Th e S u rg e o n G e neral’ s Call to Action

To Prevent and Reduce

Underage Drinking
What It Means to YOU

A Guide to Action
for Communities

·
About This
Surgeon General’s
Call to Action
The Surgeon General is the Nation’s top doctor and public health officer. The President
of the United States appoints the Surgeon General to help protect and promote the
health of the Nation.
The Surgeon General lets people across the country know the latest news on how to
get healthy and stay healthy. He explains how to avoid illness and injury.
When a health topic needs special attention, the Surgeon General issues a national call to
action to everyone in America. The Surgeon General’s Call to Action To Prevent and Reduce
Underage Drinking explains why underage alcohol use is a major public health and safety
issue. It asks everyone to take action.
About This Guide to Action for Communities
When it comes to tackling public health problems, knowledge is power. When people have
the facts and the right tools, they can take action. This guide gives you the knowledge and
tools you need to take action against underage drinking. It tells you about underage alcohol
use and the damage it can do. And, it suggests ways you can end underage drinking in your
community and across the country.

Suggested Citation: U.S. Department of Health and Human Services. The Surgeon General’s Call to Action To
Prevent and Reduce Underage Drinking: A Guide to Action for Communities. U.S. Department of Health and
Human Services, Office of the Surgeon General, 2007.
All material in this report is in the public domain and may be reproduced or copied without permission from the
Federal government. Citation of the source is appreciated.
 TODAY, NEARLY 10.8 MILLION YOUTH,
AGES 12-20, ARE UNDERAGE DRINKERS

Drinking alcohol can harm the growing body and brain. That’s why it’s important for young people
to grow up alcohol-free. And it takes every adult in the community to help young people choose not
to drink alcohol. It takes you.

What Is Underage Drinking?

When anyone under age 21 drinks alcohol, we call it underage drinking. And underage drinking
is against the law, except in special cases, such as when it is part of a religious ceremony. Underage
drinking is also dangerous. It can harm the mind and body of a growing teen in ways many people
don’t realize.
Yet, children and teens still drink, even though it can harm them. Underage drinking is a serious
problem, with roots deep in our culture. It is time to change that picture. It’s time to take action. It’s
time to stop looking the other way. It’s time to tell children and teens that underage drinking is not
okay. It will take a lot of work over time to change how people think about underage drinking. It’s a
long-term project for parents, schools, local groups, community leaders, and other concerned adults.
And it’s a project that should start when children are young and continue through the teen years.
u In any month, more youth are drinking than are smoking cigarettes or using marijuana.

Alcohol Is the Substance of Choice for Youth

50
Percent Who Used in the Past Month

45

40

35

30 More teens
25
drink than
20

15
smoke or
10 use drugs.
5

0
8th 10th 12th
Grade

Alcohol Cigarettes Marijuana

—Johnston, et al. 2006 Monitoring the Future National Survey Results on Drug Use.


THE FACTS
u A
 s they grow older, the chance
that young people will use
alcohol grows. Approximately
10% of 12-year-olds say they have
used alcohol at least once. By age 13
that number doubles. And by age 15,
approximately 50% have had at least one drink.
u A
 lcohol dependence is a term doctors use when
people have trouble controlling their drinking, and
when their consumption of, or preoccupation with, alcohol
occurs to the extent that it interferes with normal personal,
family, social, or work life. Alcohol dependence rates are highest
among young people between ages 18 and 20. And they’re not even
old enough to drink legally.

Did You Know?

u T
 he greatest influence on young people’s decisions to begin drinking is the
world they live in, which includes their families, friends, schools, the larger
community, and society as a whole.
u A
 lcohol use by young people often is made possible by adults. After all, teens
can’t legally get alcohol on their own.
ST
FA

FACT
Most young people who start drinking before age 21 do so when
they are about 13-14 years old. That’s why it’s important to start
talking early and keep talking about underage drinking. And
that’s why ALL adults working with young people should send
the same message that underage drinking is not okay.


WHAT IS “A DRINK,”
ANYWAY?
A drink can come in many forms. It can be a shot of hard
liquor or a mixed drink containing vodka, rum, tequila, gin,
scotch, etc. It can also be wine, a wine cooler, beer, or malt liquor.
A standard drink is any drink that contains about 14 grams of pure
alcohol (about 0.6 fluid ounces or 1.2 tablespoons). This is the amount of
alcohol usually found in—
u One 12-ounce beer
u One 4- to 5-ounce glass of wine
u One 1.5-ounce shot of 80 proof liquor

What’s a Standard Drink?

But not all drinks are standard drinks. In fact, different drinks often have different amounts
of alcohol. Mixed drinks may contain more than one shot of liquor, and different beers or
wines may not have the same amount of alcohol in them, even when the drinks are the same
size. For example, some beers and beer products, like “ice” beers, and malt liquors, and some
wines, have more alcohol than others.

Remember, the legal drinking age is 21 and underage

drinking can be a threat to health and development.

 Why Is Underage Drinking
A Problem?
So many young people drink. Percent of Youth Who Have Used Alcohol by Age and Gender

Many more young people use alcohol than 100

tobacco or illegal drugs. By age 18, more than 90

70% of teens have had at least one drink. 80

70
When young people drink, they 60

Percent
drink a lot at one time. Teens drink less 50
often than adults. But when teens do drink, 40
they drink more than adults. On average,
30
young people have about 5 drinks on a single
20
occasion. This is called binge drinking, a very
10
dangerous way of drinking that can lead to
0
serious problems and even death. 12 13 14 15 16 17 18 19 20
Age

Early drinking can cause later

male female

—SAMHSA, 2005 National Survey on Drug Use & Health (NSDUH)

alcohol problems. Of adults who started
drinking before age 15, around 40% say they
have the signs of alcohol dependence. That rate is
four times higher than for adults who didn’t drink
until they were age 21.

Alcohol may have a special appeal for

ST

young people. The teen years are a time of

FA

adventure, challenges, and taking risks.

FACT Alcohol is often one of the risks young people
take. But most people don’t know how alcohol
Rates of death and injury
affects a teen’s body and behavior. They don’t
nearly triple between the realize that alcohol can affect young people
early teen years and early in different ways from adults. And they don’t
adult life. Dangerous realize that underage drinkers can also harm
people other than themselves.
activities like underage
drinking play a large role.
That’s why ending teen
alcohol use can help
save lives.


The results of underage
drinking can be grave
 any people don’t know that underage
M
alcohol use—
u I s a major cause of death from injuries among young people. Each year,
approximately 5,000 people under the age of 21 die as a result of underage drinking;
this includes about 1,900 deaths from motor vehicle crashes, 1,600 as a result of
homicides, 300 from suicide, as well as hundreds from other injuries such as falls,
burns, and drownings.
u Increases the risk of carrying out, or being a victim of, a physical or sexual assault.
u C
 an affect the body in many ways. The effects of alcohol range from hangovers to
death from alcohol poisoning.
u C
 an lead to other problems. These may include bad grades in school, run-ins with
the law, and drug use.
u A
 ffects how well a young person judges risk and makes sound decisions. For
example, after drinking, a teen may see nothing wrong with driving a car or riding
with a driver who has been drinking.
u P
 lays a role in risky
sexual activity. This can
increase the chance of teen
pregnancy and sexually
transmitted diseases (STDs),
including HIV, the virus
that causes AIDS.
u C
 an harm the growing
brain, especially when
teens drink a lot. Today
we know that the brain
continues to develop from
birth through the teen years
into the mid-20s.


 The Teen Years Are a Time of Many Changes
u Boys physically become young men and girls become young women.
u Y
 oung people move from elementary to middle to high school. Responsibilities
increase. For example, teens learn to drive, may get a job, and have more chores, and
more homework.
u T
 eens spend less time with their parents. They spend more time alone or with friends.
They also like to stay up later and sleep in.
u T
 eens search for who they really are and who they want to be. They worry about
friendships and social groups. And they have growing romantic and sexual interests.
u T
 he desire for adventure, excitement, and action increases. That’s why many young
people want to take more chances, try new things, and be more independent.
These changes are important steps on the road to adult life. However, these changes also
increase the chance that some young people may turn to alcohol.

Did You Know?

The different “worlds” teens live in can have a big effect on their drinking. Some young
people are more involved with family than others. Others turn to their friends first. Still
others turn to social groups like sports teams and clubs, faith-based groups or groups of
like-minded youth. The Internet, media, music, and videos are also an important part of the
world of most teens. All of these affect a young person’s choices about using alcohol.
ST
FA

FACT
Factors in an adolescent’s environment affect both the appeal
of alcohol and its availability. Among these factors are the social
systems within which teens function and with which they interact.
Examples of these social systems are parents, friends, family, schools,
and the community. The media and the larger social culture,
including how alcohol is marketed and portrayed, also contribute to
alcohol’s appeal to young people.


 Why Teens May Choose
to Drink
Many things affect a young person’s decisions
about drinking—
u T
 he different “worlds” in which teens live,
including family, friends, school, and community
u A greater desire to take risks
u Less connection to parents and more independence
u More time spent with friends and by themselves
u Increased stress
u Greater attention to what they see and hear about alcohol

Did You Know?

 eens with behavior or family problems are at higher risk for alcohol use. And if
T
anyone in the family has a drinking problem, it can affect the entire family. It also may
affect a teen’s choices about drinking.
ST
FA

FACT
Youth with histories of behavior problems (for example,
delinquent activity, impulsive actions, and difficulty controlling
responses) are more likely to use alcohol than are other young
people. The same is true for youth who have an unusually strong
desire for new experiences and sensations, and for those with
histories of family conflict and stress, and/or alcohol problems.

7

Underage Drinking Is
Everyone’s Problem
Underage drinking can affect anyone,
including people who don’t drink.
u Underage alcohol use can lead to dangerous behavior, property damage, and violence.
u The results can be injury and even death for the drinker, and for other people nearby.
u A
 bout 45% of people who die in car crashes involving a drinking driver under age 21
are people other than the driver.
The effects of underage drinking can be felt by everyone. That makes underage alcohol use
everyone’s problem.
ST
FA

FACT
Most 6-year-olds know that alcohol is

only for adults. Between ages 9 and 13,

youth begin to think that alcohol use is

okay. That’s why it’s never too early to

start talking with young people about

the dangers of underage drinking.

Teens say that they rely on adults in

their lives more than anyone else to

help them make tough decisions and to

provide good advice.

8

Ending underage drinking
is everyone’s job

There is a role for everyone.

u E
 veryone can work together to create a community where
young people can grow up and feel good about themselves
without drinking.
u E
 veryone in the community should deliver the message that
underage drinking is not okay. The message should be the same whether youth hear
it in school, at home, in places of worship, on the sports field, in youth programs, or
in other places where young people gather.
u F
 amilies can help prevent underage drinking by staying involved in their
children’s lives. It is important for families to pay attention to what’s happening
with their teens.
u Y
 oung people can learn about the dangers of alcohol use. They can change
how they and others think about drinking.

It’s time to change how we all think, talk, and act when it
comes to underage drinking. We need to stop accepting it
and to start discouraging it. It’s time to help young people
understand that it is not okay for them to drink alcohol.
The discussion needs to start long before youth start
thinking about drinking.


9
What communities can do
about underage drinking
While many teens drink, underage alcohol use is not inevitable. It will take everyone
in the community to make change happen. All of us can help change attitudes about teen
drinking and help replace environments that enable underage alcohol use with environments
that discourage it.
After all, changing how people think isn’t easy. Drinking is legal for adults. That’s why some
people think drinking is a rite of passage for youth. Many young people think drinking is a
way for them to feel more grown-up. People of all ages forget that underage drinking is illegal
and dangerous.
Communities can come together to encourage a new attitude about underage drinking. A
community that opposes underage drinking can help change how people think and act. But it
takes time. So it’s important to keep sending the message that the community does not approve
of underage drinking. Together, communities can support teen decisions NOT to drink.

Get organized.
u W
 ork on underage drinking as a community health and safety problem that everyone
can solve together.
u O
 rganize groups to change community thinking about underage alcohol use.
Support the message that underage drinking is not okay.
u W
 ork with sponsors of community events to help them send the message that
underage drinking is not allowed.

Share knowledge.
u G
 et the word out about policies to prevent underage drinking. This includes age
checks for people buying alcohol, including on the Internet.
u H
 elp people learn about the latest research on underage alcohol use. Include
information about the dangers of youth alcohol use for teens and others. An
informed public is key to ending underage drinking.
u T
 each young people about the dangers of underage alcohol use. Support programs
that help teens already involved with drinking.

10
Change the teen scene.
u C
 reate friendly, alcohol-free
places where teens can gather.
u C
 reate programs, including
volunteer work, where young
people can grow, explore their options, succeed, and feel good about themselves
without alcohol.
u H
 elp teens realize that, like “doing drugs” or smoking, underage drinking is unhealthy
and can drastically impact their lives.
u Let teens involved with underage drinking know that it’s okay to ask for and get help.

Take action.
u Work to change community attitudes about underage drinking.
u Focus as much community attention on underage drinking as on tobacco and drug use.
u Work with State, Tribal, and local groups to reduce underage drinking.
u M
 ake it easier for young people who are involved with or at risk for underage
drinking to get help.
u G
 et the word out about underage drinking laws. The law that makes drinking under
age 21 illegal is only one of them. Other laws forbid selling or giving alcohol to
youth. Others make it against the law to drink and drive. Work to help ensure these
laws are always enforced.

11
Advancing the
call to action
The Surgeon General’s Call to Action To Prevent and Reduce Underage Drinking was written
to improve public knowledge about underage drinking. It encourages action by people and
groups nationwide. Each person in America has a role to play to help prevent and reduce
underage alcohol use. This Call to Action helps adults across the country rethink underage
drinking as we know it today. It provides the tools to get the word out in discussions around
the dinner table, in school or campus-based programs, and in communities. It can also
inform local, Tribal, State, and national programs and policies.
Adults in the community are better able to help protect youth from the dangers of underage
drinking when they know how underage drinking affects a young person’s body and brain.
People and communities working with individual adolescents or groups of teens can help
them choose not to drink. In addition, communities can help create a safer environment
for adolescents when they work with parents, schools, health care professionals, local
organizations, and policymakers to prevent and reduce underage drinking.
This Call To Action is exactly that. It calls on every adult in the country to join with the
Surgeon General in a national effort to address underage drinking early and often.
Underage alcohol use is everyone’s problem—and its solutions are everyone’s responsibility.

References for “A Guide to Action for Communities”

The data, facts, and suggestions presented here come primarily from the Surgeon General’s Call to Action To Prevent
and Reduce Underage Drinking, cited on the inside front cover. Other sources of some data presented in this
document include:

Grant BF, Dawson DA, Stinson FS, Chou SP, Dufour MC, Pickering RP. The 12-month prevalence and trends
in DSM-IV alcohol abuse and dependence: United States, 1991-1992 and 2001-2002. Drug and Alcohol
Dependence 74:223-234, 2004.

Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE. (December 21, 2006). Teen drug use continues down
in 2006, particularly among older teens; but use of prescription-type drugs remains high. University of Michigan
News and Information Services: Ann Arbor, MI. [On-line]. Available: www.monitoringthefuture.org; accessed
01/03/07.

Substance Abuse and Mental Health Services Administration. Results from the 2005 National Survey on Drug Use
and Health: National Findings. Rockville (MD): U.S. Department of Health and Human Services, Substance
Abuse and Mental Health Services Administration; 2006. Available: www.oas.samhsa.gov/nsduh.htm;
accessed 01/03/07.

12
Acknowledgements
This public document was prepared by the U.S. Department of Health and Human Services (DHHS) under
the direction of the Office of the Surgeon General. Its purpose is to make information contained in the Surgeon
General’s Call to Action To Prevent and Reduce Underage Drinking available in a brief, accessible format to
improve public knowledge on this topic.

Rear Admiral Kenneth P. Moritsugu, M.D., M.P.H., Acting Surgeon General, U.S. Public Health Service,
Office of the Surgeon General, Office of the Secretary, DHHS, Washington, D.C.

Richard H. Carmona, M.D., M.P.H., F.A.C.S., former Surgeon General, U.S. Public Health Service,
Office of the Surgeon General, Office of the Secretary, DHHS, Washington, D.C.

Commander Karen A. Near, M.D., M.S., Senior Science Advisor, Office of the Surgeon General,
U.S. Public Health Service, Office of the Secretary, DHHS, Washington, D.C.

Ron Schoenfeld, Ph.D., former Senior Science Advisor, Office of the Surgeon General,
U.S. Public Health Service, Office of the Secretary, DHHS, Washington, D.C.

Ting-Kai Li, M.D., Director, National Institute on Alcohol Abuse and Alcoholism, DHHS, Bethesda, MD.

Rear Admiral Eric B. Broderick, D.D.S., M.P.H., Acting Deputy Administrator, Assistant Surgeon General,
Substance Abuse and Mental Health Services Administration, DHHS, Rockville, MD.

Editors and Writers

Patricia A. Powell, Ph.D., Senior Scientific Editor, Acting Chief, Science Policy Branch, Office of Science Policy
and Communications, National Institute on Alcohol Abuse and Alcoholism, DHHS, Bethesda, MD.

Vivian B. Faden, Ph.D., Senior Scientific Editor, Deputy Director, Division of Epidemiology and Prevention
Research, National Institute on Alcohol Abuse and Alcoholism, DHHS, Bethesda, MD.

Stephen Wing, M.S.W., Associate Administrator for Alcohol Policy, Substance Abuse and Mental Health
Services Administration, DHHS, Rockville, MD.

Science Writers
Hamilton Beazley, Ph.D. Scholar-in-Residence, St. Edward’s University, Austin, TX.

Theodora Fine, M.A., A.B.D., Executive Officer, Fine WordCrafters: Communications and Editing Alchemy,
Ellicott City, MD.

13
fo r mo r e i nfo rm at ion

Underage drinking is a public health and safety problem that results in serious personal, social,
and economic consequences for adolescents, their families, communities, and the Nation as a
whole. Your involvement can make a difference.
Many free sources of information are available to help you take action to prevent and reduce
underage drinking. Some of the materials can help better educate youth and their families,
your colleagues and your community about the dangers of underage drinking and how to
help stop it before it starts.
u T
 o read the entire Surgeon General’s Call to Action To Prevent and Reduce Underage
Drinking, be sure to log on to the Surgeon General’s Web site at www.surgeongeneral.gov.
u F
 or more information about ways you can help to prevent and reduce underage
drinking in your community, please check out www.stopalcoholabuse.gov, a
comprehensive portal of Federal resources for information on underage drinking
and ideas for combating the problem.
u A
 nother excellent source of information is the Web site of the National Institute on
Alcohol Abuse and Alcoholism at http://www.niaaa.nih.gov.
u G
 eneral information about underage drinking, its effects on adolescents, families
and communities, and what you can do to help stop underage drinking is available
through the National Clearinghouse on Alcohol and Drug Information (NCADI),
on the Internet at http://ncadi.samhsa.gov/ or by calling (800) 729-6686.
The words and images in this Guide to Action were designed to reach a broad audience.
Copies of this booklet and the Surgeon General’s Call to Action To Prevent and Reduce
Underage Drinking can be downloaded from both of the Web sites noted. To order copies by
mail, please contact the National Clearinghouse on Alcohol and Drug Information (NCADI)
http://ncadi.samhsa.gov/ or by calling (800) 729-6686.