NC makes good start, but US has long way to go on underage drinking

Gov. Pat McCrory, Lt. Gov. Dan Forest and state Alcoholic Beverage Control Commission Chairman Jim Gardner recently announced the state's new underage drinking initiative. The initiative as reflected in its theme "Talk It Out" is aimed at encouraging parents - especially of middle school students - to have frank conversations with their children about the dangers of underage drinking.

The state's new website TalkItOutNC.org provides useful facts and figures, showing the magnitude of the problem of underage drinking and provides parents with helpful guidance on how to have these important conversations with their children. The initiative has also developed a series of radio and TV ads, intended to be a catalyst for these conversations.

McCrory and his team are to be commended for shining a light on this critical issue. For over 25 years, all 50 states have had a minimum legal drinking age of 21 (some states, including North Carolina, allow exceptions in certain circumstances). These laws have been a boon to public health. The National Highway Traffic Safety Administration estimates that the MLDA saved 4,242 lives between 2004 and 2008.

That said, there's still a long way for us to go as a state and nation. According to data from the Centers for Disease Control and Prevention, the median state rate of current (past 30 day) alcohol use by high school students in 2011, among the 43 states that participated in the CDC's Youth Risk Behavior Survey, was 36.2 percent.

The median state rate of "binge" drinking - defined by the CDC as having five or more drinks of alcohol in a row within a couple of hours on at least one day during the 30 days before the survey - was 21.8 percent. North Carolina's rates were roughly on par with those of other states: 34.3 percent for current alcohol use and 17.6 percent for binge drinking. This translates into 175,000 North Carolina high school students reporting current use, and 90,000 reporting binge drinking.

Underage drinking can lead to a number of health and social harms, including injuries and deaths from motor vehicle crashes, violence, alcohol poisoning, falls and drowning; being the victim of sexual assault; encounters with the criminal justice system; and long-term risk of addiction.

Engaging parents to have conversations with their kids about drinking, which is the central thrust of the North Carolina campaign, is a good place to start. There is some research that parents' having these conversations can have small, but persistent effects on adolescents' drinking.

We want to challenge McCrory and his team to consider taking broader, and potentially more impactful, action on underage drinking. Reviews of the research, including those done by the Institute of Medicine and the U.S. Preventive Services Task Force, point to a number of critical actions that the governor and his team could implement directly, or advocate for in the General Assembly.

The first is to correctly classify "Alcopops." Our research, as well as that of others, indicates that these sweetened, but potent, beverages (popular brands include Smirnoff Ice, Mike's Hard Lemonade and Bacardi Silver) are extremely popular with youth and serve as a sort of "starter product." North Carolina, along with many other states, incorrectly classifies them as malt beverages, rather than distilled spirits. This has the unfortunate consequence of ensuring widespread retail availability of these products (in groceries and convenience stores), as well as keeping the price very low.

The second is to advocate in the General Assembly for an increase in the tax on beer. The beer tax has not seen a significant increase in North Carolina since 1969 (an increase of less than 1 cent per bottle/can was passed during the 2009 legislative session). Beer is cheap, compared with wine and distilled spirits, and dozens of studies have shown that young people are very sensitive to price. This is probably the single most important step that McCrory and his team can support to achieve a measurable impact on underage drinking.

We want to thank the governor and his team for their leadership on what is indisputably the No. 1 public health issue for adolescents. We look forward to their continued leadership in using the best available science to make a difference in the lives of North Carolina youth, parents and communities.

Mark Wolfson, Ph.D., is a professor and Kimberly Wagoner, Dr.P.H., is a senior research associate in the Department of Social Sciences and Health Policy at Wake Forest Baptist Medical Center.