is declining, underage drinking rates remain high. About 11 million Americans younger than 21 drink. Nearly half drink to excess -- consuming five or more drinks in a row, one or more times in a two-week period.

Studies also show that kids often have their first taste before age 12. By 18, more than 70% have had a drink. Generally speaking, boys experiment first -- around age 11; girls at 13. But girls' patterns are resembling that of boys more and more.

Although a temptation exists within our culture to view this experimentation as a simple rite of passage, as kids being kids, harm is done.

Research indicates that early alcohol use and abuse impacts brain development. Moreover, adolescent drinkers perform worse in school, are more likely to fall behind and have an increased risk of social problems, depression, suicidal thoughts and violence. Other studies have found that kids who begin drinking before age 15 are five times more likely to have alcohol-related problems later in life.

It's this body of evidence that led the surgeon general to appeal to Americans to do more to curb underage drinking. The Call to Action is a science-based document, developed in collaboration with the National Institute on Alcohol Abuse and Alcoholism and the Substance Abuse and Mental Health Services Administration, that offers recommendations involving people from all walks of life -- government and school officials, parents, other adults, young people and even health professionals. Its goal is to change the culture in which young people mature to make drinking a less likely choice. It moves in this direction not just through government policies but also through practice -- whether encouraging positive family structures or supportive school environments, among other things.

The American Medical Association has long-standing policy in sync with many of these concepts, calling for aggressive action at the community, state and national levels of government. The Association also has, through its Office of Alcohol, Tobacco and Other Drug Abuse Prevention in conjunction with the Robert Wood Johnson Foundation, directed national programs to break the youth and alcohol connection through environmental change. In another example, AMA delegates and other members have joined to form the AMA Action Team on Alcohol and Health. In part, this effort encourages state and local medical societies to pass underage drinking policies and get more involved in community policy advocacy.

But the surgeon general points out that more still needs to be done. For instance, physicians should continue to be aware of and sensitive to the level of risks adolescents face in regard to alcohol; discuss alcohol use with young patients; identify use when it is happening; and be knowledgeable about the appropriate resources and referrals that exist in their communities.

After all, underage drinking is a factor in nearly half of all teen automobile crashes. It also contributes to youth suicides, homicides and fatal injuries and is linked to as many as two-thirds of all sexual assaults and date rapes of teens and college students. It is also a major factor in unprotected sex among youth.

Because physicians are the ones who treat these wounds, they also have a strong interest in preventing them. But they are not alone. The surgeon general is pressing forward to challenge our cultural and national understanding of this epidemic.

Underage drinking is everyone's problem. Preventing it -- and minimizing its health and societal costs -- will require exactly the types of comprehensive solutions the surgeon general hopes to inspire.