Underage drinking in the United States is a serious problem that leads to substantial harm. Traffic crashes, of course are a major source of tragedy. In 2011, the National Highway Traffic Safety Administration estimates that 24 percent of the young drivers involved in fatal crashes had been drinking. This amounts to 640 fatalities and 419 serious injuries in alcohol related crashes among drivers aged 15-20.¹

In addition, underage drinking is associated with violent crime, property crime, unintentional injury, risky sex, and long-term alcohol problems. Consider these statistics:

• During 2009, an estimated 1,506 traffic fatalities and 36,963 nonfatal traffic injuries were attributable to driving after underage drinking.
• In 2009, an estimated 1,844 homicides; 949,400 nonfatal violent crimes such as rape, robbery and assault; and 1,811,300 property crimes including burglary, larceny, and car theft were attributable to underage drinking.
• In 2007, an estimated 359 alcohol involved fatal burns, drownings, and suicides were attributable to underage drinking.
• In 2009, an estimated 28,161 teen pregnancies and 937,972 teens having risky sex were attributable to underage drinking.²

In addition to these immediate dangers, young people who begin drinking before age 15 are four times more likely to develop alcohol dependence and are two and a half times more likely to become abusers of alcohol than those who begin drinking at age 21. In 2009, 64,831 youth 12- 20 years old were admitted for alcohol treatment in the United States, accounting for 8% of all treatment admissions for alcohol abuse in the country.⁴

For more information on the effects of alcohol on the adolescent brain:
Alcohol and the Adolescent Brain Webinar – 1/17/2013
Presentation  /  Dr. Aaron White bio  / Audio file  

Underage drinking cost the citizens of the United States $62.0 billion in 2010. These costs include medical care, work loss, and pain and suffering associated with the multiple problems resulting from the use of alcohol by youth. This translates to a cost of $2,070 per year for each youth in the State or $3.17 per drink consumed underage.⁵

To find the cost of underage drinking in your state, follow the link below. Underage Drinking Costs

To find more statistics about children and youth in your state or community, go to the “Kids count” website at http://datacenter.kidscount.org

According to the results of the 2013 Youth Risk Behavior Survey, reported by the U.S. Centers for Disease Control and Prevention⁶:

• 18.6% of high school students had their first drink of alcohol before 13
• 34.9% had at least one drink in last 30 days.
• 46.8% of 12th graders had a drink in the last 30 days.
• 20.8% of all high school students had 5 or more drinks on one occasion in last 30 days;
• 29.2% of 12th graders binged on 5 or more drinks in the last 30 days.

Binge drinking is a particularly dangerous behavior for young people. The National Institute on Alcohol Abuse and Alcoholism defines binge drinking as the amount of alcohol leading to a blood alcohol level (BAL) of 0.08%, which, for most adults, would be reached by consuming 5 drinks for men or 4 drinks for women during a 2-hour period.¹ As mentioned above, rates of binge drinking have declined among young people, but this style of drinking is particularly dangerous and the usual definition of binge drinking does not always capture the extreme behavior that young people engage in. Among high school seniors, 10.5% reported consuming 10 to 14 drinks, and 5.6% consumed 15 drinks or more. Between 2005 and 2011, the percent of students who peaked at 5 to 9 drinks and 10 to 14 drinks per occasion declined but not the percent of students peaking at 15 or more drinks⁷.

Between 2000 and 2013, the proportion of students in grades eight, ten, and twelve who reported binge drinking declined by 56, 43, and 26 percent, respectively – See more at: http://www.childtrends.org/?indicators=binge-drinking#sthash.Dh4x13VP.dpuf

Despite the continued underage consumption and the negative consequences resulting from this consumption, it is important to keep in mind that the laws in each of the states that established 21 as the minimum purchase age for alcohol have been highly effective. As an example, the number of drinking drivers over age 21 involved in alcohol related fatal crashes decreased 33% since 1982, when states first began to raise their drinking age. That is very gratifying progress. But during that same time period, the number of drinking drivers under 21 involved in fatal crashes has decreased by 62% – almost twice as much. The figure below shows that change graphically. Progress has been made in all age groups, but reducing alcohol availability to young people has had a particularly dramatic effect.¹⁶

The adoption of age 21 laws has also been associated with a sharp decline in binge drinking among young people. In the early 1980s, before all states adopted age 21 years as the minimum legal drinking age,³ the percentage of high school seniors who consumed 5 or more drinks on occasion during the last 2 weeks exceeded 40%. In contrast, a total of 20.2% of seniors consumed 5 or more drinks at a single setting in the last 2 weeks between 2005 and 2011.

Age 21 laws have also reduced alcohol-related homicides, suicides, and unintentional injuries among young people.

It is widely believed that other countries that allow young people to drink at earlier ages have a more rational approach to introducing alcohol use to youth. But that belief is largely incorrect. Research demonstrates that, in comparison with young people in the United States:

• A greater percentage of young people from nearly all European countries report drinking in the past 30 days;
• A majority of the European countries have higher intoxication rates among young people than do youth from the United States (see figure below);
• For a majority of these European countries, a greater percentage of young people report having been intoxicated before the age of 13.⁸

Additional information can be found in the publication, Youth Drinking Rates and Problems: A Comparison of European Countries and the United States (Revised 2010); YouthDrinkingRatesandProblems.pdf.

Creating a healthy environment by changing the way alcohol is sold and served in the community is the most effective strategy for reducing underage drinking. Educating young people about the dangers of underage drinking or trying to change attitudes about underage drinking are less likely to be effective if alcohol is easily available to underage drinkers.

Communities have traditionally used a number of ways to prevent underage drinking. One main strategy is to provide education about alcohol and underage drinking. School based programs designed to reduce alcohol and other drug use have typically had modest or inconsistent results and often these results have only worked for the short term. In addition, the programs have limitations that be considered. For example, the most vulnerable groups may not attend school regularly.

Communities may use other approaches, such as trying to catch and punish young people when they attempt to purchase alcohol or raising public awareness about underage drinking. These types of programs have limited evidence of effectiveness.

When considering programs that are designed to affect youth, communities must recognize that underage drinking is not an underage problem. It is important for young people to have needed information, strong values and skills that enable them to resist temptation. Communities, however, must work hard to make alcohol less available to youth and thus create environments in which it is easier for young people to make safe and healthy choices.

Environmental strategies create environments in which the opportunities to drink are fewer and the temptations are weaker. When environmental strategies are used, alcohol is made less available to young people, alcohol is promoted in ways that are less likely to be seen by and appeal to young people, and the consequences of illegal sales and use are made clear and compelling.

Many strategies that focus on changing social environments regarding alcohol have been shown to be highly effective. Using these strategies can empower States and communities to take charge of their own environments and help them to provide a healthier setting for all their residents, including young people. Of the various ways communities might approach creating healthier environments, limiting underage access to alcohol is one of the most effective.

Youth usually obtain alcohol—either directly or indirectly— from adults. Efforts to reduce underage drinking, therefore, need to focus on adults and must engage the society at large.

Institute of Medicine, National Research Council of the National Academies (2003)

For more information on environmental strategies, see strategies.pdf
Environmental Strategies to Prevent Alcohol Problems on College Campuses; EnvStratCollege.pdf
Underage Drinking Laws: How are we doing and where are we going? – 1/23/2014
Presentation slides  /  Presenter Bios  /  Transcription  / Audio file

Strategies that limit access to alcohol by youth are some of the most powerful and well-documented approaches to reducing underage drinking and related problems. The report of the Institute of Medicine placed great emphasis on limiting youth access to alcohol.⁹ In implementing strategies to reduce access, it is important to keep in mind that young people obtain alcohol from a variety of sources: friends, family members, and other adults as well as from commercial sources, such as stores.¹⁰ In designing strategies to reduce access, all of these sources must be considered. But any effort to reduce youth access to alcohol should place a strong emphasis on enforcement of laws against sales to minors.

For an overview of laws and policies to control youth access to alcohol, see:
accesslaws.pdf and strategies.pdf

Social sources of alcohol, such as at parties and from older friends or other adults are also important. More information about dealing with underage drinking parties can be found at:
Preventing and Dispersing Underage Drinking Parties

Social Host Laws: Why is One Approach More Effective than Another in Addressing Underage Drinking? – 8/4/2015
Research and Social Host handout  /  Audio file  

Information about reducing purchase of alcohol by adults for minors can be found at:
Strategies for Reducing Third Party Transactions of Alcohol to Underage Youth

Party Patrols: Best Practice Guidelines for College Communities

For more information about reducing access to alcohol on and around college campuses, see information from PRC’s “Safer Universities” website. This includes a toolkit for communities to get started.
https://prev.org/safer

Enforcement of laws against selling alcohol to minors should be the cornerstone of any underage drinking prevention effort. Even though young people obtain alcohol from a variety of sources, no other reductions in access can be fully effective if underage purchases are easy. Not only does enforcement reduce sales to minors, but it also reduces underage drinking and heavy drinking.¹¹

In general, the most effective and efficient strategies are aimed at retailers who are licensed and presumably responsible adults who should be obeying the law.¹² To be maximally effective, communities should place primary emphasis on the vigorous enforcement of the laws prohibiting sales to minors.

Enforcement aimed at retailers includes the following key elements:

• Vigorous use of compliance checks
• Application of appropriate sanctions to violating merchants
• Education of merchants regarding techniques and responsibilities
• Development of community support for enforcement.

More information about related topics is available:
Responsible Beverage Service:
Guide to Responsible Alcohol Sales: Off Premise Clerk, Licensee, and Manager Training
Preventing Sales of Alcohol to Minors: What You Should Know About Merchant Education Programs
Community Support for Enforcement:
Guide to Conducting Alcohol Purchase Surveys
How to Use Local Regulatory and Land Use Powers to Prevent Underage Drinking
Strategic Media Advocacy for Enforcement of Underage Drinking Laws

Compliance checks are law enforcement operations in which an underage volunteer enters an alcohol outlet, usually a store that sells alcohol for off-premises consumption, and attempts to purchase alcohol. If the young person is asked for identification, he/she shows it to the clerk. If the store sells the alcohol without asking for identification or despite the fact that the identification indicates that the customer is under age, the store and/or the clerk receive a citation for violating the law.

Usually these enforcement operations are carried out on a regular basis. The outlets may be selected randomly or they may be selected based on reported problems with underage sales.

For more information, see Reducing Alcohol Sales to Underage Purchasers: A Practical Guide to Compliance Investigations, at AlcoholSales.pdf.

Numerous studies and the experience of communities around the country indicate that compliance checks are effective. For example, In Concord, New Hampshire, sales to youth decreased from 28% to 10% after quarterly compliance checks (coupled with increased penalties and a media campaign) at 539 off-premise alcohol establishments.¹³ In a large study in Minnesota, sales to youth were reduced immediately by 17% in alcohol establishments that experienced a check.¹⁴ In 2004-2005, the police in Butte, Montana conducted two waves of compliance checks at 105 alcohol establishments. Sixty-one percent of stores passed the checks during the first wave in October through December 2004. That compliance rate jumped to 81% after the second wave during January through March 2005.¹⁵

Clearly, compliance checks can result in a dramatic reduction in sales to minors. More importantly, when the rate of illegal sales is reduced, young people drink less and binge drink less.¹⁶

For more information, go to
http://www.aep.umn.edu/index.php/publications/underage-alcohol-use-and-access.

Once there are people in a community who are concerned about underage drinking, there are a number of important steps they can take to implement a program to reduce youth access to alcohol through reducing sales to minors. They can start a planning process that is efficient and effective and moves quickly to action. Some key features of an effective planning process are:

• Community participants are involved only as they are needed to move the process forward or to implement strategies.
• Meetings are kept to a minimum.
• Planning is carefully focused on the most important problems identified and the most effective strategies that respond to those problems.

The most effective and efficient process in any given community depends on the current situation. Some communities already have a compliance check program in place. Perhaps it just needs to be strengthened and revitalized. Perhaps it just needs more community attention. In some communities, there may already be concern about underage drinking but not much action has yet taken place. Perhaps these communities just need to be pointed in the right direction of compliance checks as an effective strategy to address the problem. Some communities may not yet think of underage drinking as a serious health and safety problem. Perhaps the local culture is complacent about youth alcohol use or the community feels like it has more pressing problems to be addressed. In these communities, enforcement agencies, local governments, and the general public may need to be convinced that underage drinking is a problem worth addressing and that there are effective and feasible steps that can be taken to prevent it.

Success Story: Community-wide Effort Involving Youth Reduces Illegal Sales in a College Town

Success Story: SC 2014; South Carolina’s Alcohol Enforcement Teams (AET) Lead the Way in Reducing Youth Access to Alcohol

Enforcement efforts are most effective when they maximize the deterrence effects of the enforcement campaign. It may seem counterintuitive to want potential violators to know that enforcement is going on, but research indicates that it is more powerful to persuade many people that they shouldn’t violate the law in order to avoid detection, arrest and punishment than to arrest and punish just a few. Publicizing enforcement is especially important in the case of compliance checks. Alcohol outlets are primarily run by people who prefer to operate within the law but who may become careless or complacent. Publicizing the enforcement campaign gives them a chance to work harder to avoid violation.

Publicity can take a variety of forms. It is likely to get the most attention if newsworthy media events are organized. For example, the mayor and/or police chief could participate in a ceremony in which he/she signs a proclamation declaring the town a no-underage-sale zone. Young people can hold a joint press conference with enforcement officials announcing the campaign.

Typically, efforts to address underage drinking begin with the formation of a coalition and a meeting. If effective action is to be taken, these meetings need to be focused and to the point. It isn’t necessary to involve every segment of the community – comprehensive task forces have important roles, but when it comes to taking very specific action, it can be more effective and efficient to include only those parts of the community directly involved. In this case, participants would probably include representatives of local government, local law enforcement, alcoholic beverage control agencies along with community groups that are advocating for action, such as MADD.

Not only should the membership of the group be focused, the topics under discussion should be focused. There are many different approaches to preventing underage drinking. This is not the time to try to discuss or implement them all. The purpose of this effort is to reduce the likelihood that the youth of the community can purchase alcohol illegally. Later, after an effective compliance check program has already been implemented, the community can build on that success with additional efforts.

Success Story: Media Support and Consistent Enforcement Lead to 100% Compliance in Conway, Arkansas

Success Story: Cooperative Effort by Task Force Results in Reduced Sales to Minors and a Safer Community

For information about how to carry out compliance checks and media campaigns, see:
mediaadvocacy.pdf
purchase.pdf
AlcoholSales.pdf
http://www.aep.umn.edu/index.php/aep-tools/underage-access

For a distance learning course on this topic, go to:
https://www.ncjtc.org/PIRE/CC/Pages/ComplianceChecks.aspx

Compliance checks are a law enforcement strategy. Stores that sell to the underage decoy are subject to legal sanctions like fines or suspension of their liquor license. There are alternatives to compliance checks if law enforcement agencies do not wish to carry them out or if there are legal barriers in the state (for example, if the minors cannot be given legal immunity for attempting to purchase alcohol illegally – even under police supervision). The best alternative is alcohol purchase surveys.

Alcohol purchase surveys can be carried out without direct law enforcement participation, though it is best to keep law enforcement agencies informed to avoid confusion and potential conflict. In fact, excellent communication with law enforcement is extremely important if at all possible. Without this communication, coalitions and law enforcement may inadvertently undermine one another.

In these surveys, no illegal purchase actually takes place. There are various ways of doing this, but the most common is that the young person who attempts the purchase is actually 21 years old but has been judged by a panel to appear to be well under 21. If asked for identification, the “customer” says they forgot it. If the young person is allowed to purchase the alcohol without showing identification, the outlet is considered out of compliance. If the outlet refuses to sell, they are considered in compliance with the law.

For more information about alcohol purchase surveys, go to http://www.durhamtry.org/apps/articles/default.asp?blogid=2534&view=post&articleid=63733

Alcohol purchase surveys can be done in lieu of compliance checks when compliance checks are not feasible. They can also be an important tool in their own right or as an adjunct to compliance checks. Most communities need valid information in order to do the most effective job of reducing underage access to alcohol. Alcohol purchase surveys can provide this information.

Alcohol purchase surveys:

• Provide information about who is selling to minors and how often
• Raise community awareness and build support for reducing sales to minors
• Inform merchants that they are being monitored by the community
• Aid law enforcement
• Help monitor the impact of prevention strategies.

Success Story: Using Purchase Surveys to Guide Enforcement in Indiana

Purchase surveys are simpler to implement because they do not require the active involvement of law enforcement. A citizen group can simply organize a survey on their own following available guidelines. The surveys can be used for a variety of purposes, including:

• To educate alcohol outlets (either rewarding them for following the law or reminding them about the requirements of the law)
• Bringing public attention to the problem of sales to minors through publicizing the results
• Provide guidance to law enforcement to indicate the size of the problem and/or which outlets need greater enforcement focus

The exact protocol used for the surveys depends on what the community is trying to accomplish. For example, if the community is trying to measure the size of the problem or identify non-compliant outlets, publicity about the effort should be minimal until the survey is completed. If the survey is being used as a reward and reminder program or to convey the message that outlets are being monitored, publicity throughout the survey can be helpful.

For information about carrying out alcohol purchase surveys, see: purchase.pdf

For a sample media announcement, go to
http://www.courierherald.com/news/260976661.html

To see a sample letter to merchants, about enforcement, click here

To see a flyer for alcohol sellers, click here

As with most prevention strategies, compliance checks and purchase surveys are not one-time activities. Their effects wear off over time as the memory of the enforcement fades and as outlet owners and staff turn over. This kind of effort should be incorporated into standard operations in the community. Obviously, there is a trade-off between the intensity and frequency of the activities and the resources required to do them well. Compliance checks should be done frequently and on an unscheduled basis. Cities that conduct at least two compliance checks per year for over two years report illegal alcohol purchase rates under 20%.¹⁷ Similarly, a large scientific study showed that effects of compliance checks diminish after several months, and hence, should be repeated regularly.¹⁸

Compliance checks should also be conducted at all liquor licensees. A large study showed that effects of compliance checks do not diffuse to other establishment in the community— so checks should be done at all establishments rather than just a sample.¹⁹ Checking all alcohol licensees encourages greater compliance of age-of-sale laws throughout the community and helps avoid complaints that some outlets are being arbitrarily or unfairly targeted.

For information about merchant education, see:
PreventingSales.pdf

For detailed information about carrying out compliance checks, see:
AlcoholSales.pdf
http://www.epi.umn.edu/alcohol/policy/compchks.shtm

For a distance learning course on this topic, go to:
https://www.ncjtc.org/PIRE/CC/Pages/ComplianceChecks.aspx

For information about carrying out alcohol purchase surveys, see: purchase.pdf

For information about merchant education, see:
PreventingSales.pdf

For information about how to carry out media campaigns, see:
mediaadvocacy.pdf

Reducing Underage Drinking: A Collective Responsibility  http://www.nap.edu/catalog/10729.html

Reducing Underage Drinking addresses relevant questions and proposes a way to combat underage alcohol use. It explores the ways in which many different individuals and groups contribute to the problem and how they can be enlisted to prevent it. Reducing Underage Drinking will serve as both a game plan and a call to arms for anyone with an investment in youth health and safety. Report to Congress on the Reduction and Prevention of Underage Drinking:
http://store.samhsa.gov/product/PEP12-RTCUAD

ICCPUD Report to Congress, 2012. This Report is the fourth to Congress and summarizes the status of the latest scientific research regarding adolescent alcohol use, describes the characteristics and consequences of underage drinking, and outlines the comprehensive efforts of the Federal Government to address the problem. The Alcohol Policy Information System (APIS) also provides information on the 1984 National Minimum Drinking Age Act:
https://alcoholpolicy.niaaa.nih.gov/the_1984_national_minimum_drinking_age_act_2.html

For more research on alcohol availability and underage drinking, see:
M. J. Paschall, J. Grube, C. Black, R. Flewelling, C. Ringwalt, and A. Biglan. Alcohol Outlet Characteristics and Alcohol Sales to Youth: Results of Alcohol Purchase Surveys in 45 Oregon Communities, Prev Sci. 2007 June; 8(2): 153-159. http://www.ncbi.nlm.nih.gov/pmc/articles/P

M. J. Paschall, J. Grube, C. Black, and C. Ringwalt. Is Commercial Alcohol Availability Related to Adolescent Alcohol Sources and Alcohol Use? Findings from a Multi-Level Study, J Adolesc Health. 2007 August; 41(2): 168-174. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2213632

For more information on underage drinking and enforcement, see:
NHTSA’s Community How to Guide on Enforcement; http://www.nhtsa.gov/people/injury/alcohol/Community%20Guides%20HTML/Guides_index.html

NLLEA; http://nllea.org/enforcementnews.asp?id=1#bot

CDC; http://www.cdc.gov/alcohol/fact-sheets/underage-drinking.htm