Evolving beyond the 'Just Say No' message

April 15, 2001

Adolescent alcohol use continues to pose significant public health problems, such as unwanted pregnancies, sexually transmitted diseases, delinquency, and traffic-related injuries and death. In fact, motor vehicle crashes are the leading cause of death for 15- to 20-year-old youth in the United States, according to mortality data from the National Center for Health Statistics. More than one quarter of the drivers killed in crashes had been drinking. Policy makers and prevention advocates face the challenge of further reducing underage drinking. A study in the April issue of Alcoholism: Clinical & Experimental Research seeks to identify the traits of individuals who support policies designed to reduce underage drinking and its associated health risks.

"We know that public unrest about rising alcohol-related traffic deaths among youth during the 1970s and 1980s contributed to raising the minimum drinking age to 21," said William W. Latimer, assistant professor in the Johns Hopkins University School of Hygiene and Public Health and the study's lead author. "Since 1975, minimum drinking age laws have subsequently reduced traffic fatalities among drivers 18 to 20 years old by 13 percent, and saved more than 18,000 lives. This study represents the next step in research. Namely, we wanted to know what kinds of individual traits of people would be associated with greater or less support of various policy approaches to regulating underage drinking. The study's ultimate value is its ability to inform efforts that are designed to mobilize public opinion to support legislative changes that will result in the adoption of policies to reduce underage drinking."

"Young people abuse alcohol, along with tobacco, more than all other illicit drugs combined," added Ken Winters, associate professor of psychiatry at the University of Minnesota. "Despite concerns about illicit drugs, the licit ones present the bigger public health concern. And drinking, particularly binge drinking, continues to be a frequent problem among teenagers."

Previous media campaigns to reduce adolescent drinking and drug use - such as the "Just Say No" and "This is your brain on drugs" messages - appear to have had limited effectiveness. Youth report that the messages are too simplistic or seem childish. Latimer noted that this study is an attempt to approach the same issue from another angle: heightening adult awareness about the negative things that can happen when kids drink. In order to achieve this, Latimer and his colleagues first wanted to understand what adult characteristics were associated with the support of certain alcohol policies.

The study found that women, infrequent drinkers, and adults with greater knowledge about or concern for youth exhibited the greatest support across the five alcohol policy scales used. Older adults favored policies that restricted alcohol use in public places, while younger adults favored an increase in alcohol taxes to address underage alcohol use. Consistent with previous research, sociodemographic factors such as political orientation, parental status, employment status, and marital status did not predict attitudes on alcohol policy.

"One of the core findings," said Latimer, "is that individual factors - such as how much an adult drinks alcohol, how much they know about teen issues, and how much concern he or she has for teens - were consistently the primary traits that predicted how much people supported a range of policy approaches to regulate and ultimately reduce underage alcohol use. Previous studies have tended to focus exclusively on sociodemographic factors like age and gender. Indeed, consistent with these studies, we found that women showed the greatest support for policies designed to regulate underage drinking."

Winters called some of the findings logical. "People who hold certain values about health will generally espouse to public policies that are consistent with those values," he said. "The gender finding is not that surprising when you consider that women are more likely than men to place a higher value on the personal and social importance of health promotion." What is somewhat surprising is that, regardless of political orientation, support for a range of alcohol policy measures was uniformly very high.

"These are not partisan issues," said Latimer, "but issues on how we can create healthier communities for our youth and all of us. Citizens are tired of subsiding the alcohol producers by paying for all the damage their product does."

"Perhaps the topic reflects a general enough issue from a public health standpoint," added Winters. "Thus, basic differences in life style and political orientation did not translate to group differences." He found a different set of findings intriguing, that older adults favored a restricted-access-to-alcohol policy while younger adults favored increasing alcohol taxes. "One speculation is that these two groups chose the preferred policy based on how it would affect their own behavior," he said. "Older adults may have more experience in seeing the benefits of environmental controls in shaping behavior. Younger people, who generally have less money than older adults, may appreciate more that contingencies based on money have a meaningful impact on their own behavior."

Latimer summed up the study's findings by noting that advertising campaigns that target adults may achieve their greatest influence by promoting the individual factors shown to predict support for alcohol regulation policies. "Knowledge and concern about teens were the strongest predictors," he said. "Women and infrequent drinkers also represent segments within the public who exhibit consistent support for alcohol regulation policies across several dimensions. Overall, the study findings suggest that reductions in morbidity and mortality associated with underage drinking may be realized by campaigns designed to mobilize adult support of alcohol regulation policies by raising awareness of the associated risks of underage drinking."

Some of the study's findings may also be applied at more of a grassroots level, said Winters. "The one factor that had the highest association with alcohol policy attitudes was 'concern for teenagers.' This finding suggests that people at the community level can increase the likelihood of widespread support for alcohol policies if they work to sensitize adults about the importance of young people's health."
Co-authors of the Alcoholism: Clinical & Experimental Research paper included: Eileen M Harwood and Alexander C. Wagenaar of the School of Public Health at the University of Minnesota; and Michael D. Newcomb of the School of Education at the University of Southern California. The study was funded by the Robert Wood Johnson Foundation and the National Institute on Drug Abuse.

Alcoholism: Clinical & Experimental Research

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