which underage drinking laws have been effective?

Which Underage Drinking Laws Have

Been Effective?James C. Fell

Senior Research ScientistPacific Institute for Research & Evaluation

August 25, 2014

The Problem

Young Drivers and Alcohol

Graduated Driver Licensing

Underage Drinking

Minimum Legal Drinking Age 21 [MLDA-21]

Background

MLDA-21 Law Components

Prior Research

Current Research

Methods

Strengths of the MLDA-21 Laws

Results of Current Research

Should the MLDA Remain at 21?

The Problem

What are some of the leading causes of death for young

people?

Leading Causes of Death Ages 16-20: 2009

Rank CausePercent of

DeathsNumber

of Deaths

1 Motor Vehicle Crashes 28% 3,947

2 Homicide 17% 2,386

3 Suicide 14% 1,948

4 Other Injury (falls, drowning, etc.)

10% 1,446

5 Cancer 5% 714

6 Heart Disease 3% 423

All Other Causes Combined 22% 3,016

TOTAL 100% 13,880

Leading Causes of Death Ages 16-20: 2007

Rank CausePercent of

DeathsNumber of

Deaths

1 Motor Vehicle Crashes 34% 5,360

2 Homicide 17% 2,711

3 Suicide 11% 1,784

4 Accidental Poisoning 8% 1,178

5 Cancer 5% 724

6 Heart Disease 3% 396

All Other Causes (falls, drowning, etc.)

22% 3,543

TOTAL 100% 15,696

Young Drivers and Alcohol

The current problem and what is working to reduce their crash risk

Young Drivers Aged 15-20 in 2012 More than one out of four (28%) deaths of young

people aged 16-20 are from motor vehicle crashes.

More than one out of five (22%) young drivers aged 15-20 involved in fatal crashes had been drinking.

Almost three out of four (71%) young drinking drivers killed in crashes were not wearing safety belts.

Half (50%) of the underage 21 drinking drivers involved in fatal crashes were speeding.

Young Driver Over-Involvement in Fatal Crashes Ages 15-20

0

2

4

6

8

10

12

14

Young Licensed Drivers Young Drivers Involved inFatal Crashes

Young Alcohol-InvolvedDrivers in Fatal Crashes

6.4% of All Licensed Drivers

13.6% of All Drivers Involved in Fatal Crashes

13% of All Alcohol- Involved Drivers in Fatal Crashes

Source: NHTSA Traffic Safety Facts, 2003

The Problem

16-year-old drivers have crash rates that are 3 times that of 17 year olds, 5 times that of 18 year olds, and even twice that of 85 year olds.

15% of 16 year olds involved in fatal crashes in 2012 had been drinking (BACs>=.01)

The problem is particularly acute

for 16-year-old drivers

What are some of the reasons for the high crash rates of

young drivers?

The Research: Risk Factors Inexperience – Especially the first few months of

licensure

Late night driving (without supervision)

The number of teen passengers

The presence of alcohol (and other drugs) in young drivers

The low rate of seat belt usage

Type of vehicle driven

Distractions (especially cell phones)

Attention Deficit and Hyperactivity Disorder (ADHD)

Crashes per Million Miles by Driver Age in the U.S.

0

10

20

30

40

50

16 17 18 19 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75- 80- 85+

DRIVER AGE

16 17 18 19 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75- 80- 85+

Percent of Licensed Drivers in Crashes in One Year by Age and Gender in the U.S.

0

10

20

30

40

50

16 17 18 19 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75- 80- 85+

male

female

DRIVER AGE

16 17 18 19 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75- 80- 85+

Crash Rates in the U.S. by Driver Age and Passenger Presence Per 10,000 trips

1

2

3

4

5

6

0 1 2 3+ 0 1 2 3+ 0 1 2 3+

ages 18-19 ages 30-59ages 16-17

number of passengers

Graduated Driver Licensing (GDL) in the U.S.

Permit beginning drivers to acquire on-the-road driving experience under low-risk conditions

Adopt special restrictions and requirements after initial learning phase

Allow young drivers to “graduate” to full license privileges after successfully completing certain stages

Premise:

Minimum age requirement Vision/knowledge tests Basic skills training Licensed adult (at least age 21) required in vehicle at all

times Teenage passenger limitations All occupants must wear safety belts No alcohol or drugs (zero tolerance: BAC<.02) Crash- and conviction-free for at least six months Parental certification of practice hours Distinctive permit from other licenses

Stage 1: Learner’s Permit – Model Components

Graduated Driver Licensing in the U.S.

Complete Stage 1 Minimum age requirement Behind-the-wheel test Advanced driver education training Teen passenger restrictions All occupants must wear safety belts Nighttime driving restrictions: Licensed adult required in vehicle

for all late night driving (when drinking most likely to occur) Zero tolerance (no alcohol or drugs) Crash- and conviction-free for at least 12 consecutive months Distinctive license from full license

Stage 2: Intermediate or Provisional License – Model Components


Complete Stage 2 Minimum age requirement Zero tolerance (no alcohol or

drugs) up to age 21

Stage 3: Full Licensure


Florida 9% reduction in crashes for drivers aged 16-17

California5% reduction in crashes; 10% reduction in convictions for drivers aged 16-17

Oregon16% reduction in crashes for 16-17 year old male drivers

North Carolina

26% reduction in crashes for 16 year old drivers

Michigan 27% reduction in crashes for 16 year old drivers

Nova Scotia

24% reduction in crashes for 16 year old drivers

Ontario 31% reduction in crashes for drivers aged 15-19

Evaluations of Effectiveness in the U.S. and Canada


“Good” GDL Law if it has 5 out of the following 7 components:Minimum age for learner’s permitMandatory waiting period to advance to intermediate stageMinimum hours of supervised drivingMinimum age for intermediate licenseNighttime restriction in intermediate stagePassenger limitation in intermediate stageMinimum age for full unrestricted license

Insurance Institute for Highway Safety Ratings:


Dee, et al., (2005) – Significant 4.4% reduction in 15- to 17-year-old driver deaths attributable to GDL laws when covariate laws included

Chen, et al., (2006) – GDL associated with an 11% lower fatal crash involvement rate for 16 year olds; 16-21% reduction with GDL programs with 5 of 7 key components

Morrisey, Grabowski, Dee & Campbell (2006) – “Good” GDL programs reduce fatalities among 15- to 17-year-old drivers by 19%; “Fair” GDL programs reduce nighttime fatal crash involvements by 13% but no effect on daytime fatal crashes; “Marginal” GDL programs had no effect.

National Studies in the U.S.


Vanlaar, et al., (2009) – Meta-analysis showed significant reduction of fatal crashes of 16-year-old drivers, but not 17, 18, or 19 year old drivers

McCartt, et al., (2009) – GDL laws rated as “Good” had 30% lower fatal crash rate for 15- to 17-year-old drivers compared to GDL laws rated as “Poor”

Lyon, Pan & Li (2012) – a strict GDL permit stage was associated with a 58% reduction in fatal crash risk by 16-year-old drivers compared to a lenient permit stage. Intermediate stage associated with a 44% reduction in fatal crashes but little effect on injury crashes. Strongest effects were seen for crashes with passengers, followed by nighttime crashes, and then overall crashes.

National Studies in the U.S.



Fell, Jones, Romano, Voas (2011)Traffic Injury Prevention, 12(5), 423-431

States that adopt a basic GDL law can expect a decrease of 7-11% in the proportion of 16- to 17-year-old drivers involved in fatal crashes relative to 21- to 25-year-old drivers depending upon their other existing laws (zero tolerance; primary belt; .08 BAC; use and lose)

States that adopt “Good” GDL laws can expect decreases of 8-13% in the proportion of 16- to 17-year-old drivers involved in fatal crashes relative to 21- to 25-year-old drivers depending upon their other existing laws (zero tolerance; primary belt; .08 BAC; use and lose)

Three National Studies in the U.S.: First Study Results

Fell, Todd, Voas (2011):Journal of Safety Research, 42, 283-290

GDL nighttime restrictions reduce 16- to 17-year-old driver involvements in nighttime fatal crashes by 10% Nighttime restrictions reduce 16- to 17-year-old drinking drivers in nighttime fatal crashes by 13%. Passenger restrictions reduce 16- to 17-year-old driver involvements in fatal crashes with teen passengers by 9%

Graduated Driver LicensingThree National Studies in the U.S.: Second Study Results

Romano, Fell, Voas (2011)Annals of Advances in Automotive Medicine, 55, 51-61

Found GDL effects for White, African-Americans and Asian young drivers but not Hispanic young drivers GDL had no apparent effect on speeding-related fatal crashes of novice driversThe observed differences involving young Hispanic drivers might be related to factors other than GDL (e.g., SES causing young Hispanics not to drive as much as Whites).

Graduated Driver LicensingThree National Studies in the U.S.: Third Study Results

Graduated Driver Licensing EffectivenessReductions in 16-17 year old drivers in fatal crashes

-7% GDLwhen otherlaws present

-11% whenGDL alone

-10% innighttimefatal crashes

-13% fordrinking16-17 yearold driver innighttime fatalcrashes

-9% in fatalcrashes withteenpassengers

Fell, Jones, Romano, Voas, 2011

Fell, Todd,Voas, 2011

Fell, Todd,Voas, 2011

GDL effects Nighttime restrictioneffects

Passengerlimitation effects


GDL is a rational way to deal with novice driver problems GDL allows beginning drivers to gradually gain experience

under low-risk conditions GDL provides incentives to drive safely to graduate to full

licensure Surveys indicate substantial support for GDL by parents GDL significantly reduces crashes involving 16- to 17-

year-olds GDL can save thousands of lives in the future if all States

adopt it and if it is extended to all young drivers under age 21.

Summary

So, has Graduated Driver Licensing

been a total success?

Masten, Foss, Marshall (2011)Journal of the American Medical Association, 306(10), 1098-1103

“Good” GDL programs associated with lower incidence of fatal crashes for 16-year-old drivers by 26%, resulting in about 1,348 fewer fatal crashes.However, “Good” GDL programs were associated with a 12% increase in fatal crashes by 18-year-old drivers, resulting in about 1,086 more fatal crashes.Lead author (Masten) speculated that the increase in 18-year-old fatal crashes was due to them delaying licensure in the “Good” GDL states because of the strong restrictions.

Recent National Study



(based upon Fell, Romano & Voas, 2013)

RESULTSAny GDL law reduces fatal crash involvements of 16-year-old drivers by 17% (p<.05) saving 1,945 lives over the years.“Good” GDL laws reduce fatal crash involvements of 16-year-old drivers by 20% (p<.05) saving 2,347 lives over the years.However, 18-year-old fatal crash involvements increased by 11% (p<.05) associated with “Good” GDL laws, resulting in 2,724 fatalities over the years. Why?

Additional Recent Analyses


Drivers aged 18-19 are skipping GDL phases and driving at a later age---reducing their experience

Drivers aged 18-19 are exhibiting more risk-taking behaviors (e.g. impaired driving; lack of safety belt use; distracted driving)

Drivers aged 18-19 have increased exposure to risk for a fatal crash (more late night driving; driving on high speed roads; driving more miles)

Drivers aged 18-19 who have gone through two phases of GDL lack experience under high-risk conditions because of GDL restrictions

Possible Reasons for the Conflict:


Should States require GDL up to age 21? Only one State does (New Jersey).

Has the license status and license type changed over the years for 16-, 17-, and 18-year-old drivers compared to the same ages in fatal crashes before GDL?

Have 18-year-old drivers delayed licensure? In which states? Why?

What other components of GDL laws are effective? Minimum ages, holding periods, practice hours, etc.?

Which GDL components affect impaired driving the most?

Further Research is Needed

Underage Drinking

What percent of 18-20 year olds in the

U.S. report drinking alcohol?

Some Young People Do Drink, But a Smaller Percent Compared to Adults: 2002

15- to 17-year-olds

18- to 20-year-olds

Drinking Occasions

0 1 to 4 5 or more

Drinking Among Youth(past 30 days)

94%

12- to 14-year-olds

18%

72%

10%

49%

27%

24%5% 1%

Source: NSDUH, 2002

Some Young People Do Drink, But a Smaller Percent Compared to Adults: 2012

15- to 17-year-olds

18- to 20-year-olds

Drinking Occasions

0 1 to 4 5 or more

Drinking Among Youth(past 30 days)

96%

12- to 14-year-olds

15%

80%

5%

55%

26%

19%3% 1%

Source: NSDUH, 2012

But, Young Drinkers Drink More Heavily than Adult Drinkers: 2002

Comparison of drinking patterns for adult and underage drinkers (past 30 days)

Non-bingers Bingers

50%

65%72%

43%

50%

35%28%

57%

0%

20%

40%

60%

80%

100%

12- to 14- year-olds 15- to 17- year-olds 18- to 20- year-olds Adults

Source: NSDUH, 2002

Comparison of drinking patterns for adult and underage drinkers (past 30 days)

Non-bingers BingersSource: NSDUH, 2012

But, Young Drinkers Drink More Heavily than Adult Drinkers: 2012

Relative Risk* of Being Involved in a Fatal Crash by BAC

BACDriver Age .05 - .079 .08 - .099 >.15

16-20 6.24 12.61 490.41

21-34 4.78 8.74 200.03

35+ 4.03 6.89 111.94

*Risk relative to BAC=.00 for same age group

Relative risks are the same for men and women at a given BAC. Relative risk for 16-20 year old women are now the same as 16-20 year old men at a given BAC (a change from 1996).Source: Voas, Torres, Romano, Lacey, JSAD, (2012)

Relative Risk of Being Killed as a Driver in a Single Vehicle Crash

(Relative to BAC =.00)

Source: Voas, Torres, Romano, Lacey (2012)

RELATIVE RISK BY AGE

16 - 20

15 - 68

7 - 21 tim es

3 - 5 tim es

Both Male/Fem ale Both Male/Fem ale

21 - 34

14 - 38

7 - 14 tim es

3 - 4 tim es

Both Male/Fem ale

35+

15 - 29

7 - 11 tim es

3 - 4 tim es

.10+BAC

.08

.06

.04

.05

.02

.00

Minimum Legal Drinking Age

Laws

Minimum Legal Drinking AgesAround the World

Australia – 18 Canada – 18

France – 16 Italy – 16

Japan – 20 Sweden – 18

Switzerland – 14 Great Britain – 16

USA – 21 Venezuela – 18

Source: WHO

Background

Minimum Legal Drinking Age 21 (MLDA-21)

History in the United States Minimum Legal Drinking Age (MLDA) Laws

established in the States after the Repeal of Prohibition in 1933(21st Amendment to the US Constitution)

Most States set the MLDA at 21(e.g., 11 States set and stayed at 21):

AR (1935); CA (1933); IN (1934); KY (1938);

NV (1935); NM (1934); ND (1936); OR (1933);

PA (1935); UT (1935); WA (1934)

Minimum Legal Drinking Age 21 History in the United States

Voting age lowered from 21 to 18 in 1971 (26th Amendment to the US Constitution)

Many States began to lower the drinking age to 18 or 19 in the early 1970s

Studies in the 1970s and 1980s showed significant increases in alcohol-related fatal traffic crashes involving youth aged 16-20 in States that lowered their drinking age

Minimum Legal Drinking Age 21 History in the United States

Mothers Against Drunk Driving (MADD) founded in 1980

President’s Commission on Drunk Driving established in 1982

MADD, President’s Commission, Members of Congress recommended a National Uniform Drinking Age Law set at 21 in order to reduce youthful alcohol-related fatalities and eliminate the “blood borders”

MLDA 21 Milestones

President Ronald Reagan signs federal 21 Minimum Drinking Age law in 1984.

All 50 States plus DC adopt age 21 as minimum legal drinking age (illegal topossess alcohol and illegal to purchase alcohol) by 1988 or risk the withholding of a portion of Federal Highway Construction funds.

MD

DE

DC

MA

OR

RINJ

NH

ME

PA

WV

NC

SC

GA

FL

OH

MI

INIL

WI

IA

MO

LA

NM

CO

SD

ID

CA

WA

TN

VT

MS

MT ND

NV

AZ

UT

WY

NE

KS

OK

TX

AR

MN

AL

KY VA

NY

CT

AK

HI

US Minimum Legal Drinking Ages as of December 31, 196935 states had 21 as the drinking age

21 years old

20 years old

18 years old

MD

DE

DC

MA

OR

RINJ

NH

ME

PA

WV

NC

SC

GA

FL

OH

MI

INIL

WI

IA

MO

LA

NM

CO

SD

ID

CA

WA

TN

VT

MS

MT ND

NV

AZ

UT

WY

NE

KS

OK

TX

AR

MN

AL

KY VA

NY

CT

AK

HI

US Minimum Legal Drinking Ages as of December 31, 1975Only 12 states had 21 as the drinking age

21 years old

20 years old

19 years old

18 years old

MD

DE

DC

MA

OR

RINJ

NH

ME

PA

WV

NC

SC

GA

FL

OH

MI

INIL

WI

IA

MO

LA

NM

CO

SD

ID

CA

WA

TN

VT

MS

MT ND

NV

AZ

UT

WY

NE

KS

OK

TX

AR

MN

AL

KY VA

NY

CT

AK

HI

US Minimum Legal Drinking Ages as of July 1, 1988

All states had 21 as the drinking age

What Have Been the Effects of the Minimum Legal Drinking Age 21 in the United States?

What Have Been the Effects of the Minimum Legal Drinking Age 21 in the United States? Reduction in alcohol consumption by those <21

Reduction in drinking driver fatal crashes by those <21

Reduction in alcohol-related homicides, suicides, unintentional injuries by those <21

Research Studies in the 1980s and 1990s show that

raising the drinking age saves lives

Studies from the National Highway Traffic Safety Administration (NHTSA) show that MLDA 21 laws reduce 18- to 20-year-old driver involvements in fatal crashes by 13% (Arnold, 1985; Womble, 1989; Kindelberger, 2005)

MLDA-21 laws estimated to save 800-900 lives each year in reductions in traffic fatalities

Drivers Over Age 21 Involvedin Fatal Crashes, 1982-2004

Sources: FARS; NHTSA

-33%

+38%

Drinking drivers age 21+

Sober drivers age 21+

Drivers Under Age 21 Involved in Fatal Crashes, 1982-2004

Sources: FARS; NHTSA

+9%

-62%Drinking drivers under age 21

Sober drivers under age 21

Other than illegal to possess and illegal to purchase

alcohol if you are under age 21, what other MLDA-21 laws

are there in the States?

MLDA-21Law

Components

20 Key Components of Underage Drinking Laws in the United States

MLDA 21 Law Components # States with LawCORE LAWS: Apply to Youth

Possession 51 Purchase/attempt to purchase 48

EXPANDED LAWS: Apply to Youth

Consumption 35 Internal possession 9 Use and lose driving privileges 40 Use of fake ID illegal 51

Apply to Youth Driving Zero tolerance 51 GDL with night restrictions 51


MLDA 21 Law Components # States with Law

Apply to Providers Furnishing/selling 51 Age 21 for on-premises

Server (all 3 beverage types) 13 Age 21 for on-premises

Bartender (all 3 beverage types) 24 Age 21 for off-premises Seller 23 Keg registration 31 Beverage Service Training 38 Retail Support Provisions for Fake ID 45 Hosting underage drinking parties 28 Dram Shop Liability 45 Social Host Civil Liability 33


MLDA 21 Law Components # States with Law

Apply to Manufacturers of Fake ID

Transfer/production of Fake ID illegal 24 Apply to State

State control of alcohol (at least 1 beverage) 11


Utah has all 20 MLDA-21 Components Kentucky has only 9 out of the 20 laws Georgia has 11 of the laws Only 5 laws have been adopted by all 50

States and DC

5 MLDA-21 Laws Adopted by all States and DC in the United States

Illegal to possess alcohol Illegal to use a fake ID to purchase alcohol Zero Tolerance (BAC>.02) for driving Graduated Driver Licensing System Illegal to furnish alcohol to persons under

age 21

Georgia’s MLDA-21 Laws Possession Purchase Use & Lose Fake ID Use Zero Tolerance for Driving GDL with Night Restrictions Furnishing Keg Registration Fake ID Retail Support Dram Shop Social Host Civil Liability

Prior Research from PIRE

Prior Research

We evaluated 6 of the 20 MLDA-21 laws:

The Impact of Underage Drinking Laws on Alcohol-Related Fatal Crashes of Young Drivers

By Fell, Fisher, Voas, Blackman & TippettsAlcoholism: Clinical and Experimental ResearchVol. 33, No. 7, July 2009

ResultsMLDA 21 Law Effects on Ratio of <Age 21 Drinking Drivers to Non- Drinking Drivers

in Fatal Crashes (1982-2004)

-16%(p<.001)

-5% (p=.026)

-5% (p=.015)

12%(p<.001)

No Effect

-20%

-10%

0%

10%

20%

Core LawsPossession/

Purchase

Use & Lose Zero ToleranceDriving

Keg Registration

GDL with Night Restriction

Traffic Safety Law Effects on the Ratio of Underage 21 Drinking Drivers to Non-Drinking Drivers

in Fatal Crashes (1982-2004)

.08 BAC Per Se

.10 BACPer Se

Seat Belt Law

ALR

-8%

(p=.002)

-7%(p =.065)

-3%

(p=.041) -5%(p =.024)

-10%

0%

10%

Results

Traffic Safety Law Effects and Enforcement on the Ratio of Over Age 25 Drinking Drivers

to Non-Drinking Drivers in Fatal Crashes (1982-2004)

.08 BAC Per Se

ALR.10 BAC

Per Se Sobriety

CheckpointFrequency

-6%(p<.001)

-4%(p<.001)

-4%(p=.042)

-1.4%(p=.004)

-10%

0%

10%

Results

Current Research

Methods

MLDA-21 LawsWe selected for evaluation: Three False Identification (FID) laws:

(1) FID for minors; (2) FID for suppliers (3) FID for retailer support; and

Two social host laws: (4) Social Host Prohibition (SHP); and (5) Social Host Civil Liability (SHCL).

MLDA-21 LawsFake ID laws

(1)for minors prohibited the use of false identification cards by minors (i.e., minors under age 21);

(2)for suppliers prohibited a person from lending, transferring to, or producing false identification for an underage person (i.e., suppliers); and

(3)for retailer support established policies which allowed one or more of the following for retailers of alcohol outlets: the use of identification scanners, distinctive licenses for those under age 21, seizure of identification cards deemed false, or the right to sue an underage person that uses false identification to purchase alcohol (i.e., retailer support).

MLDA-21 LawsSocial Host Laws

1. Social Host Civil Liability (SHCL) laws involve the liability faced by noncommercial alcohol servers for injuries or damages caused by their intoxicated or underage drinking guests. In states with SHCL laws, injured third parties are able to sue social hosts (as well as the minor who caused the crash) for monetary damages. SHCL law is established by statute or by a state court through common law.

MLDA-21 LawsSocial Host Laws

2. Social Host Prohibitions (SHP) involve underage furnishing and host party criminal policies which can result in penalties imposed by the state (e.g., fines, jail, etc.).

Data Sources

Legal ResearchAlcohol Policy Information System (APIS) developed and maintained by the National Institute on Alcohol Abuse and Alcoholism (NIAAA); Westlaw; HeinOnline

Crash AnalysesFatality Analysis Reporting System (FARS) developed and maintained by the National Highway Traffic Safety Administration (NHTSA) for the years 1982-2010

ModelThe model we used is composed of:

1.Three FID laws (i.e., minor, retailer support, and supplier);

2.Two versions of the social host laws (i.e., social host prohibitions (SHP) and social host civil liability (SHCL) laws)

3.Three drinking-and-driving laws (0.08 legal limit, 0.10 legal limit, and ALR);

4.Two driving-safety laws (use of sobriety checkpoints and seatbelt use laws);

5.Two variables determining economic strength (employment rate and VMT by state and year);

6.Per capita beer consumption by state and year;

7.Ratio of underage 21 drinking drivers to underage 21 non-drinking drivers in fatal crashes; and

8.Ratio of drinking drivers to non-drinking drivers in fatal crashes among drivers aged 26 years and older as a comparison.

Structural Equation Modeling (SEM)

Strengths of the Laws

Fake Identification – MinorScoring Criteria Weight Point Values

Fake Identification law +1.0 point for presence of the lawLicense sanction procedure +2.0 points for administrative

sanctionsOR

+2.0 points for administrative and judicial sanctions

OR+1.0 points for judicial sanctions only

Scoring

Fake Identification – SupplierScoring Criteria Weight Point Values

Lending, transfer or sale of false IDs criminalized

+1.0 point if yes

Manufacturing and distribution of false IDs criminalized

+1.0 point if yes

Scoring

Fake Identification – Retailer SupportScoring Criteria Weight Point Values

Incentives for retailers to use scanners

+1.0 point if yes

Use of distinctive licenses +2.0 points if yesSeizure of suspicious ID by retailer permitted

+1.0 point if yes

Right to sue minor +1.0 point if yesAffirmative defense -1.0 point for general affirmative

defense 0.0 points for specific affirmative defense or none

Scoring

Scoring Criteria Weight Point Values

Social Host ProhibitionsType of statute +2.0 points for general

OR+1.0 point for specific

Underage guest actions triggering violation +1.0 point for possession+1.0 point for consumption+1.0 point for intention to possess or consume

Property type covered by law +1.0 point for residence+1.0 point for outdoor area+1.0 point for other areas

Knowledge standard +2.0 points for negligence+1.0 point for knowledge 0 points for overt act

Preventive actions available to offender -1.0 if yesExceptions to law -1.0 point for family

-1.0 point for resident of household-1.0 point for other

Scoring

Social Host Civil LiabilityCommon law or common law and statutory law

+3.0 points

Statutory law only +3.0 pointsLimitations to the law -1.0 point for limitation on who may be

sued-1.0 point for limitation on elements or standards of proof

Scoring

Which of the 5 MLDA-21 laws have had a significant effect on underage drinking

driver fatal crashes?

Results

Effects of five MLDA-21 laws on the ratio of <age 21 drinking drivers to <age 21 nondrinking drivers involved in fatal crashes (Source: FARS 1982-2010)

Model including strength of FID and SHP laws

Predictor Estimate S.E. p-value

Outcome = under 21 FARS ratio

Alcohol-impaired driving laws -.160 .019 <.001

Driving safety laws -.151 .007 <.001

Economic strength .001 .003 .866

FID minor laws -.003 .006 .564

FID supplier laws -.010 .005 .030

FID retailer laws -.004 .003 .218

SHP laws -.001 .001 .937

SHCL laws -.006 .003 .054

Beer consumption .181 .022 <.001

Regression Weights and Significance Levelfor Direct Effects Including Strength of Fake Identification and Social Host MLDA-21 Laws

[values in bold and italics indicate a significant effect]

Conclusions

Only 24 States have Fake ID Supplier Laws and only 33 States have Social Host Civil Liability Laws

If all States adopt fake ID supplier laws (effect size 1.0%) an additional 30 lives per year would be saved—of which 14 lives are currently being saved in the 24 States that have the law.

Conclusions Our prior study (Fell et al., 2009) estimated

that the two core MLDA-21 laws (possession and purchase) and the zero tolerance law for driving (BAC>.02 illegal) are saving 732 lives per year.

Use & Lose laws are saving an additional 132 lives annually and if all states adopted Use & Lose laws an estimated 165 lives could be saved per year.

Conclusions

An estimated 878 lives per year are being saved by these five effective laws. If all states adopted all five laws, up to 927 lives could be saved each year.

What does NHTSA officially say about

MLDA-21 Laws?

Conclusions

Future Research Eleven of the 20 MLDA-21 Laws have now

been evaluated for their effectiveness on underage drinking driver fatal crashes.

Under a NIAAA grant [R03 AA022446] we are currently evaluating:

Dram Shop Laws State Alcohol Control Laws Responsible Beverage Service Training Laws

Eventually all 20 MLDA-21 Laws with strengths will be evaluated.

Acknowledgements■ This study was conducted under a grant from the

National Institute on Alcohol Abuse and Alcoholism (NIAAA) [R21 AA019539]. We thank Mr. Gregory Bloss of NIAAA for his excellent guidance and Dr. Ralph Hingson of NIAAA for his comments and suggestions.

■ The scoring of the 20 underage drinking laws was conducted under a NIAAA grant [R03 AA022446] and a grant from the Office of Juvenile Justice and Delinquency Prevention (OJJDP) [2012-AH-FX-0005].

■ This study is scheduled to be published in Traffic Injury Prevention in October 2014.

Should the Minimum Legal Drinking Age

Remain at 21?

Should the Minimum Legal Drinking Age

Remain at 21?

Have you heard about the Amethyst

Initiative led by college president John McCardell?

Have you heard about the Amethyst

Initiative led by college president John McCardell?

John M. McCardell, Jr.

Director of Choose Responsibility

President Emeritus of Middlebury College and current Vice Chancellor of

The University of the South in Sewanee, TN

MLDA-21 Does Not Make Sense At 18, you can vote, get married, serve in

the military, smoke, etc. Why can’t you drink at 18? MLDA-21 is frequently and easily broken Alcohol has become a forbidden fruit for

those under 21

John McCardell

MLDA-21 Promotes Binge Drinking

Promotes drinking by <21 in clandestine locations without supervision

Reason for a 50% increase in binge drinking by college students

Reason for a significant increase in alcohol-related off-road underage 21 deaths

Reason for increase in underage 21 alcohol poisoning deaths

John McCardell

MLDA-21 Not a Traffic Safety Issue Anymore

More youth die in off-road accidents than on-road

Canada had a similar decrease in underage 21 drinking driver fatal crashes and they have MLDAs of 18 and 19

Youth in European countries with lower drinking ages don’t have the problems we do in the US

John McCardell

Solution Repeal the Federal Law Lower the MLDA to 18 Require 40 hours of alcohol education to

obtain a “drinking license” License revoked for any violations This will Promote Responsible drinking Drinking will occur in supervised

environments

John McCardell

Amethyst Initiative 135 College Presidents have signed the

initiative to take a harder look at the MLDA-21

Keep in mind: This is only 3-4% of the 3500 college presidents in the U.S. who have signed off

Initiated by John McCardell

Is Dr. McCardell right?

Is Dr. McCardell right?

Evidence of MLDA 21 Law Effectiveness

Williams, Zador, Harris, Karpf, 1983 Arnold, 1985 Decker, Graitcer, Schaffner, 1988 Womble, 1989 O’Malley & Wagenaar, 1991 Toomey, Rosenfeld & Wagenaar, 1996 Voas, Tippetts & Fell, 2003 Ponicki, Gruenewald & LaScala, 2007 Many Others

Reviews of the Literature on MLDA 21 Wagenaar & Toomey, 2002

Examined all of the research from 1960 to 2000 when states lowered the drinking age and then raised the drinking age

Every one of the 46 high-quality studies that found an effect found that the MLDA 21 saves lives

Shults, et al, 2001

Centers for Disease Control reviewed all of the high quality peer-reviewed published studies on drinking ages

Concluded:

Lowering the MLDA = crash increase of 10%

Increasing the MLDA = crash decrease 16%

One of the best studied public health laws in history

30-day Alcohol Use by Youth Under Age 21: Minimum Drinking Age Effect

Years Before and After MDA was Raised

Me

an

30

-Da

y A

l co

hol

U

se

Source: O’Malley & Wagenaar (1991)

13% Decline

Evidence of MLDA 21 Law Effectiveness

Drinking drivers over age 21 involved in fatal crashes: the decrease between 1982 and 2004 was

-33%

Drinking drivers under age 21 involved in fatal crashes: the decrease between 1982 and 2004 was

-62%

MLDA 21 accounted for much of the difference (Hedlund, et al., 2001)

Canada Experienced similar decreases in underage 21

drinking drivers in fatal crashes even though MLDA was 18-19

However, drinking drivers over age 21 experienced almost the same rate of decrease

Therefore, factors other than the MLDA accounted for the Canadian decrease

Remember, in the U.S., the <21 drinking driver rate decreased twice as much as the >21 drinking driver rate

More Evidence of Effectiveness

Additional studies have shown a decrease in other injuries associated with MLDA 21:

Decrease in homicides by 18-20 year-oldso Jones, Pieper, and Robertson, 1992

Decrease in suicides by 18-20 year-olds

o Links, 2000

o Birckmayer and Hemenway, 1999

Decrease in other unintentional injuries by 18-20 year-olds

o Jones, Pieper, and Robertson, 1992

Do European youth drink responsibly?Do European youth drink responsibly?

The European Drinking Age Myth

Experimenting with alcohol Drinking in the past year Drinking in the past 30 days Heavy episodic drinking Intoxication

26 countries show higher rates of adolescent intoxication compared to the US rate.

9 countries show lower rates.

A higher percentage of young people from a majority of European countries in 2007 report:

Prevalence of Intoxication in Past Year - 2007Adolescents Aged 15-16

Sources: Hibell, et al., 2009; Johnston, O’Malley, Bachman, & Schulenberg, 2008

First Intoxication Before Age 13 - 2007Adolescents Aged 15-16

Sources: Hibell, et al., 2009; Johnston, O’Malley, Bachman, & Schulenberg, 2008

Drunkenness Among 15-Year-Olds, 2005-6 (Drunk at least twice in life)

Source: O.E.C.D.; Currie et al. (2008)

July 17, 2008

French Combat Youth Binge-Drinking

By Bruce Crumley / Paris

50% increase in 15-24 year olds hospitalized for excess drinking since 2004

50% of 17 year olds reported being drunk in the past month

Alcohol is the leading factor in deaths among French youth

December 17, 2008

Binge Drinking Comes to France

By David Chazan

Binge drinking is now on the rise among young people

France used to take pride in initiating children into the art of sipping wine with their parents

But these days it does not seem to work

The government recognizes the problem and plans to raise the legal age for buying alcohol from 16 to 18 next year

How long has binge drinking in U.S.

colleges been going on?

How long has binge drinking in U.S.

colleges been going on?

Binge Drinking

Straus & Bacon (1953): Drinking in College – discusses binge drinking since 1920s

Straus & Bacon (1953) estimated 65% of college students drank in past 30 days in 1950

College Alcohol Survey (2007) estimated 70% of college students drank in past 30 days

College binge drinking is cultural and not caused by the MLDA-21

Is College Binge Drinking Increasing?

Source: Monitoring the Future, College Students and Adults, 1975-2006, NIH

Percent of College Students Who Report Being Drunk in the Past 30 Days

Source: Monitoring the Future, 1975-2006, NIH

Are Young People Binge Drinking More?

5+ drinks in one session past 2 weeks19-20 Year Olds

Underage Binge Drinking: 1975-2007[% who had 5+ drinks in a row in previous 2 weeks]Source: Monitoring the Future 2007

12 th G rade10 th G rade8 th G rade

‘7 5 ‘7 7 ‘7 9 ‘8 1 ‘8 3 ‘85 ‘8 7 ‘8 9 ‘9 1 ‘9 3 ‘9 5 ‘9 7 ‘9 9 ‘0 1 ‘0 3 ‘0 5 ‘0 7

Y E A R

0

2 0

4 0

6 0

PER

CENT

How many young people under age 21

die of alcohol poisoning each

year?

How many young people under age 21

die of alcohol poisoning each

year?

Alcohol-Attributable DeathsYouth Under Age 21 – 2001(Source: CDC, Midanik, et al, MMWR, 2004)

Motor Vehicle Crashes 2,075 Homicides 1,227 Suicides 480 Poisoning (drug and alcohol) 234 Alcohol Poisoning 18 Drowning 125 Fires 41 Falls 37 Etc. ………. TOTAL 4,492

21

28

19

24 24 25

9 1012 11 10 10

0

10

20

30

2001 2002 2003 2004 2005 2006

Alc

oh

ol

Att

rib

uta

ble

D

ea

ths

(A

lco

ho

l P

ois

on

ing

)

21 - 24 Year Olds

18 - 20 Year Olds

Number of Deaths Attributable to the Harmful Effects of Excessive Alcohol Use Among 18-20 and 21-24 Year Olds:

Alcohol Poisoning 2001-2006

Sources: CDC; Alcohol-Related Disease Impact (ARDI) Software; Alcohol Attributable Deaths (AAD)

Number of Deaths Attributable to the Harmful Effects of Excessive Alcohol Use Among 18-20 and 21-24 Year Olds:

Non-Highway Injury Deaths 2001-2006

Sources: CDC; Alcohol-Related Disease Impact (ARDI) Software; Alcohol Attributable Deaths (AAD)

267 269255 258 255 260

150 151 142 143 141 143

0

100

200

300

2001 2002 2003 2004 2005 2006

Alc

oh

ol

Att

rib

uta

ble

De

ath

s

(No

n-H

igh

wa

y) 21 - 24 Year Olds

18 - 20 Year Olds

Surgeon General’s Call to Action to Prevent and Reduce Underage Drinking, 2007

Not one page, not one

paragraph, not one word

even suggests that

lowering the legal drinking

age is part of the solution

Reducing Underage Drinking: A Collective Responsibility National Academy of Sciences, Institute of Medicine, 2004

Has the MLDA 21 Been Effective?Yes.

40-50 peer-reviewed studies say it has

Research also shows that when the drinking age is lowered, alcohol related problems increase: traffic fatalities, suicides, STDs, assaults, etc.

Raising the drinking age reduces problems

Lowering the drinking age increases problems

Does the MLDA 21 eliminate underage drinking? No.

Should It Remain at 21?Yes.

15% become alcohol dependent vs. 9%

2.4 times the odds of being in a motor vehicle crash as a drinking driver

1.6 times the odds of being in a fight after drinking

Those who start drinking at age 18 vs. those who start at age 21:

Has the MLDA 21 Been Harmful?No.

Increases in alcohol poisoning

Binge drinking in uncontrolled, clandestine environments

Alcohol-related injuries of any kind

There is no evidence of associations with drinking age 21 and the following:

What are some of the arguments people use to

advocate lowering the drinking age?

What are some of the arguments people use to

advocate lowering the drinking age?

Argument: “If I’m old enough to vote and go to war, I should be old enough to drink.”

Response: Many rights have different ages of initiation:

Driver’s license Age 16Vote Age 18Serve in the Military Age 18License to carry handgun Age 21Rent a Hotel Room Age 21Rent a Car Age 25Serve in the House Age 25Elected President Age 35

The brain is not fully developed until about age 25.

Argument: “If people cannot drink until they are 21, will they just drink more when they reach 21?”

Response:

■ Research shows that they will not drink more once they turn 21

■ Early legal access to alcohol is associated with higher rates of drinking later in life

■ Those who wait until they are 21 to start drinking have significantly fewer alcohol-related problems later in life

Argument: “Since 19 and 20-year-olds drink anyway, wouldn’t it be better to let them drink in controlled settings?”

Response:■ Are bars “safe” and “controlled”?

− Many individuals stopped for drinking and driving come from a bar

− 79% of licensed establishments will sell to an obviously intoxicated person

■ MLDA 21 saves many 19- and 20-year-old lives

■ We need to enforce age-21 law in all settings

New Zealand Natural Experiment

It has been 30 years since the last state in the U.S. lowered its drinking age.

If a state were to lower its drinking age under the current conditions—would youthful crash injuries increase?

New Zealand lowered its drinking age from 20 to 18 in 1999, providing an opportunity to study such a reduction.

New Zealand Study Conclusions(Kypri, et al., 2006)

The size of the effect for 18- to 19-year-olds (increases of 12% for males and 51% for females in traffic crash injuries) was remarkable given the legal exceptions to the pre-1999 law and its poor enforcement.

There were large “trickle-down” effects for 15-to 17-year-olds (increases of 14% for males and 24% for females).

There were significantly more alcohol-involved crashes among 15- to 19-year-olds than would have occurred had the purchase age not been reduced to 18.

No Evidence that Lowering MLDA to 18 for those who Complete an Alcohol Education Course will Reducethe Problem Driver education courses did not reduce crashes

for beginning drivers

DARE education program did not reduce drug usage by youth

How can we expect an 18 year old to “choose responsibility” when they are drinking alcohol? They actually lose their inhibitions when under the influence.

College Interventions (IOM, 2004)

Campuses should adopt comprehensive evidence-based approaches:

Screening and brief interventions Limit alcohol availability and access for underage

students Consistent enforcement of laws and policies Universal educational approaches as well as

selective and indicated approaches

NIAAA and SAMHSA should continue to fund evaluation of college-based programs and should maintain list of evidence-based programs.

Promoting a College or University Climate

that De-Emphasizes the Role of Alcohol:

Strategies that Work

Dr. Jonathan Gibralter

President, Frostburg State University

Policies and Procedures Identified campus and community policies and

practices addressing alcohol use and abuse

Addressing off-campus behavior as violations of University policy—in Student Code of Conduct

Increased communications with two other local colleges

Are bringing High Schools into the mix also.

Results Reduction in off-campus citations

Number of repeat offenders has decreased dramatically—almost no third offenses.

Built awareness that off-campus parties also consist of non-students

Improved relations with community

Addressed high-risk events

Students understand the message

Off-campus events involve fewer people

What can we do over the next 5 years to further

reduce underage drinking?

What can we do over the next 5 years to further

reduce underage drinking?

Strategies That Show Evidence of Reducing Underage Drinking

Strengthen the Laws

Better Enforcement of the Laws (against the youth and the providers)

Educate Parents

Increase the excise tax and the price of alcohol – consumption goes down (10% increase in price results in a 5% decrease in consumption)

Delay the age of onset of drinking

De-normalize binge drinking

U.S. Public Supports MLDA-21The public is in favor of keeping the MLDA at 21

Latest Gallup Poll showed 74% opposed lowering the MLDA to 18

Virtually every major public health organization supports the MLDA-21 law:

AMA CDC NHTSA NTSB IIHS APHA NSC

CADCA GHSA CSPI MADD SADD

Only 135 college presidents (3-4%) out of 3500 colleges signed the Amethyst Initiative

New Brain Research Validates 21

Alcohol on the developing brain can interfere with learning and memory

The hippocampus in an adolescent who drinks heavily can be up to 10% smaller

Teenage drinkers score worse on vocabulary and memory tests and are more likely to perform poorly in school

147

Why Should the Minimum Legal Drinking Age Stay at 21?

Minimum drinking age 21 laws save 800-900 lives per year in reductions in traffic fatalities involving young drivers.

Early onset of drinking increases the risk for future alcohol abuse problems, crashes and assaults.

European countries with lower drinking ages experience higher percentages of youth that report intoxication in the past month.

Emerging medical research shows that the brain is not fully developed until about age 25 and excessive drinking by youth under age 21 may cause brain damage as well as reduce brain function.

47%

QUESTIONS?

Strategies for Discussion What strategies can you offer to change social

norms around binge drinking?

What strategies can you offer to avoid adverse circumstances for someone else’s excessive drinking?

Knowing the drinking culture on local college campuses, what recommendations would you make to the college administration to reduce the adverse effects of underage drinking? To law enforcement?

Contact Information

James C. Fell, M.S.

Pacific Institute for Research and Evaluation (PIRE)

11720 Beltsville Dr., Suite 900

Calverton, MD 20705-3111

301-755-2746

[email protected]

which underage drinking laws have been effective?

Documents

young drinking drivers

problemyoung drivers

fatal crashes ages

crash riskyoung drivers

percent of licensed

driver age1617181920

year olds

young driver overinvolvement