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NAS Testimony on Underage Drinking

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Written Testimony of

George A. Hacker, Director


Kimberly Miller, Manager of Federal Relations

Alcohol Policies Project

Center for Science in the Public Interest

to the

Committee on Developing a Strategy to Prevent

and Reduce Underage Drinking

National Academy of Sciences

Board on Children, Youth and Families

November 18, 2002


For more information, please contact Kim Miller, Manager of Federal Relations.




Thank you for the opportunity to submit testimony and testify regarding the important work of this committee. We welcome the chance this committee has to help refine and strengthen prevention efforts to reduce underage drinking and its horrendous toll in the United States.


For the past 20 years, the Center for Science in the Public Interest (CSPI) has worked to prevent and reduce alcohol problems by advocating numerous policy reforms that would contribute to improving public health and safety and help save young lives. During that time we have developed the strong conviction that federal efforts to prevent and reduce underage drinking have been sorely underfunded, woefully fragmented, fundamentally invisible and largely ineffective. Numerous obstacles have thwarted the creation of a comprehensive, highly focused, clearly identified, and hard-hitting federal effort to attack underage drinking. We anticipate that the work of this Committee will help overcome some of those long-standing barriers.


We view the Committee's charge as a truly historic opportunity to take the first steps toward ending decades of complacency and neglect of critical federal responsibilities: the protection of underage persons and the amelioration of one of the most damaging and widespread public health and safety threats facing our society today.


First, we would like to review the legislative and policy context which gave rise to this study. That history, we believe, should substantially inform and shape its direction and focus. Second, we will address the longstanding absence of, and glaring need for, a stronger, more visible, consistent, and effective federal leadership role in reducing underage drinking and its widespread public health and safety harms. Finally, we will outline why a media and communications campaign to prevent underage drinking needs to be the centerpiece of a comprehensive, aggressive national prevention-oriented public health and safety strategy.


Legislative and Policy Context


As the committee may be aware, CSPI was part of a broad coalition of national and local public health and safety organizations that for two years supported Congressional efforts to include underage drinking prevention messages in the Office of National Drug Control Policy’s billion-dollar Youth Anti-Drug Media Campaign (see attached list of organizations). Although ultimately unsuccessful, efforts by Representatives Wolf and Roybal-Allard in the House and by Senator Frank Lautenberg in the Senate generated substantial support and hotly contested debate on the issue.


Despite votes that excluded alcohol from ONDCP's media campaign, Congressional debate on the issue strongly affirmed the clear and compelling need for a parallel, but comparable national media campaign to prevent underage drinking. Numerous members of Congress recognized the incongruity of spending hundreds of millions of dollars to prevent illicit drug use, while ignoring underage alcohol use, widely recognized as the far more devastating, severe, and widespread drug problem for young Americans. Congressional debate reflected strong support1 --- and recognition of the need -- for an underage drinking prevention campaign to raise awareness of the problems associated with underage drinking and deliver prevention messages to young people, parents, community leaders, and public health and safety officials.


In this context, on April 4, 2001, Representatives Lucille Roybal-Allard (D-CA) and Frank Wolf (R-VA) introduced legislation to establish a "National Media Campaign to Prevent Underage Drinking" (H.R. 1509). Shortly thereafter, Senators Harry Reid (D-NV) and John Warner (R-VA), and others, introduced companion legislation in the Senate (S. 866). The proposed legislation would create a discrete underage-drinking media campaign focused on alcohol and housed in the Department of Health and Human Services. These bills are backed by a broad array of public health and safety groups, including CSPI, the American Medical Association (AMA), Mothers Against Drunk Driving (MADD), Consumer Federation of America, Latino Council on Alcohol & Tobacco, the Trauma Foundation, and the American Academy of Pediatrics, as well as by the Advertising Council and the National Partnership for a Drug-Free America. Countless local and statewide groups also support the measure. The bi-partisan bills have garnered 82 co-sponsors in the House and 18 in the Senate, and we expect that they will be re-introduced in the 108th Congress.


While the legislation was not enacted in the 107th Congress, report language in the FY 2002 Labor, Health and Human Services and Education appropriations bill represented an important first step in moving the media-campaign issue forward. With support from the National Beer Wholesalers Association and the Distilled Spirits Council of the United States, appropriations language provided $500,000 for the National Academy of Sciences and Institute of Medicine to develop a strategy to reduce and prevent underage drinking. The charge to fashion such a strategy emanates from language in proposed legislation to establish a National Media Campaign to Prevent Underage Drinking (H.R. 1509 and S. 866). Those bills, in relevant part, direct the Secretary of HHS to:


"... develop and submit to the Congress a comprehensive strategy that identifies the nature and extent of the problem of underage drinking, the scientific basis for the strategy, including a review of the existing scientific research, target audiences, goals and objectives of the campaign, message points that will be effective in changing attitudes and behavior, a campaign outline and implementation plan, an evaluation plan, and the estimated costs of implementation."


This language inspired and served as the basis for report language that provides for the Committee’s study. It envisions the development of a planning document for a comprehensive national public education campaign – using television, radio and print media – to educate youth and parents about the risks of  underage drinking. This intent is buttressed by report language calling for the strategy to be "cost effective," implying the use of mass media to efficiently reach large numbers of youth. And, the report’s specific reference to a review of media-based programs designed to change the attitudes and health behaviors of youth leaves little doubt as to the nature of the purpose of the strategy.


Congress charged the Academy to produce a comprehensive policy and prevention strategy to combat underage drinking and its consequences. However, for reasons that I will enumerate below, we believe that a strong media campaign component needs to be at its core. The media campaign to prevent underage drinking should draw on the successes of ONDCP's Youth Anti-Drug Media Campaign and other public health media initiatives, including those conducted and/or planned by state governments, the American Legacy Foundation, foreign health agencies, and private or public sources. Incorporating the lessons of other promising media campaigns in changing health behaviors among youth is central to the mission of this committee.


The Glaring Absence of a Visible, Cohesive Federal Voice on Underage Drinking


For too long, the federal government has been far too silent on underage drinking and the promise of many policy interventions and communications strategies to reduce problems that have devastating economic and public health and safety consequences. We believe that the longstanding absence of a visible, effective, coordinated federal voice and role in addressing underage drinking and its harms contributes to a social norm of acceptance, tolerance, and even accommodation of underage drinking.


Worse yet, this abdication of federal responsibility on underage drinking has left alcohol producers primarily in charge of educating young people and the public, both about alcohol use and about how to combat underage drinking. Despite wildly self-serving industry propaganda, those efforts to address underage drinking have been unevaluated and generally ineffective. Although more visible than federal media programs to prevent underage drinking, industry’s investment in those messages – both financial and creative – pales in comparison with what it spends promoting drinking. For example, Anheuser-Busch, the world’s largest brewer, claims to have spent some $350 million since 1982 on public awareness and social responsibility messages. That’s about what the company spends in just one year on advertising.


One way to measure the government’s sorry commitment to this issue is to look at the resources devoted to preventing alcohol problems among young people. A May, 2001 report released by the U.S. General Accounting Office (GAO), Underage Drinking: Information on Federal Funds Targeted at Prevention, concludes that only $71 million of the federal government's fiscal year 2000 budget was allocated specifically to the prevention of underage drinking. This pitiful allocation is dwarfed by the $18 billion our government spends on the drug war, the $52 billion in estimated costs of underage drinking, and the $2 billion alcohol producers spend per year on alcohol advertising and promotion. To make matters worse, these woefully inadequate resources are scattered among disparate federal agencies, and many programs have been developed with little coordination among the agencies and no unifying vision or strategy.


Unlike with tobacco, for which the Department of Health and Human Services has been designated as the lead agency for the government’s efforts in the area of smoking and health and chairs a statutorily established Inter-Agency Committee on Smoking and Health, there’s no lead agency for the development or implementation of a strategy on underage drinking or combating societal alcohol problems.


The Surgeon General has issued several widely publicized reports on the public health hazards of tobacco, and regularly issues reports on the marketing of tobacco products to young people. Despite numerous appeals over the years from an array of public health and safety groups, the Surgeon General has never held a single workshop or issued any report on underage drinking. In fact, the 1988 Surgeon General’s Workshop on Drunk Driving stands out as the Department’s sole high-visibility forum on alcohol, period.


Similarly, the federal government’s efforts to combat the devastation of illicit drugs are backed by a well-funded, cohesive, publicly articulated, national drug-control strategy. That strategy is coordinated by ONDCP, an executive-department agency that reports directly to the President. Since the mid-1990s, Congress has appropriated billions to that agency, including hundreds of millions of dollars for a national youth anti-drug media campaign.


Nothing remotely resembling such a concerted effort has ever existed to address underage drinking, or alcohol abuse. Yet, according to DHHS, alcohol is the most costly of all drug problems, imposing economic costs of more than $185 billion on the nation each year and causing more than 100,000 deaths. According to the Centers for Disease Control, alcohol is a key factor in the three leading causes of death among young people in America: accidents, homicides, and suicides. Unlike tobacco, which kills its users in middle age and later, alcohol is a drug that actually kills thousands of young people each year, many more than die from the use of all other drugs combined.


The Need for a Media Campaign as the Centerpiece of Federal Efforts to Prevent Underage Drinking


According to the Department of Health and Human Services, prevention efforts are beginning to pay off in declining rates of teen smoking. However, in part due to the absence of comparable efforts to combat underage drinking, alcohol use and binge drinking among teens continue at alarmingly high rates. The latest National Household Survey data suggest that alcohol use among American youth has even increased. Ten million 12- to 20-year-olds reported drinking alcohol in the year prior to the survey. Of those, nearly 6.8 million (19 percent) reported binge drinking and 2.1 million (6 percent) were heavy drinkers. Among the 12- to 17-year-olds, 10.6% binge drink and 2.5% say they’re heavy drinkers. In fact, previous month alcohol use among 12- to 17-year-olds increased more than 5% since 2000; 17.3 percent reported alcohol use in the past month.


As a society, we have invested heavily in massive public awareness campaigns designed to deter young people from taking up smoking and experimenting with illicit drugs. Those campaigns have provided an effective backdrop for a myriad of revolutionary public and private reforms that range from the imposition of advertising restrictions on cigarettes to the prohibition – even in bars – of indoor tobacco use. There is little doubt that they have helped to change the social and political conversation about smoking and drugs, and have empowered citizens and communities to take effective action on behalf of young people and society.


Recently, it has become increasingly apparent that comprehensive communications programs have actually played an important role in steering young people away from tobacco use. Evidence from Florida, California, and Massachusetts demonstrates that reaching young people with the right messages can make a difference. Although perhaps more complicated to implement, a similarly effective media campaign to prevent and reduce underage drinking is both imperative and achievable.


Of course, not even the best media campaign would magically eradicate underage drinking, any more than ONDCP’s campaign has eliminated youth drug use. Nor is it realistic to imagine that sufficient resources would be available for a media campaign that, independently, could compete with more than $2 billion dollars a year in aggressive alcohol advertising and promotion, much of which appeals directly to underage youth. However, a highly visible media campaign that reaches mass – and target – audiences with consistent, powerful, credible, and persuasive messages on underage drinking can help in many ways. As the centerpiece of an integrated prevention strategy, it would:

  • Provide a clear, consistent federal voice and message on underage drinking that would highlight government interest in, leadership for, and commitment to reducing the widespread harms of underage drinking.

  • Focus public attention on underage drinking as a significant public health and safety issue and elevate it on the public’s and policy makers’ radar screens. A well-financed, focused, appropriately targeted, creative, and provocative media campaign can generate discussion and debate, challenge complacency, and prompt state and community action for needed policy and practice reforms. Media involvement will help motivate and bolster community members working to change those community norms that contribute to youth alcohol use.

  • Communicate highly visible, culturally imbedded media messages that (when effectively crafted and delivered) can help shift attitudes, shape perceptions, and change the national conversation about underage drinking, both among youth and adults. Administered effectively, a national media campaign would put to good use the enormous creativity and talent of willing participants in the media and advertising industries. Those professionals pride themselves on their prowess in influencing youths’ attitudes and behaviors.

  • For too long, the absence of cohesive, well-researched, coordinated, and highly promoted prevention messages has allowed alcohol producers free reign to poison the airwaves, both with seductive product appeals and with ineffective, vague, and self-serving "socially responsible" public relations pitches. Those generally untested and unevaluated messages serve more to inoculate alcohol marketers from potential legal liability and Congressional and regulatory scrutiny than they do as real prevention.


    Despite our reservations about industry’s public awareness campaigns, we would not expect a national, government-sponsored media campaign on underage drinking to supplant those messages. Industry efforts would and should continue, given the alcoholic-beverage industry’s undeniable responsibility to discourage the misuse of its products. However, just as we would never delegate the responsibility for youth smoking prevention efforts primarily to cigarette companies, we should not continue to allow vested interests in the alcoholic-beverage industry to have the principal voice when it comes to communicating with young people and adults about preventing underage drinking.


    If the alcoholic-beverage industry is sincere in its commitment to prevent underage drinking, it would embrace public efforts to educate young people and parents about alcohol. A media campaign on underage drinking will not be about prohibition. It would not be about stigmatizing drinkers or alcohol producers. It would not, we would hope, be about communicating simplistic and self-defeating messages that heighten youth rebellion and interest in alcohol. What it would be about is ending our national denial of underage drinking as a major public health and safety issue. A national media campaign would help increase public awareness and understanding of the destructive role of alcohol in young people’s lives, and it would strengthen community resolve and capacity to take effective action to reduce and prevent underage drinking and its myriad harms.


    We thank the Committee for its consideration of our views, and would be pleased to assist its efforts in any way we can.




    1.  Congressional Record, Volume 145, July 1, 1999 (Senate)] [Page S7987-S8010], Floor debate on Lautenberg Amendment No. 1214 to S. 1282 (FY2000 Treasury Postal Appropriations bill).




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