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Prevention of Underage Drinking: Logic Model Documentation

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Prevention of Underage Drinking: Logic Model Documentation Underage Drinking Causal Model Documentation Prevention of Underage Drinking: Logic Model Documentation Pacific Institute for Research and Evaluation (PIRE) 11720 Beltsville Drive, Suite 900 Calverton, MD 20705 Tel: (301) 755-2700 Fax: (301) 755-2799 February 8, 2008 Contributing authors (in alphabetical order): Johanna D. Birckmayer, Ph.D., M.P.H., Renée I. Boothroyd, Ph.D., M.P.H., Deborah A. Fisher, Ph.D., Joel W. Grube, Ph.D., Harold D. Holder, Ph.D. The Logic Models here are a work in progress; no Logic Model is ever complete or final. The goal of this Logic Model is to document the best available research evidence as well as identify gaps or areas in our understanding which need further study or replication in future research. These documents are presented freely for the use of prevention researchers and prevention practitioners, and can be downloaded and reprinted as desired. PIRE respectively requests that any uses or distributions of these documents in part or in whole give credit to the Pacific Institute for Research and Evaluation, Calverton, MD. i Underage Drinking Causal Model Documentation Table of Contents I. Definition .................................................................................................................................................................. 1 Measurement of the Problem ........................................................................................................................... 1 II. Logic Model of Underage Drinking Prevention ........................................................................................ 3 III. Documentation of Intermediate Variables, Relationships, and Prevention Strategies ............ 5 Drinking Beliefs ...................................................................................................................................................... 6 Family Influence .................................................................................................................................................. 13 School Influence ................................................................................................................................................... 16 Peer Influence ....................................................................................................................................................... 20 Drinking Context ................................................................................................................................................. 22 Retail Availability of Alcohol to Youth ........................................................................................................ 25 Social Availability of Alcohol to Youth ........................................................................................................ 34 Price .......................................................................................................................................................................... 40 Visible Enforcement ........................................................................................................................................... 43 Underage Drinking Laws .................................................................................................................................. 52 Community Norms about Youth Drinking ................................................................................................ 57 Alcohol Promotion .............................................................................................................................................. 60 IV. References .............................................................................................................................................................. 70 ii Underage Drinking Causal Model Documentation I. Definition Underage Drinking refers to any use of alcohol by persons under the legal drinking age of 21. Consumption and/or purchase of alcohol by persons under the age of 21 is illegal in all 50 states and the District of Columbia. According to the NIAAA Alcohol Policy Information System (APIS) while all 50 States and DC prohibit underage possession, only 30 prohibit consumption and 47 prohibit purchase. Justification: Alcohol led to 3,170 deaths and 2.6 million other harmful events among underage drinkers in the US in 2001. Underage drinking is associated with a host of problems, including traffic crashes and fatalities, unwanted and risky sex, pregnancy, and intentional injury. It is estimated that underage drinking costs America as much as $61.5 billion each year. Studies have shown that youth who begin drinking at an early age are at a 3-5 fold increased risk of problem drinking later in life. Measurement of the Problem Recommended Indicator/Measure 1: Current use of alcohol by persons under the age of 21 years Definition: Percent of persons aged 12 and older reporting any use of alcohol within the past 30 days and past year. Data Source: National Survey on Drug Use and Health (NSDUH), Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (DHHS). Frequency: Annual and past 30-day use Geographic Levels: National and State Demographic Categories: Age, gender, ethnicity, socio-economic status Strengths: NSDUH is the only national source that currently provides prevalence of use estimates for both adolescents and adults for every state. Limitations: State-level estimates for most states are based on relatively small samples. Although augmented by model-based estimation procedures, estimates for specific age groups have relatively low precision (i.e., large confidence intervals). The estimates are provided directly by SAMHSA and raw data that could be used for alternative calculations (e.g., demographic subgroups) are not available. The estimates are subject to bias due to self-report and non- response (refusal/no answer). Recommended Indicator/Measure 2: Current use of alcohol by high school students Definition: Percent of students in grades 9 through 12 reporting any use of alcohol within the past 30 days Hosted by Pacific Institute for Research and Evaluation (PIRE), www.pire.org 1 Underage Drinking Causal Model Documentation Data Source: Youth Risk Behavior Surveillance System (YRBSS), Centers for Disease Control and Prevention (CDC) Frequency: Biennial Geographic Levels: National and State Demographic Categories: Grade Level, age, Gender, Race/Ethnicity Strengths: YRBSS estimates are typically based on larger samples than the National Survey on Drug Use and Health, and can be further broken down by grade level, gender, and race/ethnicity. Some states also collect YRBSS data for individual communities or school districts, which can be compared with their state-level data. Limitations: As of 2003, weighted representative samples were available for only 32 states. Not all states participate, and some participating states do not provide representative samples. YRBSS is a school-based survey, so students who have dropped out of school are not represented. It is also subject to bias due to self-report, non-coverage (refusal by selected schools to participate), and non-response (refusal/no answer). Estimates for some subgroups may have relatively low precision (i.e., large confidence intervals). Recommended Indicator/Measure 3: Current use of alcohol by persons under the age of 21. Definition: Percent of persons under the age of 21 who used alcohol in the past year and in the past 30 days. Data Source: Behavioral Risk Factor Surveillance System (BRFSS), Centers for Disease Control and Prevention (CDC) Frequency: Annual Geographic Levels: National and State Demographic Categories: Age, Gender, and Race/Ethnicity Strengths: BRFSS provides prevalence estimates of adult use for every state. State-level estimates are typically based on larger samples than the National Survey on Drug Use and Health and may be further broken down by age, gender, and race/ethnicity. Limitations: BRFSS is a telephone survey subject to potential bias due to self-report, non- coverage (households without phones), and non-response (refusal/no answer). Estimates for subgroups may have relatively low precision (i.e., large confidence intervals). Hosted by Pacific Institute for Research and Evaluation (PIRE), www.pire.org 2 Underage Drinking Causal Model Documentation II. Logic Model of Underage Drinking Prevention A Logic Model is a combination of (a) a causal model which shows the key intermediate variables in a system of relationships to explain a specific outcome (in this case, underage drinking) and (b) the relationship of variables to the outcome or to other variables which have been actually affected via purposeful prevention interventions. This logic model is a public health approach, concerned primarily with underage drinking and associated alcohol-related problems. As such, this model emphasizes variables, relationships, and prevention effects at the population level or the community-wide level. (a) Causal Relationships: Figure 1 is first a general causal model for underage drinking based upon existing research and/or theory. The figure shows key intermediate variables which research has identified as being empirically associated with underage drinking and alcohol- related problems as well as to other intermediate variables in the model. Most of these variables have sufficient strength of association with either underage drinking, alcohol-related problems, or other key variables to
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