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...

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…