A push for increased national attention to the problem of youth alcohol consumption and misuse that began with an influential report from the National Academies of Science (NAS) in 2003 picked up momentum last month, when U.S. Surgeon General Richard Carmona, M.D., officially announced his intention to issue a Call to Action on underage drinking.

Speaking at a meeting convened by the federal government's Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD) last November, Carmona promised that he would use his bully pulpit to address underage drinking. On Feb. 22, the Surgeon General's office issued a call for comments on the proposed Call to Action, with a deadline of March 15 for public input. The document is slated for public release this spring.

"We're delighted that the Surgeon General has signaled his intent to issue an alert on underage drinking," said David Rosenbloom, director of Join Together. "Past leadership by Surgeon Generals has often been a critical turning point in getting the nation to pay attention to serious public-health problems like tobacco. We look forward to a strong call to action and a strong response by government and the private sector."

The announcement of the Call to Action has generated hundreds of responses from the public, including via the Join Together website. The Center for Science in the Public Interest (CSPI), for example, called for a "federally-funded, adult-focused national media campaign as the centerpiece of a commitment to reduce underage drinking," as well as a demand-reduction strategy that includes regulation of alcohol advertising and increases of alcohol excise taxes to cut youth consumption.

"We urge the Surgeon General, in developing the Call to Action, to continue the work of his predecessors, C. Everett Koop, Antonia Novello, and David Satcher, who vocally supported strong measures to reduce underage drinking," wrote CSPI Alcohol Policy Project director George Hacker.

"Generals Koop and Novello called for restrictions on advertising and marketing practices that reach underage youth. Dr. Koop endorsed increases in excise taxes on alcoholic beverages to save young lives; and Dr. Novello initiated a series of (Department of Health and Human Services) Inspector General reports on underage drinking, including a report calling for tighter restrictions on alcohol advertising that appeals to young people. General Satcher addressed the need to reduce youth demand for alcohol and promoted the development and widespread dissemination of campaigns to deglamorize underage drinking. He recognized, as we believe the Call to Action should, that 'until we are able to curtail the demand by young people for alcohol, increased enforcement and legal sanctions will represent only half the solution.'"

National Academy of Sciences Report Seen as Model

CSPI and a number of other respondents cited the 2003 NAS report, "Reducing Underage Drinking: A Collective Responsibility," as a model for Carmona to follow. "We'd like to see a comprehensive plan with large goals," said Penny Wells, executive director of Students Against Destructive Decisions (SADD). "A lot of the work has already been done in the NAS report, but there has been a lack of leadership in taking the next step."

The congressionally mandated NAS report, issued by the National Research Council and the Institute of Medicine, advised the federal government to educate adults about existing laws and the consequences of underage drinking, urges parents to do a better job supervising their children, and calls on the alcohol and entertainment industries to shield youth from unsuitable messages regarding alcohol consumption. 

"To fund the proposed activities and to help reduce underage consumption, Congress and state legislatures should raise excise tax rates on alcohol – particularly on beer, which studies show is the alcoholic beverage that most young people prefer," said the NAS in a press release summarizing the report. "Increasing the cost of alcohol has well-documented deterrent effects on underage drinkers." Other NAS recommendations include increased compliance checks on retailers, backed by the threat of states losing federal funding if enforcement falls short.

Governors' Spouses Played Key Role

One of the prime movers behind the Call to Action has been the group Leadership to Keep Children Alcohol Free, whose membership includes 39 governors' spouses and representatives. Whereas other alcohol policy groups have been frustrated in their attempts to meet with Carmona, Leadership co-chairs Hope Taft of Ohio, Columba Bush of Florida, and Mary Easley of North Carolina sat down with Carmona in April 2003 to request action on underage drinking. 

Numerous observers credit the governors' spouses for prompting the Surgeon General's report and maintaining the momentum generated by the NAS report. Congress also played a role; in its report on the FY2005 Labor/HHS budget bill, the Senate Appropriations Committee members said they were "disappointed to see that the Surgeon General is not engaged in any activities specifically intended to reduce underage drinking, nor does he plan any such activities in the near future."

"The Surgeon General, as the Nation's top doctor, has issued Reports and Calls to Action in the past to focus National attention on important public health issues such as suicide prevention, youth violence and obesity," the panel noted, adding that the "Surgeon General must be fully engaged in the effort to combat childhood drinking" and urging Carmona to "issue a Call to Action on the health crisis of underage drinking."

Report Won't Include Policy Recommendations

Still, many observers doubt that the Bush administration will confront issues like alcohol taxes and advertising, and Leadership project officer Patricia Powell points out that Carmona is barred from making specific policy recommendations as part of his Call to Action. 

Some suspect that Carmona's may be closer in tenor to the action plan issued by the ICCPUD in January 2005 than the NAS report. The ICCPUD plan calls for a "comprehensive, goal-driven, evidence-based, long-term, and coordinated" campaign against underage drinking, including demand reduction and steps to reduce alcohol availability to youth. Demand-reduction tactics in the ICCPUD report include parental education, aiding states in enforcing laws against underage drinking, and screening and brief intervention.

The National Alliance to Prevent Underage Drinking was sharply critical of the ICCPUD report, which it called vague and unfocused. The Alliance, which includes CSPI, Leadership to Keep Children Alcohol-Free, the Center on Alcohol Marketing and Youth, Mothers Against Drunk Driving, the National Council on Alcoholism and Drug Dependence, and the United Methodist General Board on Church and Society, said the plan reflected "an apparent continued absence of will to address seriously America's number-one youth substance use crisis."

"I don't think we can get very far without talking about the alcohol industry and limiting accessibility," said Richard Yoast, Ph.D., director of the Office of Alcohol and Other Drug Abuse at the American Medical Association.

Taft, who said that the Leadership group was "delighted" that Carmona has agreed to issue the Call to Action, noted that former Surgeon General Koop's landmark report on tobacco didn't include policy recommendations, either, but still led to a paradigm shift in how the nation viewed smoking. "We hope that this is the beginning of a shift on childhood drinking," she told Join Together. 

"Most parents spend a lot of time protecting their children from diseases, but when it comes to alcohol, they don't think that that first drink could set their children off on a lifetime of disease," said Taft.

While noting that "price and availability have a lot to do with whether kids hear their parents words or not," Taft stressed the need to educate the public in order to build momentum for broader policy changes. She credited ICCPUD for funding a series of local town hall meetings on underage drinking this spring, and expressed hope that the Surgeon General's report would be released shortly thereafter, perhaps in April to correspond with Alcohol Awareness Month.

"With obesity, who would have thought that cereal companies would be looking to ways to cut sugar and trans-fats out of cereal?" noted Taft. "They're doing it because they think the public demands it."

The culture surrounding underage drinking has "changed so gradually that people don't realize where we are," Taft added. "We don't get indignant when we see ads aimed at children ... with gas stations selling alcohol, or when you have sporting events clearly geared to kids with alcohol ads everywhere ... We have to [raise] general awareness of what has happened before we can do anything about it. The Surgeon General's report can do that." 

Editor's note: Through tomorrow, March 15, the public may submit comments to the Surgeon General about the upcoming Call to Action.