Advocacy project framework and implementation

¶ … Drinking and Driving Consequences

Are we taking the drunken drivers off the road only to turn them into drunken pedestrians?

Lawrence S. Harris, North Carolina State Medical Examiner (Simpson, 1988)

Despite Being Illegal

Despite drinking alcohol being illegal for them to do so, many underage people often heavily drink alcohol, a legal product individuals at least 21-years-old may consume in the United States. (Eigen & Noble, 1996; 1998; Office for Substance Abuse Prevention, 1991; Presley, Leichter, & Mielman, 1999; cited by Zwarun, Linz, Metzger & Kunkel, 2006) Underage alcohol consumption, in turn, Eigen & Noble (1998; cited by Zwarun, Linz, Metzger & Kunkel, 2006) report, increase the likelihood of automobile accidents, resulting from drought driving, (Eigen & Noble, 1996; Siegal, 1999; cited by Zwarun, Linz, Metzger & Kunkel, 2006)), as well as, alcohol abuse and addiction. (Grant & Dawson, 1998; cited by Zwarun, Linz, Metzger & Kunkel, 2006) in an article, published in the New York Times during June, 1986, regarding traffic deaths of individuals whose driver's licenses had been revoked for drunk driving, Harris presents the poignant question introducing this advocacy project: "Are we taking the drunken drivers off the road only to turn them into drunken pedestrians?" (Simpson, 1988) Problem Statement Consequences of underage drinking and driving include youth experiencing hangovers, behaving in ways they later regret, engaging in arguments due to influence of alcohol, and forgetting parts of the times under the influence. A primary concern, however, is alcohol-related motor vehicle accidents among underage drinkers. (Ouellette et al., 1999; cited by Arata, Stafford & Tims, 2003) Hingson (1993; cited by Arata, Stafford & Tims, 2003) estimates consumption of alcohol contributes to 50% of fatal car crashes among drivers under the age of 21. This concern contributes to the perception constituting this advocacy project's problem statement: Youth's positive perceptions of negative consequences of alcohol consumption. Significance of the Problem Alcohol consumption, according to Johnston, O'Malley, & Bachman (2002; cited by Arata, Stafford & Tims, 2003), currently constitutes a contemporary critical concern contributing to risk behaviors teens engage in, as noted by results from the 2001 Monitoring the Future survey (Johnston, O'Malley, & Bachman, 2002; cited by Arata, Stafford & Tims, 2003) which reports: "63.5% of tenth graders and 73.3% of twelfth graders reported drinking in the past year, with 39.0% and 49.8%, respectively, reporting alcohol use in the past 30 days."

Approximately 22% of 10th graders reported they had been drunk during the past 30 days. Approximately 33% of twelfth graders reported this same scenario. Although attitudes toward teenage drinking often appear mixed, research indicates problem drinking, common among high school students, does in fact constitute a contemporary problem. As a number of older adolescents routinely report drinking to excess, alcohol consumption, as well as, "problem drinking among teenagers is, not surprisingly, associated with a number of negative consequences." (Arata, Stafford & Tims, 2003)

Purpose of the Advocacy This advocacy project proposes to inform and influence youth at risk for driving while under the influence of alcohol to investigate components contributing to underage drinking, as well as, examine consequences of underage drinking and driving while under the influence of alcohol.

LITERATURE REVIEW

Summaries of Existing Literature Alcohol significantly contributes to motor vehicle crashes, Salazar, Firestone, Price, Villarreal, Guerra, and Harris (2006) report. Motor vehicle crashes continue to lead as the cause of death for youth 15-20 years of age (CDC, 2004, Lazy, Wiliszowski, & Jones, 2004). The Office of Applied Studies at the Substance Abuse and Mental Health Services Administration (2004), reports that during 2003, 21% of youth16 to 20 years old reported they had driven during the past year while intoxicated by alcohol consumption for the use of illicit drugs. "The National Highway Traffic Safety Administration (NHTSA) reports that in 2003, a quarter of young drivers ages 15 to 20 years killed in motor vehicle crashes were intoxicated." (NHTSA, 2004; cited by Salazar, Firestone, Price, Villarreal, Guerra, and Harris, 2006) During 2004, approximately 2,000 individuals killed in alcohol-related traffic crashes involved an underage driver who was drinking. Alcohol-related traffic crashes, which involved an underage drinking driver injured another half a million people. "Research continues to show that young drivers (age 15-20) are more often involved in alcohol-related crashes than any other comparable age group. Traffic crashes are the number one killer of teens, and nearly one-third of teen traffic deaths are alcohol-related." (MADD..., 2006)

Male youth range at higher risk for death in an alcohol-related motor-vehicle crash.

During 2003, at the time of the crash, 28% of young male drivers involved in fatal crashes had been drinking. Thirteen percent of young female drivers involved in fatal crashes had been drinking. (NHTSA; cited by Salazar, Firestone, Price, Villarreal, Guerra, and Harris, 2006) Common, contemporary advertising elements promoting/advertising alcohol in television and print, content studies reveal, include: "humor, sociability, physical attractiveness, success, romance, adventure, fun activities, celebrity endorsers, animation, and rock music." (Atkin, 1987; Atkin & Block, 1981; Breed & De Foe, 1984; Finn & Strickland, 1982; Kelly, Slater, Karan, & Hunn, 2000; Postman et al., 1988; Wallack, Grube, et al., 1990; Zwarun & Farrar, 2005; cited by Zwarun, Linz, Metzger & Kunkel, 2006)

Young people readily recall the appealing components, which make alcohol advertising popular with them. They report liking the ads they easily remember, and they recognize the ad sponsors. (Aitken et al., 1988; Grube, 1993; Wallack, Cassady, et al., 1990; cited by Zwarun, Linz, Metzger & Kunkel, 2006) "Alcohol expectancy theory (Goldman, Brown, & Christiansen, 1987; cited by Zwarun, Linz, Metzger & Kunkel, 2006) is an extension of social cognitive theory that has been applied to drinking behavior with much empirical success." Modeled portrayals in alcohol advertising, according to alcohol expectancy theory, can result in individuals forming the perception that drinking alcohol produces social and physical rewards, prompting the intent to drink, along with drinking behavior, as a result. (Abrams & Niaura, 1987; Gerbner, Gross, Morgan, Signorielli, & Shanahan, 2002; Austin & Meili, 1994; cited by Zwarun, Linz, Metzger & Kunkel, 2006) Studies also reveal, Zwarun, Linz, Metzger & Kunkel (2006) purport, that youth more aware of alcohol advertising possess more positive beliefs about drinking. Consequently, this awareness "mediates their intention to drink as adults. (Grube, 1993; cited by Zwarun, Linz, Metzger & Kunkel, 2006) Aitken et al. (1988; cited by Zwarun, Linz, Metzger & Kunkel, 2006) concur that underage drinking correlates with an appreciation of alcohol advertising; (1984; cited by Zwarun, Linz, Metzger & Kunkel, 2006); while Atkin et al. (1988; cited by Zwarun, Linz, Metzger & Kunkel, 2006) found considerable links exist between exposure to alcohol advertising and teenagers' self-reported consumption of alcohol among themselves, as well as, their intention to consume alcohol in the future. Zwarun, Linz, Metzger & Kunkel (2006) report that widespread research on alcohol expectancies, evolving from advertisements, consistently reveals the following promoted perceptions, which many youth adopt:

Alcohol serves to powerfully transform experiences in positive ways.

Alcohol automatically increases physical and social pleasures.

Alcohol enhances an individual's cognitive and motor functioning, as well as, his/her power.

Alcohol increases an individual's ability to perform sexually and enhances the sexual experience.

Alcohol strengthens an individual's ability to be assertive.

Alcohol enhances an individual's mood and helps him/her relax. (Brown, Goldman, Inn, & Anderson, 1980; Goldman et al., 1987; cited by Zwarun, Linz, Metzger & Kunkel, 2006)

Although courts regularly mandate treatment for individuals charged with drinking and driving to attempt to treat alcohol problems and research identifies some effective mandated treatment modalities, a dearth of gaps in knowledge and "sure" treatment modalities continue to challenge courts and individuals who drink and drive. (Dill & Wells-Parker, 2006)

Alcohol Expectancies

Primary problematic alcohol expectancies young people possess appear to pertain to social benefits in anticipated physical/psychological perks. (Brown et al., 1980; Christiansen et al., 1982; Goldman et al., 1987; cited by Zwarun, Linz, Metzger & Kunkel, 2006) Youth who abstain from consuming alcohol, albeit, are distinguished by their disbelief in alcohol's benefits/perks. (Martin et al., 2002; cited by Zwarun, Linz, Metzger & Kunkel, 2006) Due to the content of numerous beer ads portraying social, as well as, social and physical activities, when youth view these ads, they may begin to anticipate that drinking beer produces positive social and positive physical outcomes. (Zwarun, Linz, Metzger & Kunkel, 2006; cited by Zwarun, Linz, Metzger & Kunkel, 2006) in general, Arata, Stafford & Tims (2003) report: "males and females who consumed more alcohol, binged at least twice in the past 2 weeks, reported more liberal drinking norms, and had more friends who got drunk" related the most negative alcohol consumption related consequences. These findings concur with the prior research which demonstrates the significance of peer norms relating to drinking, particularly in terms of negative, alcohol use consequences.

Numerous prevention tactics schools utilize reportedly have impacted underage drinking. Strategies include:

School policies regarding alcohol use on school property or at school-sponsored events. (These policies are especially important in colleges and universities, as well as in junior high and high schools.)

Media literacy programs to make youth more sophisticated about the manipulative techniques of advertisers.

Prevention curricula. Sometimes the content of these or similar curricula are delivered in other venues, e.g., youth clubs. (Strategies..., N.d., p. 5)

Strategy

Priority

Level of Effectiveness

School policies regarding alcohol use on school property or at school sponsored events (These policies are especially important in high schools, but are even more important in colleges and universities.)

This strategy has been found to reduce substance use problems.

Media literacy programs to make youth more sophisticated about the manipulative techniques of advertisers

Some effects on attitudes have been found.

Prevention curricula. Sometimes the content of these or similar curricula are delivered in other venues, e.g., youth clubs

In general, research and evaluations have found that these programs have weak and inconsistent effects on alcohol use

Prevention of Impaired Driving

Establishment and enforcement of "zero tolerance" laws for drivers under 21

All States now have these laws. They can be very effective in reducing alcohol-related traffic crashes (as much as 50-percent reductions), especially if well publicized and enforced.

Sobriety checkpoints for impaired drivers (especially important as a method of enforcing zero tolerance laws)

This strategy can be very effective in reducing impaired driving and crashes. Specific effects on youth have not been evaluated.

Vigorous and well-publicized enforcement of impaired driving laws in general, as well as other traffic enforcement (e.g., speeding, running red lights)

This strategy has a strong effect on impaired driving. Specific effects on youth have not been evaluated.

Responsible beverage service techniques that can reduce sales to minors as well as reduce sales of alcohol to intoxicated persons

Some studies have shown improvements in ID checking as a result of training. Stronger effects have been shown on reducing service to intoxicated patrons, especially when combined with enforcement. (Strategies..., N.d., p. 13)

Activities Specific to Underage Drinking:

Youth Underage Drinking Prevention Campaign - Too SMART to START (TSTS): Too Smart to Start is a national community education program targeting children and youth, ages 9-13. This public education initiative, tried and tested in 9 communities nationwide, provides professionals, volunteers, and parents with tools and materials that can help shape healthy behaviors regarding alcohol use for a lifetime. TSTS includes a web page, technical assistance, and a community action kit to help plan, develop, promote and support local underage alcohol use prevention. The program includes materials and strategies that are flexible for use in communities of all sizes and actively involves entire communities in sending clear, consistent messages about why children should reject underage drinking.

Reach Out Now Fifth and Sixth Grade Scholastic Supplements: SAMHSA and Scholastic Magazine have developed a special edition targeting ten and eleven-year-olds and their parents. Known as Reach Out Now: Talk with Your Fifth Graders about Underage Drinking, these materials have been focus group-tested with parents and teachers, and include a classroom discussion guide for teachers, activity sheet for students, and a take-home packet for parents. In March 2002, the package was sent for the first time to every fifth grade class in the country and to the States participating in the Leadership to Keep Children Alcohol Free Initiative. In spring 2004, packages are being sent to every fifth and sixth grade class in the country.

Reach Out Now Teach-in: To further alert children, parents, and teachers about the dangers of underage alcohol use, and to reinforce the messages in these school-based materials, SAMHSA is encouraging prominent national, State, and local leaders to conduct teach-ins for fifth grade classrooms nationwide during the week of April 26-30, 2004, the last week of Alcohol Awareness Month. Experience has shown that these teach-ins raise awareness of the problem of underage drinking and encourage greater use of the materials. The teach-ins have expanded from the First Spouses of States who participated in the past two years to a national effort that includes community-based organizations and schools in all 50 States and the District of Columbia.

Governors' Spouses Initiative - the Leadership to Keep Children Alcohol Free: This initiative is a unique coalition of Governors' spouses, Federal agencies, public and private organizations, to prevent the use of alcohol by children ages 9 to 15. The goal of this initiative is to educate the public about the dangers of early alcohol use and to mobilize action to prevent it. In addition to supporting the Leadership initiative itself through an interagency agreement with NIAAA, SAMHSA funds an effort to link this initiative with prevention programs funded by the Substance Abuse Prevention and Treatment Block Grant in the States and with certain SAMHSA programs, such as Too Smart to Start and the Reach Out Now Teach-Ins.

Preventing Underage and Binge Drinking and Alcohol Problems Among Youth and College Students in El Paso and Brownsville, Texas: In 1997, "Operation Safe Crossing" was developed in San Diego/Tijuana to reduce the number of youth ages 18-25 from crossing the U.S./Mexico border to drink in Mexico. In 2001, a series of replications was developed using the San Diego environmentally oriented prevention approach began in El Paso and Brownsville, Texas. Laredo, Texas was added this year. An additional goal along the U.S./Mexico border is to reduce the harm associated with cross-border and binge drinking behaviors (e.g., impaired driving, date rape, and fights). The original program was highly successful, reducing cross-border drinking by 37% and was named a SAMHSA Model Program in 2002. Funding additionally supports community coalitions in each city, including law enforcement, local policy-makers, alcohol beverage workers (bartenders and bar owners) and representatives from prevention, who manage and ensure overall program effectiveness. (Substance Abuse and Mental Health..., 2008)

Activities Related to Underage Drinking:

Substance Abuse Prevention and Treatment (SAPT) Block Grant: The SAPT Block Grant contains a prevention set-aside that reserves a minimum of 20% of each State's block grant allocation for prevention activities. While the majority of the programs supported by these funds are designed to prevent substance abuse in general, many can be expected to have an impact on the reduction of underage drinking. The SAPT Block Grant application has historically asked States to report voluntarily on underage drinking strategies. Examples include State's implementation of public education and/or media campaigns; State laws against consuming alcohol on college campuses; policies or enforcement of laws reducing access to alcohol by minors, including event restrictions, product price increases, or penalties for sales to minors; estimated age of drinking onset; and statutes restricting alcohol promotions to underage audiences. Data on States' answers to these questions are in CSAP's "e-prevention" Block Grant database.

Fetal Alcohol Spectrum Disorders (FASD): The largest of CSAP's alcohol programs addresses Fetal Alcohol Spectrum Disorders (FASD). Programs include a Center for Excellence, a FASD Materials Development Center for Excellence, and Alaska's Five-Year FAS Cooperative Agreement, which is jointly funded by CSAP and CSAT. While these programs do not specifically target underage drinkers, they can be expected to reach this population as well as adults.

Building Blocks for a Healthy Future: Building Blocks for a Healthy Future is an early childhood substance abuse prevention program that educates parents and caregivers about the basics of risk and protective factors, ways to reduce risk factors, and how to reinforce skills that will enable caregivers to better nurture and protect their children in order to promote healthy lifestyles. Designed for parents and caregivers of children ages 3 to 6, Building Blocks is designed to help open up the lines of communication with young children and make it easier to keep those lines of communication open as they grow older. Building Blocks collaborates with the National Head Start Association, the National Association for Elementary School Principals, the League of Cities, and the American Medial Association Alliance to facilitate the training and dissemination efforts of the materials and products.

Outreach to Children of Parents in Treatment (OCPT): In collaboration with the National Association for Children of Alcoholics (NACoA), the OCPT project has developed a kit that includes prevention materials that target the children of parents in substance abuse treatment. The materials are being disseminated to substance abuse treatment centers to use for staff in-services and for children of parents in treatment. The kit includes a promising practices program list which identifies existing prevention and support services to children of substance abusing parents in various settings (e.g., treatment centers, faith/community settings, private voluntary organizations); a practice manual and resource packet; videos; and colorful announcement posters. (Substance Abuse and Mental Health..., 2008)

The following table depicts a crash's relative risk for drivers whoe are 21-35 years old.

Drivers in the age range of 16-20 prove to be at considerably greater risk "than illustrated (e.g., at a BAC of.10-.149%, 16- to 20-year-old males have a relative risk for a fatal crash that is about 50-1200 times greater than non-intoxicated controls)."

Table 1. Relative Risk for Fatal Crash and Bio-behavioral Effects of Alcohol (Brick, 2005)

BAC

Relative Risk Males/Females

Ages 21-34

Biobehavioral Effects

- 3x

Impaired on some lab tests. Start of increased risk for fatal crash

6-8x

0.04% and higher defines intoxication in many European countries and for commercial vehicle operators in the U.S.

11-17x

0.08% defines intoxicated driving in the majority of the states in the U.S.

28-49x

At 0.10%, most drinkers show impairment in SFSTs and would be by law, intoxicated in about 15 states

343x

Most people appear visibly intoxicated at 0.15% without special tests

Most people lose consciousness above this level

Realm of surgical anesthesia

Lethal concentration for about half the population

Due to the fact young people are drinking at an earlier age, the Division of Alcoholic Beverage Control developed a variety of programs "geared towards involving parents, as well as their children, in the efforts to combat underage alcohol use. " Jerry Fischer, Director, stressed: "We must include parents in the dialogue, if we are to truly make a difference in the choices young people make regarding alcohol use." (Efforts to..., 2008)

Comparison of the Literature

Most of the literature reviewed made a point to stress the fact alcohol drastically contributes to motor vehicle crashes, Salazar, Firestone, Price, Villarreal, Guerra, and Harris (2006) report.

In addition, most literature notes that many youth freely admit they drive while they have been drinking. More than any other comparable age group, research repeatedly reveals: young drivers (age 15-20) are more frequently involved in alcohol-related crashes.

Research also repeatedly confirms that traffic crashes rate as the number one killer of youth; with approximately one-third of teen traffic deaths realted to alcohol consumption. (MADD..., 2006) Zwarun, Linz, Metzger & Kunkel (2006) and Arata, Stafford & Tims (2003) concur that youth's attitudes regarding alcohol contribute to their decisions of whether to onsume alcohol. Numerous studies confirm that in print and television, advertising elements promote individual who consume alcohol as physically attractive, successful, romantic, adventureous, etc. (Atkin, 1987; Atkin & Block, 1981; Breed & De Foe, 1984; Finn & Strickland, 1982; Kelly, Slater, Karan, & Hunn, 2000; Postman et al., 1988; Wallack, Grube, et al., 1990; Zwarun & Farrar, 2005; cited by Zwarun, Linz, Metzger & Kunkel, 2006)

Zwarun, Linz, Metzger & Kunkel (2006) also stress that youth who are more aware of alcohol advertising contend drinking as more positive.

Prevention tactics vary in some senses, yet most purport to educate youth regarding the truth about alcohol.

Young people who drink at an early age frequently have to contend with a lifetime of negative consequences, research purports, particularly if/when they choose to, as an underage individual, drink and drive.

Further research is Needed..." "Further research is needed to identify variables that differentiate problem drinkers from non-problem drinkers and to develop effective interventions for reducing adolescent drinking and its consequences," Zwarun, Linz, Metzger & Kunkel (2006) state. These authors, as many in the literature reviewed for this advocacy project, also note that further research is needs to expand the finding that the number of individuals who inferred they perceived drinking and risky behavior in the beer ads in this study varied for each advertisement. Dill & Wells-Parker (2006) purport that future researchers need to aim to overcome numerous research challenges inherent to the study related to knowledge gaps regarding how to best intervene when courts mandate treatment to reduce drinking and driving and treat alcohol problems. When they examined concerns associated with underage drinking, Miller, Levy, Spicer & Taylor (2006) secluded the role of alcohol in stipulations of involvement rates particularly for youth. Attributed percentages of alcohol-involved cases, however, were basically developed for the entire population, instead of specifically for youth, albeit, the authors note that underage drinkers, less habituated to alcohol, tend to be more impaired when driving.

Miller, Levy, Spicer & Taylor (2006) purport that alcohol poisonings, suspected to be seriously underreported (DuFour and Caces, 1993; Miller, Levy, Spicer & Taylor, 2006), along with alcohol attribution in crime and risky sexual behavior warrant further research. (Miller, Levy, Spicer & Taylor, 2006) Further research is required to understand what specific factors potentially contribute to the difference in people who experience consequences, reporting higher risk cognitions, and individuals who do not experience any consequences, even after alcohol use and DD. "Longitudinal studies are also required to understand the relationship between behavioral experience, exposure to consequences and drunk driving (DD) cognitions." These authors question if the perceived threat of sanctions influences individuals' future behaviors, or are future behaviors offset by additional DD cognitions. "Understanding factors that alter perceived risk associated with DD can help inform both intervention and treatment programs for DD." (McCarthy, Pedersen and Leuty, 2005) Rsults of the study Hingson, Heeren, and Edwards (2008) complete, these authors contend, reveal the need for further exploration as to individuals who begin drinking alcohol at early ages and were alcohol dependent, more likely use drugs and become addicted/dependent on drugs.

The authors also question if personal psychological characteristics, genetics, peer pressure, familial environment, community, and / orother factors "may predispose some youths to engage in a variety of risky behaviors, such as early drinking and drug use onset, driving after drinking and drug use, and other reckless driving behaviors." (Hingson, Heeren, and Edwards, 2008)

Synthesis of the Literature

In sum, the recurring themes appearing most frequently include:

Alcohol significantly contributes to motor vehicle crashes.

A majority of deaths involving alcohol in traffic crashes involved an underage driver who was drinking.

Contemporary advertising promotes positive rewards from alcohol consumption, while neglecting to readily relate regularly, recurring negative consequences from underage drinking and driving.

Youth more aware of alcohol advertising possess more positive beliefs about drinking.

More knowledge regarding treatment for individuals charged with drinking and driving is needed.

Emergent Questions and/or Issues from Literature

Even though alcohol manufacturers retain the right to advertise their products to a legal audience, concern arises regarding the content alcohol manufacturers utilize to market their products and messages, particularly as young people perceive the marketed messages to be appealing. The alcohol industry, however, denies their advertising causes underage drinking. Social science research, albeit, determined alcohol ads do contribute to expectations that drinking alcohol will prove to be positive experience. These perceptions, consequently, "known as expectancies, predict drinking." (Aitken, Eadie, Leathar, McNeill, & Scott, 1988; Atkin, Hocking, & Block, 1984; Austin & Meili, 1994; Grube & Wallack, 1994; Wallack, Cassady, & Grube, 1990; cited by Zwarun, Linz, Metzger & Kunkel, 2006) Numerous underage drinkers, for example, think that drinking alcoholic beverages will enhance their social lives (Smith & Goldman, 1995; cited by Zwarun, Linz, Metzger & Kunkel, 2006), while nondrinkers do not readily believe this contention. The belief alcohol enhances a drinker's physical abilities can project heavy underage drinking. (Brown, Christiansen, & Goldman, 1987; Darkes & Goldman, 1993; cited by Zwarun, Linz, Metzger & Kunkel, 2006)

PROPOSED PLAN

The three great essentials to achieve anything worthwhile are, first, hard work;

second, stick-to-itiveness; third, common sense."

Thomas a. Edison

Participants for the "Weekend AD - VENT," this research advocate proposes, will include youth who currently "admit" to experimenting with underage alcohol consumption.

Structural Elements

Blueprint/Design:

In a myriad of ways, reveal truths, contrary to advertising, regarding how alcohol affects underage drivers. (Hanson, 2007)

Stakeholders

Youth participants; Leaders; Community; Law Enforcement Personnel; Medical Personnel; Parents.

Active Participants

At risk" Youth participants; Leaders.

Location

Proposed Time Frame

Friday afternoon, 3 hours; 8 hours on a Saturday.

Resources Needed

Writing Materials

Poster Boards

Paints

Substantive Elements

http://www.iihs.org/research/qanda/default.html"Q&as: Teenagers -- " underage drinking (see Appendix a) Questions to be handed out and when answered; discussed.

A www.iihs.org/research/qanda/underage.html" Is alcohol a significant factor in teenagers' crashes?

Yes. Young drivers are less likely than adults to drive after drinking alcohol, but their crash risk is substantially higher when they do. This is especially true at low and moderate blood alcohol concentrations (BACs) and is thought to result from teenagers' relative inexperience with drinking, with driving, and with combining the two. 1, 2

In 2006, 25% of 16-20-year-old passenger vehicle drivers fatally injured in crashes had BACs of 0.08% or higher. The percentage of fatally injured drivers with high BACs was much lower among females (15%) than among males (29%), and also was lower among 16-17-year-old drivers (18%) than among 18-19-year-old (25%) or 20-year-old (33%) drivers.

Drivers ages 16-20 with BACs of 0.05-0.08% are far more likely than sober teenage drivers to be killed in single-vehicle crashes -- " 17 times more likely for males, 7 times more likely for females. At BACs of 0.08-0.10, fatality risks are even higher, 52 times for males, 15 times for females. 2

Are there special laws aimed at reducing drinking and driving among teenagers?

Yes. Minimum alcohol purchasing age laws limit access to alcohol among teenagers. For a long time, the legal age for purchasing alcohol was 21 in most of the United States. In the 1960s and early 1970s, many states lowered their minimum purchasing ages to 18 or 19. However, states gradually restored higher minimum purchasing ages so that, by the end of 1984, 23 states had minimum purchasing ages of 21, and federal legislation was enacted to withhold highway funds from the remaining 27 states if they did not follow suit. Since July 1988, the minimum alcohol purchase age has been 21 in all 50 states and the District of Columbia. 3

All 50 states and the District of Columbia also have established lower blood alcohol thresholds that are illegal per se for drivers younger than 21. Federal legislation enacted in 1995 that allowed for the withholding of highway funds played a role in motivating states to pass such zero tolerance laws. Typically, these laws prohibit driving with a BAC of 0.02% or greater.

A www.iihs.org/research/qanda/underage.html" Are minimum purchasing age laws and zero tolerance laws effective in reducing drinking and driving among teenagers?

Yes. When minimum alcohol purchasing age laws were lowered in many states in the 1960s and early 1970s, Institute research indicated an increase in the number of drivers younger than 21 involved in nighttime fatal crashes. 4 When a number of states restored higher purchasing age laws as a result of this and other studies, Institute researchers in 1981 evaluated this development in 9 states, finding that nighttime fatal crashes among young drivers were reduced by 28%. 5 a subsequent study in 26 states that raised minimum purchasing ages during 1975-84 estimated a 13% reduction in nighttime driver fatal crash involvement. 6

Studies of zero tolerance laws indicate they reduce crashes among drivers younger than 21. A study of 12 states that passed zero tolerance laws reported a 20% reduction in the proportion of fatal crashes that were single-vehicle nighttime events (crashes likely to involve alcohol impairment) among drivers ages 15-20. 7 www.iihs.org/research/topics/min_drinking_age/default.html" IIHS support for 21 drinking age www.iihs.org/research/qanda/underage.html" How has the teenage drinking and driving problem changed over time?

Trends in alcohol involvement in fatal crashes can be monitored through the National Highway Traffic Safety Administration's Fatality Analysis Reporting System, a census of all fatal crashes in the United States. During the 1980s, the percentages of fatally injured drivers with BACs of 0.08% or higher declined among drivers of all ages. Reductions among young drivers were greatest, in part because of changing minimum alcohol purchasing age laws. In 1982, fewer than half of the states had a minimum purchasing age of 21, and 53% of all fatally injured drivers younger than 21 had BACs of 0.08% or higher. This statistic declined dramatically as states adopted older purchasing age laws. By 1995, it had declined to 24%, the biggest improvement for any age group, and was 27% in 2006. Between 1996 and 2005, the proportion of fatally injured drivers with positive BACs fell by 16% for 16-year-olds and 5-9% for 17-19-year-olds. 8 www.iihs.org/research/qanda/underage.html" What can be done to further reduce teenage drinking and driving?

States and communities need to make it more difficult for teenagers to purchase alcohol. During 1990-91, Institute researchers found that 19-20-year-olds could easily buy a six-pack of beer in Washington, DC, and a New York City suburb. 9 but in two New York counties where police recently had cracked down on underage alcohol purchases, youths were less successful. In these studies, the underage purchasers generally were not even asked by sellers for proof of their ages. During 1994-95, Institute researchers surveyed high school and college students younger than 21 in New York and Pennsylvania about alcohol use and purchasing. Fifty-nine percent of college students and 28% of high school students in New York and 37% of college students and 14% of high school students in Pennsylvania reported they had used false identification to obtain alcohol. 10 According to the 2006 Monitoring the Future survey, almost all (92%) of high school seniors believe it is fairly easy or very easy to get alcohol. 11

One barrier to rigorous enforcement of minimum legal drinking age laws is low funding for state alcohol beverage control agencies. This may inhibit not only the identification of servers, sellers, and purchasers who are violating the law but also the timely application of administrative penalties. Establishments do not always check teenagers' identification cards to establish age, and some teenagers use borrowed/altered or false identifications that are difficult to distinguish from official licenses. 12 Research shows that increased sales law enforcement can reduce the sale of alcohol to minors. 13 Clearly, stepping up enforcement of minimum alcohol purchasing age laws is needed to make them more effective.

Institute research has shown that the potential of zero tolerance laws has not been realized. Researchers found such laws difficult to enforce in some states because police must suspect that a young driver has a high BAC before administering an alcohol test for any measurable BAC. 14 Enforcement of zero tolerance laws reinforces enforcement of underage drinking laws. However, zero tolerance laws are difficult to enforce independent of DUI because offenders with low BACs are not likely to display the erratic driving that results in drivers with high BACs being stopped. 3 Institute surveys of young people in three states found limited knowledge about zero tolerance laws, and many of those who knew about the laws did not believe they often were enforced. 15 When zero tolerance laws are enforced they are effective. An Institute study of Washington state's zero tolerance law found that the law increased the likelihood that an underage person would be sanctioned for drinking and driving, especially among drivers with BACs less than 0.08g/dL. 16 Full enforcement of zero tolerance laws accompanied by publicity about the enforcement will be needed to increase effectiveness. Changes to the laws may encourage enforcement efforts. (as: Teenagers..., 2008)

Underage youth who consume alcohol and drive or ride with an underage peer who has been drinking places him/her self "at risk" for death/injury in an automobile crash. Another risk associated with underage drinking, as the above figure relates, is the fact that drinking too much too fast can stop a person's heart. "Overdosing on alcohol can cause cardiac arrest." (Face Resources, 2004)

If someone passes out from drinking, those around the individual should not let the person who passed out "sleep it off." Instead, one needs to turn the unconscious person on his/her side and an immediately phone [HIDDEN] the person phoning 911 needs to stay with the individual passed out from drinking too much - even if he/she is afraid he/she could get in trouble. The best advice is to: "Get over it" [fear of getting in trouble] and, "Be the one who does something." (Face Resources, 2004)

FACE, a national non-profit organization focusing exclusively on alcohol issues, perform work in the following three areas:

FACE provides research-based public information resources, such as "films, television and radio public service announcements, billboards, theater ads, PowerPoint presentations and a variety of print products (posters, brochures, bookmarks, camera-ready art)."

FACE hosts face-to-face, as well as, online training, designed to discover components r contributing to alcohol problems, and consequently establish actions to resolve and/or reduce those problems.

FACE collaborates with local, state and national level partners to address and reduce alcohol problems. This organization documents community actions' models that contribute to and result in positive changes, along with sharing success stories with others.

FACE receives funding through the sale of its materials, and from private corporate foundations, private family and community foundations, and individual donors. FACE refuses to accept any funding from the alcohol beverage industry.

FACE is not a prohibitionist, and specifically condones legal, safe, low-risk use of alcohol. Prohibition, FACE purports, does not serve as a solution to/for alcohol-related problems and concerns.