The Prevention of Underage Drinking in
Central Health District
UCLA School of Nursing
Winter 2015 N171 Group D
Faculty: Ka...
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Population of Interest
Data from the 2013 Youth Risk Behavior Survey (YRBS) revealed that 34.9% of...
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Strategies to
Prevent Drinking
There are four current evidenced-based
strategies to reduce alcohol...
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Results of Field Assessment
Based on our assessment of alcohol outlets, it appears that most youth...
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A detailed action plan would need to be developed for each intermediate objective and the corr...
American Community Survey. (2010). Economic data. Retrieved from
Bouchery, E.E., Ha...
of 6

Prevention of Underage Drinking-Flyer

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Transcripts - Prevention of Underage Drinking-Flyer

  • 1. The Prevention of Underage Drinking in Central Health District UCLA School of Nursing Winter 2015 N171 Group D Faculty: Kathleen Smith Kayelalah Asanion, Vaidehi Buch, Regina Capistrano, Maribel Capitan, Daisy Castro, Brittney Daniels, Estelle Kao, Keren Lei, Amy Letwin, Nancy Nguyen, & Kayla Swank Central Health District (CHD) is located in the Service Planning Area 4: Metropolitan Los Angeles (City of Los Angeles Department of City Planning, 2012). San Fernando Road roughly bounds CHD on the east side and highway 134 on the north side. The west boundaries consist of Vermont Avenue and borders of Griffith Park while the south boundaries consist of 20th Street, 21st Street and 25th Street. CHD is very accessible via the highway system of U.S. 101, highway 134, highway 2, Interstate 5, and Interstate 10 (Healthy City, 2015). The topography is irregularly shaped with some flat areas and hilly areas, especially prominent in Griffith Park and Elysian Valley. There are three main bodies of water and three reservoirs in CHD, namely, Echo Lake, MacArthur Park Lake, Los Angeles River, Rowena Reservoir, Silver Lake Reservoir and Elysian Reservoir. CHD is an amalgamation of diverse urban and suburban neighborhoods (Healthy City, 2014). Some of the neighborhoods in the CHD include Silver Lake, East Hollywood, part of Los Feliz, Echo Park, Angeleno Heights, Bellvue neighborhood, South of Sunset, Chinatown, Elysian Valley, Central City East, South Park, Figueroa Corridor, Little Tokyo, Historic Filipinotown, Toy District, Fashion District, Industrial Area, Skid Row, Downtown L.A., Westlake, Central City West, MacArthur Park, and Pico- Union (Healthy City, 2014). Like majority of Los Angeles districts, CHD experiences Mediterranean climate and ethnic diversity. In CHD, approximately 47.4% of the population is Hispanic, 24.3% White, 6.7% African American, 0.2% American Indian, 19.1% Asian, 0.1% Pacific Islander, and 2.1% others (U.S. Census Bureau Decennial Census, 2010). The prominent industries in CHD are corporal and small businesses, manufacturing, health services, sports, technology, and fashion (City Data, 2009). CHD is home to several public parks, plazas, gardens and open spaces. Majority of the corporate businesses and skyline is located in Downtown L.A. while a large homeless population can be found in Central City East (Pool, 2009). Community Description
  • 2. 2 lorem ipsum :: [Date] Population of Interest Data from the 2013 Youth Risk Behavior Survey (YRBS) revealed that 34.9% of national public and private high school students within the 50 states and the District of Columbia consumed alcohol within the past 30 days (Centers for Disease Control and Prevention [CDC], 2014d). For Los Angeles County, the percentage of teens ages 14-17 years who consumed at least one alcoholic drink in the past thirty days was 32.9% in 2011 (Los Angeles County Department of Public Health, 2013). Similarly, data from the Los Angeles Unified School District reveals 27.6% of public high school students consumed at least 1 drink of alcohol on at least 1 day during the 30 days prior to the survey (CDC, 2014d). Currently, there is no available data on the state, SPA 4, and the Central Health District level. Objective SA-13.1 of Healthy People 2020 seeks to reduce the proportion of adolescents ages 12-17 years old reporting use of alcohol or any illicit drugs within the past 30 days at the national level (U.S. Department of Health and Human Services, 2010). Since the Healthy People 2020 objective includes “other illicit drugs” and our focus is exclusively on the underage consumption of alcohol within the past 30 days, we will use the YRBS as a baseline instead. Due to successful prevention efforts, underage alcohol consumption rates among youth in California have decreased since 1997 (Los Angeles County Department of Public Health, 2013). Within the Los Angeles region, the trend has also been seen among youth to be declining from 46.6% in 1997 to 27.6% in 2013 (CDC, 2014d). Although data from 2003 and 2007 showed a slight increase in the prevalence of high school students consuming alcohol (CDC, 2014d). Numerous data has shown that there is illegal consumption of alcohol among adolescents ages 14-17 years old. The likelihood of developing alcohol dependence or abuse later in life is five times more likely to occur in adolescents 15 years of age versus those who began drinking after the legal limit of 21 years of age (CDC, 2014b). The reduction of underage drinking will require intervention from the local, state, and national level. Currently, several prevention strategies used are increasing alcohol excise taxes, having commercial host liability, and regulating alcohol outlet density (CDC, 2014a; CDC, 2014b). The cost of underage alcohol consumption is $31.8 billion within the state of California (Bouchery et. al, 2011). In addition to the economic costs of alcohol use, there are several health risk factors due to the underage consumption of alcohol, which can lead to negative consequences in the future. Some of the concerns that these youth are more likely to experience are alcohol-related car crashes and other unintentional injuries, a higher risk for suicide, abuse of other drugs, and changes in brain development (CDC, 2014b). Consumption of alcohol increases the risk of impaired judgment among adolescents as well. The CDC found that adolescents reported having ridden in a car with a driver who drank alcohol (2014c). Similarly, 50% of this number also reported driving after being under the influence in the same one-month period (CDC, 2014c). Incidentally, 23% of drivers ages 15 to 20 were under the influence in motor vehicle crashes (CDC, 2014c). Due to the significant statistics related to underage drinking and its health effects, continued prevention efforts are still relevant to the reduction of underage alcohol consumption and are a primary public health concern. If the prevention of underage drinking is not targeted, the risk for morbidity and mortality for adolescents ages 14 to 17 will increase therefore leading to a decrease in quality of life and an increase in years of potential life loss (YPLL). In the U.S., teenagers consume alcohol more than any other drug (Foster, Vaughan, Foster & Califano, 2003). According to the results of the 2013 Youth Risk Behavior Survey (YRBS) in Los Angeles County, 59.9% of adolescents had at least one alcoholic drink in their lifetime, 27.6% currently drank alcohol, consuming at least 1 drink in the past month of being surveyed, and 13.3% binge drank, consuming 5 or more drinks in one single occasion within the past month of being surveyed (YRBS 2013 as cited in Centers for Disease Control and Prevention [CDC]). Considering the growing incidence of underage alcohol use among adolescents, and both the short and long-term negative consequences associated with underage alcohol use, different means of preventing underage drinking were assessed in order to establish more effective primary prevention methods. For the purpose of this project, the population of interest was restricted to adolescents ranging in ages from 14-17 years old and grades 9-12, residing in the Central Health District, which is in Service Planning Area 4 of Los Angeles County. The demographics of the Central Health District are represented as follows: of the total population 1,110,502 residents, approximately 4% are youth ages 14-17 years old. This total population is divided by race and ethnicity as follows: 51.5% Hispanic or Latino, 24.2% white, 5.1% African American, 17.0% Asian, 0.2% American Indian, 0.1% Native Hawaiian or Pacific Islander, 0.3% other races, and 1.6% two or more races (U.S. Census Bureau Decennial Census 2010 as cited in Healthy City). The breakdown of race and ethnicity was not available for the youth population. The socioeconomic status as defined by the 5-year estimates of the American Community Survey (2010) revealed that 19.0% of the Central Health District population was living at the poverty level. Additional information related to the target population was not available.
  • 3. 3 lorem ipsum :: [Date] Strategies to Prevent Drinking There are four current evidenced-based strategies to reduce alcohol consumption in adolescents accepted in the public health community. The four strategies include: (1) limiting availability of alcohol, (2) restricting where alcohol consumption can occur, (3) changing community norms, and (4) changing the environment (“Office,” 2007). This assessment addresses the first three strategies: I. Restricting access and supply of alcohol to adolescents Under state jurisdiction, alcohol outlet density may be regulated at the local level through licensing and zoning restrictions. Local zoning ordinances require alcohol outlets to obtain a conditional use permit (CUP) that restricts where alcohol outlets can be located, limit how late they operate, require training sellers/servers, and allow citizens to determine if new outlets should open in their neighborhoods (Mosher & Reynolds). CUP thus limits outlet density within specified distances from schools and other places where youth congregate. The Lee Law prevents alcohol advertising signs from covering more than 33% of a store’s window. Access to alcohol can be restricted by enforcing the minimum legal drinking age (MLDA) through retailer compliance checks. The shoulder tap method detects and prevents minors from loitering and soliciting adults outside an alcohol outlet while arresting those who furnish minors with alcohol (“Decoy Shoulder,” 2009). Dram shop liability holds store owners responsible for any harm inflicted on the customer from the excess alcohol consumed at their store. Also, increasing taxes on alcohol has shown to reduce the levels and frequency of underage drinking (Komro & Toomey, 2002). II. Restricting where alcohol consumption can occur Current practices to reduce where underage drinking occurs include: providing alcohol free public events, requiring beer keg registration of purchasers, sobriety checkpoints, and enacting social hosting ordinances (SHO) (Toomey, Lenk, & Wagenaar, 2007). For public events that do serve alcohol, they are required to use ID bracelets to comply with MLDA. Sobriety checkpoints by law enforcement immediately suspend youth drivers under the influence (DUI) with a blood alcohol level (BAC) greater than 0.00%. As for SHO, it holds adults accountable for providing alcohol to underage persons at their event (Hingson & White, 2014). III. Changing community attitudes & norms Environmental changes may include the reduction of alcohol advertising in bus benches/stands, billboards, store ads, televised commercials and other media sources. Furthermore, providing youth with support services like tutoring and counseling, as well as extracurricular activities like volunteering, sports, arts, and other opportunities to explore talents may reduce the likelihood of underage drinking (Fagan, Hawkins & Catalano, 2011). According to the Youth Risk Behavior Survey report on 2013 data, 34.9% of youth drank alcohol within the last 30 days in the United States. No data exists for California. In comparison, 27.6% of middle school students and 59.9% of high school students reported ever having a sip of alcohol in their lifetime in Los Angeles County. In addition, 27.6% of high school students had alcohol within the last 30 days. Among the middle school students, 30.7% consisted of Hispanics and 15.7% were Whites who claimed ever having a sip of alcohol in their lifetime. There is no data on the ethnicity of the middle school students who drank within the last 30 days. Furthermore, there is no data on Asians or Blacks due to a small sample size of less than 100. High school students were more likely to drink than middle school students. Among the high school students, 29.4% of Hispanics and 16.7% of Asians had a drink of alcohol within the last 30 days. Hispanics were also more likely to drink than other racial/ethnic groups, with 63.4% of Hispanics and 47.0% of Asians ever having a drink in their lifetime (Youth Risk Behavior Survey, 2015). There are also socioeconomic factors that influence alcohol use among certain populations. A study conducted by Truong & Sturm (2009) noted that there are more alcohol outlets surrounding those with a lower socioeconomic status which led to increased alcohol consumption. In comparison to Whites (0.21), Hispanics were surrounded by the most alcohol outlets (0.39) per 0.1 mile radius, Asians/Pacific Islanders came in second (0.33) and Blacks came in third (0.24) (p<0.01). Hence, this may contribute to the increased rate of alcohol use among Hispanic youth compared to the youth of other racial/ethnic groups. Nationwide, the Youth Risk Behavior Survey report on 2013 data indicates that the prevalence of ever having drank alcohol in high school (between ninth and twelfth grade), is highest among female students (67.9%) than male students (64.4%). The prevalence of ever consuming alcohol by grade is highest in the twelfth grade (75.6%) compared to the ninth grade (55.6%). The prevalence of ever consuming alcohol by gender is highest among females: ninth grade (58.8%), tenth grade (64.0%), eleventh grade (72.0%), and twelfth grade (76.3%). In comparison, the prevalence of ever consuming alcohol by male students: ninth grade (52.4%), tenth grade (61.9%), eleventh grade (70.3%), and twelfth grade (74.9%). Additionally, the Youth Risk Behavior Survey report on 2013 data reported that nationwide, 18.6% of students drank alcohol (more than a few sips) prior to the age of thirteen. The prevalence of alcohol consumption before the age of thirteen was higher among males (20.5%) than females (16.6%). For Los Angeles County, the percentage of high school students that ever drank alcohol was highest among female students, 63.3% CI (60.0-66.6), than male students, 56.8% CI (50.9-62.5). The percentage of individuals who ever drank alcohol before the age of thirteen within Los Angeles County was higher amongst males, 18.6% CI (15.8-21.9), than females, 17.6% CI (13.7-22.4). Overall, the data suggests that females were more likely than males to ever drink alcohol throughout high school (ninth through twelfth grade) although males were more likely than females to have drank alcohol before the age of thirteen.
  • 4. 4 lorem ipsum :: [Date] Results of Field Assessment Based on our assessment of alcohol outlets, it appears that most youth do not purchase alcohol directly from on or off-site establishments. However, when alcohol purchase does occur, off-site outlets are more susceptible to selling to minors who use a fake ID due to lack of certified ID verification training in clerks. Additionally, many establishments only ask for identification if a customer appears to be a minor. Many outlets sell alcohol in a manner more convenient for youth, such as selling single cans, stocking a wide variety of alcohol, and remaining open for longer hours seven days a week with schools in close proximity. On-site outlets are not a significant alcohol access point for youth due to higher cost of alcohol, increased security, and more consistent assessment of identification. Overall, the schools visited and assessed were aware of the underage drinking issue amongst their respective students, and in their respective communities as a whole. Each school felt that it was an issue that needed to be addressed, however each school also found a reason to make it less of a priority. For example, some schools felt that marijuana and other drug abuse was more important to address, while others felt that gang violence and vandalism were a higher priority than underage drinking. However, each school did implement punishment towards the students, which ranged from “unwritten suspensions” to zero tolerance. No school expelled the students for drinking. All community organizations assessed agreed that underage drinking is an issue in their respective areas. They reported that youth were accessing alcohol by shoulder-tapping homeless adults, or obtaining it from friends or family members at home or at parties. They also reported that many students turn to alcohol for lack of entertainment after school. Because many families consist of a single parent working multiple jobs, which ultimately decreases parental oversight and allows students to drink unsupervised, the organizations provide afterschool activities for students, such as sports and crafts. In addition, KYCC, a community group, was granted a fund by the city to deal with underage drinking, and are actively working in the multiple levels of the community to implement preventative measures. It appears that only some neighborhood associations focus on the prevention of underage drinking. Of those that do, the primary focus is to decrease alcohol outlet density by either restricting the number of new outlets opening or closing existing outlets. One neighborhood association is taking it a step further by looking into educating local families about underage drinking, introducing stricter penalties for businesses and adults who provide alcohol to youth, and increasing the number of non-alcohol environments for youth. Unfortunately, many of the neighborhood associations in Central Health District do not have a coalition in place that focuses on the prevention of underage drinking. Other organizations and key persons we assessed included the City of LA Department of City Planning, LA Police Department, LA Unified School District Police, City Councilpersons, California Department of Alcoholic Beverage Control, State Senator Kevin de Leon, and the LA County Department of Public Health Substance Abuse Prevention and Control (SPAC). Many of these organizations and councilpersons were extremely difficult to contact. Overall, we found that the issue of underage drinking was a low priority compared to other safety issues such as gang violence or prostitution. Of these, only SPAC has been working with community agencies to develop work plans tailored to the community to decrease underage drinking using evidence-based recommendations. Language barriers between our team and liquor store clerks, and difficulty contacting city-level organizations proved to be the largest challenges in obtaining information. Community strengths lay in the political activism of several neighborhood coalitions, however, participation varied by geographic location. Our findings suggest that the largest issue preventing the community from dealing with underage drinking is that very few city-level organizations are assuming responsibility for the issue, despite their acknowledgment that underage drinking is a definite problem in the community. The city councilpersons repeatedly stated that it is up to LAPD to enforce the law, however, active enforcement begins with pressure from legal implementation, and there currently is no downward pressure at the city level to deal with underage drinking. Although communication gaps exist at multiple levels throughout the community, we believe that the true issue stems from the lack of downward pressure promoting preventative policies toward underage drinking at the city level. In looking at the results of the field assessment, there were a number of strengths in Central Health District regarding the prevention of underage drinking that were identified. These strengths include political activism of local communities to prevent the consumption of alcohol by youth, formation of neighborhood associations focused on decreasing outlet density, and overall community awareness that alcohol use by youth is a significant problem in the community that needs to be addressed. However many areas for improvement were also identified. Alcohol retailers lack standardized training and are not consistent with identification assessment. Schools feel that alcohol abuse among youth is not a main priority; the focus differs at each school, varying from marijuana use to vandalism and gang related violence. Youth obtain access to alcohol via friends, family, parties, shoulder tapping adults, and there are no social hosting ordinances in L.A. County. There are no coalitions focused on the prevention of underage drinking, and underage alcohol use is a low priority for governmental officials and organizations.
  • 5. 5 lorem ipsum :: [Date] Act A detailed action plan would need to be developed for each intermediate objective and the corresponding process objectives detailing who is responsible for each outcome. This could be an individual or team responsibility. Evaluate A plan would need to be developed to measure progress over the plan period toward improvement of the Outcome Objective and also the accomplishment of each intermediate objective and process objective. All evaluation requires measurement from a baseline.
  • 6. References American Community Survey. (2010). Economic data. Retrieved from Bouchery, E.E., Harwood, H.J., Sacks, J.J., Simon, C.J., & Brewer, R.D. (2011). Economic costs of excessive alcohol consumption in the U.S., 2006. American Journal of Preventive Medicine, 41(5), 516-524. doi: California Friday Night Live Partnership. (2013). Using the lee law to reduce youth exposure to alcohol retail outlet advertising. California Department of Alcohol and Drug Programs. Retrieved February 7, 2015, from Law-toolkit-draft_v2.pdf Centers for Disease Control and Prevention. (2013). Adolescent and school health. Retrieved from Centers for Disease Control and Prevention (CDC). (2014a). Excessive Alcohol Use. Retrieved from Centers for Disease Control and Prevention (CDC). (2014b). Fact Sheets - Underage Drinking. Retrieved form sheets/underage-drinking.htm Centers for Disease Control and Prevention (CDC). (2014c). Injury Prevention & Control: Motor Vehicle Safety. Retrieved from Centers for Disease Control and Prevention (CDC). (2014d). Youth Risk Behavior Surveillance--United States, 2013. Retrieved from Center for Disease Control and Prevention (2015). Youth Risk Behavior Surveillance System. Youth Online: High School YRBS. Retrieved from Center for Disease Control and Prevention (2015). Youth risk behavior - surveillance - united states, 2013. Morbidity and Mortality Weekly Report, 63 (4), 1-168. Retrieved from City Data. (2009). Los Angeles: Economy. Retrieved from City of Los Angeles Department of City Planning. (2012). Health Districts of Los Angeles. Retrieved from Decoy Shoulder Tap Program. (2009). Department of Alcohol Beverage Control. Retrieved February 7, 2015, from Fagan, A. A., Hawkins, J. D., & Catalano, R. F. (2011). Engaging communities to prevent underage drinking. Alcohol Research & Health, 34(2), 167–174. Foster SE, Vaughan RD, Foster WH, Califano, JA. (2003). Alcohol consumption and expenditures for underage drinking and adult excessive drinking. The Journal of the American Medical Association, 289(8), 989–995 Healthy City. (2014). Los Angeles Central Health District Map and Data. Retrieved from w/939/msh/711/ts//cm/e/cf//cat/|||||/so/dist/so_dir/asc/rpp/25/page/0/t1i/0/t1ds/0/t1y//t1vg/0/t1vt//t1vo//t1d/0/t1c//t1bm//t1b//t1bg//t1bz//t2i/0/t 2ds/0/t2y//t2vg/0/t2vt//t2vo//t2d/0/t2c//t2bm//t2b//t2bg//t2bz//t3i/0/t3ds/0/t3y//t3vg/0/t3vt//t3vo//t3d/0/t3c//t3bm//t3b//t3bg//t3bz//option_poly _geo_key//yk/20150218021128392. Hingson, R. & White, A. (2014). New research findings since the 2007 surgeon general's call to action to prevent and reduce underage drinking: a review. Journal of Studies on Alcohol and Drugs, 75(1), 158-169. Komro, K., & Toomey, T. (2002). Strategies to prevent underage drinking. Minneapolis, MN: National Institute on Alcohol Abuse and Alcoholism. Retrieved February 7, 2015, from Lewis, K., Paine, A., Fawcett, S., Francisco, V., Richter, K., Copple, B., & Copple, J. (1996). Evaluating the effects of a community coalition's efforts to reduce illegal sales of alcohol and tobacco products to minors. Journal of Community Health, 21(6), 429-36. Los Angeles County Department of Public Health. Office of Health Assessment and Epidemiology. (2013). Key Indicators of Health by Service Planning Area. Los Angeles, CA: US. Retrieved from Mosher, J. & Reynolds, B. (n.d.). How to use local regulatory and land use powers to prevent underage drinking. Office of Juvenile Justice and Delinquency Prevention. Retrieved February 9, 2015, from Office of the Surgeon General (US); National Institute on Alcohol Abuse and Alcoholism (US); Substance Abuse and Mental Health Services Administration (US). The Surgeon General's Call to Action To Prevent and Reduce Underage Drinking. Rockville (MD): Office of the Surgeon General (US); 2007. Available from: Pool, Bob. (2009). L.A neighborhoods: you are on the map. Los Angeles Times. Retrieved from 2009feb19-story.html#page=2 Reboussin, B. A., Song, E.-Y., & Wolfson, M. (2011). The impact of alcohol outlet density on the geographic clustering of underage drinking behaviors within census tracts. Alcoholism, Clinical and Experimental Research, 35(8), 1541–1549. doi:10.1111/j.1530-0277.2011.01491.x Toomey, TL., Lenk, KM., Wagenaar, AC. (2007). Environmental policies to reduce college drinking: an update of research findings. Journal of Studies on Alcohol and Drugs, 68 (2), 208-19. Truong, K.D. & Sturm, R. (2009). Alcohol Environments and Disparities in Exposure Associated with Adolescent Drinking in California. American Journal of Public Health, 99(2), 264-270. Doi: 10.2105/AJPH.2007.122077 U.S. Census Bureau Decennial Census. (2010). Census of Population and Housing. Retrieved from U.S. Department of Health and Human Services. (2010). Office of Disease Prevention and Health Promotion. Healthy People 2020. Washington, DC. Retrieved from Yoruk, BK. (2014). Can technology help to reduce underage drinking? Evidence from the false ID laws with scanner provision. Journal of Health

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