Underage Drinking in Michigan Hannah Jary, MPH CDC/CSTE Applied Epidemiology Fellow- Alcohol Michigan Department of Community Health Underage Drinking.

Underage Drinking in Michigan

Hannah Jary, MPHCDC/CSTE Applied Epidemiology Fellow- Alcohol

Michigan Department of Community Health

Underage Drinking Prevention Plan Workgroup Meeting

January 22, 2015

MDCH Alcohol EpidemiologyProgram

• Our Mission:– To strengthen the scientific foundation for

preventing excessive alcohol consumption.

• Our Goals:– Improve public health surveillance– Translate applied public health research– Support public health activities to prevent

excessive drinking

2

Population Level Strategies to Reduce & Prevent Excessive Alcohol Use

Motor Vehicle Crashes

Violent CrimeAssaultsHomicideSuicide

Domestic Violence

Alcohol Poisonings

Injuries

STIsUnplanned

Pregnancies

Overconsumption

Binge Drinking

Underage Drinking

Price

Retailer Serving

Practices

Days of Sale

Hours of Sale

Location & Density of Retailers

Factors that Affect

Drinking

Outcomes

3

UNDERAGE DRINKING TRENDSYouth Risk Behavior Survey, 2013

4

5

Any Drinking in the Past 30 Days

2011 2012 20130

10

20

30

40

Age 18-20High School

Percen

t

Age 18-20 Source: MiBRFSS, High School Source: MI YRBS

6

Binge Drinking in the Past 30 Days

2011 2012 20130

5

10

15

20

25

Age 18-20High School

Percen

t

Age 18-20 Source: MiBRFSS, High School Source: MI YRBS

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Usual Source of Alcohol, Past 30 days

05

101520253035404550

Nonbinge DrinkerBinge Drinker

Percen

t

Source: Michigan Youth Risk Behavior Survey, 2013

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Substance Use Patterns, 2013

Nondrinker Nonbinge drinker Binge drinker0

10

20

30

40

50

60

70

80

90

100

93.5

69.2

39.0

5.4

27.3

47.3

0.9 1.4 2.4

0.3 2.111.3

No marijuana or illicit drugs Marijuana only Illicit drugs onlyMarijuana and illicit drugs

Percen

t

Source: Michigan Youth Risk Behavior Survey, 2013

YOUTH DRINKING PREFERENCESYouth Tobacco Survey, 2011

9

Frequency of Consumption, past 30 days

1-2 days 3-5 days 6-9 days 10+ days0

10

20

30

40

50

60

70

80Non-binge drinkerBinge Drinker

Percen

t

Source: Youth Tobacco Survey, 201110

Largest number of drinks consumed, past 30 days, by sex

1-3 drinks 4-5 drinks 6-9 drinks 10+ drinks0

10

20

30

40

50

60

70FemaleMale

Percen

t

Source: Youth Tobacco Survey, 201111

Usual Alcohol Type Consumed, by sex

Liquor Beer FABs No Usual Type

Wine Other Type

Cordials0

10

20

30

40

50

60FemaleMale

Per

cen

t

12Source: Youth Tobacco Survey, 2011

Usual Alcohol Type Consumed, by grade

9th 10th 11th 12th0

10

20

30

40

50

60

70

80LiquorBeerFABs

Grade

Per

cen

t

Source: Youth Tobacco Survey, 201113

Usual Liquor Type Consumed, by sex

Vodka Rum Whiskey No usual type

Other type Tequila Cordials0

10

20

30

40

50

60FemaleMale

Per

cen

t

Source: Youth Tobacco Survey, 201114

Prevalence of Mixing Energy Drinks & Alcohol

Source: Youth Tobacco Survey, 201115

Non-binge drinkers Binge drinkers0

10

20

30

40

50

60

20.1

52.2

Percen

t

Conclusions

• Liquor dominates youth preferences– Vodka most popular liquor type– Other usual alcohol types:

• Beer (males) • Flavored alcoholic beverages (females)

• A large proportion of binge drinkers report hazardous drinking behaviors– Drinking more often– Mixing energy drinks & alcohol

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LIQUOR LICENSESMichigan Liquor Control Commission

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Liquor Licenses

Available at: www.michigan.gov/lcc18

Liquor License Availability

Available at: https://www.michigan.gov/lara/0,4601,7-154-35299_10570_12905---,00.html19

Liquor License Availability

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Liquor License Lists

Available at: https://www.michigan.gov/lara/0,4601,7-154-35299_10570_12905---,00.html21

Liquor License Query

Available at: http://www2.dleg.state.mi.us/llist/22

Active Wayne County Liquor Licenses

Available at: http://www2.dleg.state.mi.us/llist/23

Active Wayne County Liquor Licenses

Available at: http://www2.dleg.state.mi.us/llist/24

Violation Information for Liquor Licenses

Available at: http://www2.dleg.state.mi.us/llist/25

Liquor License Considerations• Potential for geospatial

analysis

• Updated frequently

• Types of licenses– Incomplete

• Bars vs. restaurants• Special or temporary

• Violation history available

• Establish partnerships with retailers

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PREVENTIONThe Community Guide

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Binge Drinking by High School Students and Adults Closely Related

28Source: Nelson, DE et al. American Journal of Preventive Medicine, 2009.

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Alcohol Policy Impacts Youth

Source: Paschall, MJ, et al. Effects of the local alcohol environment on adolescents’ drinking behaviors and beliefs. Addiction, 109 (2013) 407-416.

Adolescent DrinkingLocal Alcohol Environment

Alcohol-Related Beliefs

Population Level Strategies to Reduce & Prevent Excessive Alcohol Use

Increase Alcohol Excise

Taxes

Commercial Host Liability

Maintaining Limits on Days

of Sale

Maintaining Limits on

Hours of Sale

Regulating Alcohol Outlet

Density

Motor Vehicle Crashes

Violent CrimeAssaultsHomicideSuicide

Domestic Violence

Alcohol Poisonings

Injuries

STIsUnplanned

Pregnancies

Overconsumption

Binge Drinking

Underage Drinking

Price

Retailer Serving

Practices

Days of Sale

Hours of Sale

Location & Density of Retailers

Environmental Strategies Factors that

Affect Drinking

Outcomes

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Reframing Intervention Impact

Health Behavior Education, Social Norming

Frieden, TR. A Framework for Public Health Action: The Health Impact Pyramid. Am J Public Health 2010; 100(4):590-5.

Dram shop liability,

Limiting hours & days of sale,

.08 BAC Laws

Excise taxes

SBIRT, Naltrexone

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32

The Community Guide Recommendations

• Enhanced Enforcement of Laws Prohibiting Sales to Minors

• Regulation of Alcohol Outlet Density • Commercial Host Liability • Increasing Alcohol Taxes • Electronic Screening and Brief

Intervention (e-SBI) • Maintaining Limits on Days of Sale • Maintaining Limits on Hours of Sale

Source: The Community Guide, Preventing Excessive Alcohol Consumption

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Enhanced Enforcement of Laws Prohibiting Sales to Minors

• Retailer compliance checks/ “sting operations”– 42% decrease in sales to decoys

• Effective in:– Bars and liquor stores– Rural and urban communities– Different ethnic and socioeconomic groups

• Part of multicomponent, community-based efforts

Source: The Community Guide, Preventing Excessive Alcohol Consumption

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Regulation of Alcohol Outlet Density

• Applying regulatory authority to reduce density of alcohol outlets

• Increased alcohol outlet density resulted in:– Increased excessive alcohol consumption – Increased related harms

• For a typical census tract in LA with 5 off-premise outlets, closing 1 outlet was associated with 42 fewer gonorrhea cases per 100,0001

1

Cohen, DA, et al. Alcohol outlets, gonorrhea, and the Los Angeles civil unrest: A longitudinal analysis. Social Science & Medicine 62 (2006) 3062–3071.

35

On-Premise Alcohol Outlet Density

Prevention Status Report- Density

36Available at: http://www.cdc.gov/psr/alcohol/2013/MI-alcohol.pdf

37

Commercial Host Liability

• Owner/server held legally responsible for harms inflicted by an intoxicated or underage customer– E.g. Death, injury, damage from alcohol-

related car crash– MI does not have any major limitations

• All-cause motor vehicle fatalities among underage drinkers was reduced between 2.2% and 13.0%

Source: The Community Guide, Preventing Excessive Alcohol Consumption

Prevention Status Report- Commercial Host Liability

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Increasing Alcohol Taxes

• Increase the price of alcohol – Reduce harms, raise revenue, or both– 10% increase in price of beer would decrease

beer consumption by about 5%

• Based on volume sold – MI beer tax since 1966 = $0.20/gallon

• Would be $1.32/gallon if kept up with inflation

• Among adolescents– Younger drinkers more price sensitive than older– Heavier drinkers more price sensitive than light

39Source: Xu X, Chaloupka FJ. The effects of prices on alcohol use and its consequences. Alcohol Research and Health. 34(2).

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Increasing Alcohol Taxes- Example

• Illinois alcohol excise tax increase, 2009– Beer increased $0.046/gal ($0.185 $0.231)– Wine increased $0.66/gal ($0.730$1.39) – Spirits increased $4.05/gal ($4.50$8.55)

• Net effect, among ages 15-19:– Gonorrhea rates decreased 14% for whites

and 26% for blacks– Chlamydia rates decreased 6% for whites

and 7% for blacks

Source: Jernigan DH. Social and health effects of changes in alcohol prices: findings of a research collaborative. The Center of Alcohol Marketing and Youth.

Prevention Status Report- Taxes

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42

Screening and Brief Intervention

• Screening: Assess patient drinking patterns• Brief Intervention: Personalized feedback

about risks, referral if necessary

• E-SBI uses electronic devices to deliver the SBI

• Studies showed decreases in all types of alcohol consumption after using e-SBI

Alcohol Screening and Brief Intervention Resource for Youth

43Source: Alcohol screening and brief intervention for youth: a practitioner’s guide. National Institute on Alcohol Abuse and Alcoholism.

Maintaining Limits on Days and Hours of Sale

• Removing limits on days of sale:– Increases in consumption– Increases in motor vehicle-related harm

• Increasing hours of sale by 2+ hours:– Increases in vehicle crashes injuries– Increases in ED admissions– Increased alcohol-related assault & injury

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Conclusions

• Underage drinking in is prevalent in Michigan

• Underage drinking is related to adult drinking and the alcohol environment

• Evidence-based policies and interventions can be implemented on a variety of levels to prevent underage drinking and related harms

Contact Information

Hannah Jary, MPH

[email protected]

517-373-7048

Michigan.gov/substanceabuseepi

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