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![Page 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.](https://reader035.fdocuments.us/reader035/viewer/2022062300/56649dde5503460f94ad750c/html5/thumbnails/1.jpg)
William F. Wieczorek, Ph.D., CRADirector 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
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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
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Beverage Alcohol
• Source of virtually all beverage alcohol (ethanol/ethyl alcohol) is fermentation (max content about 14% ethyl alcohol by volume)
• C6H12O6 → 2C2H5OH + 2CO2
– Glucose in aqueous solution with yeast yields ethanol, gas, and energy (anaerobic respiration)
• Distillation is necessary for high percent alcohol by volume liquors.
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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)
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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
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Addicted vs Non-addicted Dopamine System
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Underage drinkers consume about 17% of all alcohol in US! Miller, TR, et al. (2006) Journal of Studies on Alcohol, 67(4) 519-528.
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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?
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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)
• DALYi = YLLi + YLDi
– YLL = Years of life lost– YLD = Years lived with disability(adjusted for the
severity)
• Allows comparisons across causes!
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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)
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Alcohol-related illnessesChronic 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
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Alcohol Attributable DALYS
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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)
• World Health Report 2002• Wegman & Said (2007) Chance, 20(3),17-25• Compare risk by examining predictors of
DALYS
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Burden of Disease in Developed Regions of the World
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Burden in North America (Said & Wegman, 2007, Chance)
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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!
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Alcohol: Favorite Drug of Teens I
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Alcohol: Favorite Drug of Teens II
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Adolescents Tend to Drink To Excess I
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Adolescents Tend to Drink To Excess II
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Adolescents Tend to Drink To Excess III
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Underage Drinking Rates
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Underage Drinking by Gender and Ethnicity
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Local Underage Drinking by 9th Graders
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• 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
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Main Causes of Death for Adolescents
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Main Cause of Fatal Injuries for Adolescents
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Alcohol and Fatal Crashes (NHTSA, DOT HS 811 169)
•About 1/3 of fatalities are alcohol-related.
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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
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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!
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Alcohol Dependence Most Prevalent Among Young People (18-24 yr olds)
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More Underage Drinkers Use Illicit Drugs (OJJDP, 2008. Co-occurrence of Substance Use Behaviors in Youth)
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Underage Drinkers & Delinquency (OJJDP, 2008. Co-occurrence of Substance Use Behaviors in Youth)
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Underage Drinking and High School Grades
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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.
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Costs of Underage Drinking(OJJDP www.udetc.org/StateInformation.asp)
• Direct costs alone over $1.1 billion.
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Costs by Category
• 80% of costs are violence and injuries.
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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
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Few Underage Drinkers Purchase Own Alcohol
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Sources of Alcohol Not Purchased by Underage Drinker
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Everybody Influences Adolescents (Surgeon General’s Call To Action on Underage Drinking)
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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
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PX2010 Initiative as Erie County Response to Underage Drinking
• Px20 group http://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
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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
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Thanks for your attention!