Remarks as prepared; not a transcript.

RADM Kenneth P. Moritsugu, M.D., M.P.H
Acting Surgeon General
U.S. Department of Health and Human Services

Address to North Carolina State University Millennium Seminar

Wednesday, September 12, 2007
Raleigh, NC

"Surgeon Generalís Call to Action to Prevent and Reduce Underage Drinking"

Introduction

(SLIDE 1)

Thank you, Larry, (NCSU Provost Larry Neilson) for that gracious introduction.

Good morning, ladies and gentlemen.

I am honored to be here today and I am pleased to be part of NCSU’s Millennium Seminar series.

Special thanks to Chancellor James Oblinger, Provost Neilson, and Mary Easley, NCSU Executive in Residence and your state’s First Lady, for extending the invitation and giving me an opportunity to share this time with you. 

I commend Ms. Easley for her longstanding commitment to improving public health, particularly her efforts to promote childhood immunization and to reduce and prevent underage drinking which contribute to the wellness and safety of our children.  

She serves as co-Chair for the Leadership to Keep Children Alcohol Free, an organization of current and former First Spouses that serves as a catalyst to create momentum for change. 

I would like to also recognize another friend and former first lady of Ohio who has worked extensively to reduce underage drinking -- Mrs. Hope Taft .  Mrs. Taft serves now as the Executive Director for the Leadership to Keep Children Alcohol Free.

Her leadership has been immensely valuable to those committed to stemming underage drinking.  Thank you for being here with us today.

(SLIDE 2)

My broad responsibilities as Acting Surgeon General involve serving as our nation’s chief “health educator; my office provides accurate and emerging information on a myriad of topics related to the health and wellness of  all Americans.  

If you are interested in learning more about the Office of the Surgeon General and our activities, I hope you will visit our website www.surgeongeneral.gov.

Priorities

(Slide 3)

I would like to mention a few of the top priorities in the Office of the Surgeon General.

The first is Prevention - what each of us can do in our own lives and communities to make ourselves and our families healthier.

According to the CDC, more than 90 million Americans live with chronic disease.

Chronic disease causes seven out of 10 deaths every year.

And treating people with chronic disease accounts for about 75% of the $2 trillion America spends on health care each year. 

Our health system is focused on treatment instead of prevention.  We must place more emphasis on prevention.  Keeping people healthier longer reduces the cost of care and can contribute to a longer life.

Five key steps can prevent most chronic diseases:

  • Tobacco control,
  • Good nutrition,
  • Physical activity,
  • Maintenance of a healthy weight, and 
  • Regular health screenings.

We need more Americans to embrace these steps to a healthier life. 

Another priority of my office is Public Health Preparedness.

This includes readiness and the capability of rapid response to all hazards, including hurricanes, earthquakes and pandemics. 

The third priority which we are especially focused on is Eliminating Health Disparities.

While, overall, our nation's health has improved, not all populations have benefited equally.  Many Americans who are members of racial and ethnic minority groups experience disparities in health outcomes and health care.

It is imperative that things change.  The Department of Health and Human Services is committed to eliminating health disparities.

Health literacy, the ability of an individual to access, understand, and use information and services to make appropriate health decisions, is another priority of my office.

  • Nearly 9 out of 10 American adults lack the skills needed to take care of their own health, or know how to prevent disease.

We know that low health literacy impacts health.

People with low health literacy are less likely to know how to navigate the health care system, understand basic health information, or get preventive health care services.

As health care continues to become more complex, the importance of being health literate will increase.

(Slide 4)

Commissioned Corps

For more than three decades, I have worn the uniform of the US Public Health Service.  As Acting Surgeon General, I have the privilege of leading the day-to-day operations of the Public Health Service Commissioned Corps – an organization of more than 6,000 public health professionals. 

We are dedicated to promoting, protecting, and advancing health, safety and quality of life in our nation.  

During my career I’ve had the honor of serving as the assistant bureau director and the medical director of the Federal Bureau of Prisons in the US Department of Justice, as well as in my current position as Acting Surgeon General.   

The Commissioned Corps of the US Public Health Service offers an unique way to serve while providing diverse career opportunities.  If any of you are interested in public health or related medical fields, I encourage you to learn more about the Commissioned Corps. 

(Slide 5)

The Medical Reserve Corps, a division of the Freedom Corps housed in the Office of the Surgeon General, is a national system of community-based teams of medical and public health volunteers.

MRCs are a way to organize health professionals who want to donate their time and expertise to prepare for and respond to emergencies and promote healthy living throughout the year.

In many ways, the M-R-C units across the country strengthen the public health infrastructure, and improve emergency preparedness.

The Purpose of your visit

(Slide 6)

As you may know, the main reason I am in North Carolina  today is to discuss underage drinking.  In March, I released a Call To Action to Prevent and Reduce Underage Drinking.  Mrs. Easley joined me in Washington, DC for the release as a co-chair of the Leadership to Keep Children Alcohol Free.  During her visit, she asked that I come to North Carolina to see firsthand how the state is working to towards the goals outlined in the Call To Action. 

From the beginning, it is important to understand that our efforts to reduce underage drinking are to ensure that our children have the greatest opportunity to succeed. 

Our goal, as parents, educators, and caring adults, is to provide them with tools to make positive and healthy choices.  Making healthy choices, such as delaying drinking, will assist them in obtaining success.

Since many of you in the audience are college students, I am sure you know some of the following: 

Alcohol is the most widely used and abused substance among our Nation’s youth. 

A higher percentage of young people between the ages of 12 and 20 use alcohol than tobacco or illicit drugs. 

Scope of the Problem

(Slide 7)

The 2005 National Survey on Drug Use and Health estimates that there are almost 11 million underage drinkers in the United States. 

Nearly 7.2 million are considered binge drinkers, meaning they drank more than five drinks on one occasion. 

In people under age 21, alcohol is a leading contributor to “death from injuries” – the main cause of death in that age group.

The Science

(Slide 8)

Alcohol use during adolescence is pervasive and it ramps up dramatically between the ages of 12 and 21.

Research shows that the brain continues to develop well beyond childhood – and through adolescence.  This research raises concerns that underage drinking may affect short-term and long-term cognitive functioning, and may even change the brain in ways that lead to future alcohol dependence. 

Research also shows that young people who start drinking before age 15 are five times more likely to have alcohol-related problems later in life. 

This research provides more reasons than ever for us to be concerned about the effects of underage drinking on our nation’s children. 

Secondhand Effects

(Slide 9)

5,000 deaths of people under the age of 21 are linked to alcohol. 

To put this into perspective, take the size of the incoming freshman here at NC State and add 1300 (according to 20005 enrollment numbers 3, 717)

Alcohol also plays a significant role in risky sexual behavior including unwanted, unintended and unprotected sexual activity.

It increases the risks of physical and sexual assault.

- Approximately 600,000 students are unintentionally injured while under the influence of alcohol (Hingson et al. 2005).

- An estimated 700,000 students are assaulted by other students who have been drinking (Hingson et al. 2005).

- About 100,000 students are victims of alcohol- related sexual assault or date rape (Hingson et al. 2005).

Let’s look at underage drinking in North Carolina. 

North Carolina

(Slide 10)

In 2005, North Carolina students in grades 9 – 12:

  • 69% had at least one drink of alcohol on one or more days during their life.
  • 21 % had their first drink of alcohol, other than a few sips, before age 13.
  • 42% had at least one drink of alcohol on one or more occasion in the past 30 days.
  • 23% had five or more drinks of alcohol in a row (i.e. binge drinking) in the past 30 days.
  • 5% had at least one drink of alcohol on school property on one or more of the past 30 days. (Center for Disease Control (CDC), 2005.

Underage drinking cost the citizens of North Carolina $1.2 billion in 2005, or about $1,560 per year for each youth in your state.

(Slide 11)

Findings like these are one reason the Office of the Surgeon General released the Call to Action.

The data are compelling.

They are evidence-based and science-driven.

Underage drinking is  not a harmless “rite of passage.” 

The reality is our young people are being harmed by underage drinking.

The Call to Action articulates the Federal commitment to the underage drinking issue but also outlines the need for action on the state and community level. 

The goals include:

(Slide 12)

  • Fostering social changes that contribute to healthy adolescent development and that help prevent and reduce underage drinking.
  • Engaging parents, schools, communities, all levels of government, all social systems that interface with youth, and youth themselves in our coordinated national effort to prevent and reduce underage drinking and its consequences.

(Slide 13)

  • Promoting an understanding of underage alcohol consumption in the context of human development and maturation that takes into account individual adolescent characteristics as well as environmental, ethnic, cultural, and gender differences.
  • Conducting additional research on adolescent alcohol use and its relationship to development.

(Slide 14)

  • Working to improve public health surveillance on underage drinking and its risk factors.
  • Ensuring that policies at all levels are consistent with the national goal of preventing and reducing underage alcohol consumption.

I am confident that - when broadly discussed among parents, teachers, community leaders, and young people themselves - the goals of the Call to Action to Reduce and Prevent Underage Drinking, will be understood, appreciated, embraced and will literally save lives.

The Federal policy effort to address underage drinking is coordinated by the Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD).

The committee’s member agencies support a wide range of programs in a comprehensive response to the challenge of preventing underage drinking.

Federal Initiatives

I would like to take a few moments to highlight some federal activities. 

(Slide 15)

Through the Enforcing Underage Drinking Laws (EUDL) (pronounced You-del) initiative, the U.S. Department of Justice devotes dollars to enforcement, to holding young people, parents and communities accountable.

The National Highway Traffic Safety Administration, within the Department of Transportation, partners with Students Against Destructive Decisions (SADD) to develop numerous program materials to address underage drinking and driving. 

Concurrently, SAMHSA has reached out to parents, their children, educators and others.  

SAMHSA convened more than 1,200 Town Hall Meetings in all 50 states last year.

With Ad CouncilSAMHSA has developed an underage drinking prevention campaign directed at parents of 9- to 15-year-olds. Products include four television PSAs as well as PSAs for radio, print, and Internet.

 “Reach Out Now,” a unique school-based underage drinking prevention initiative designed specifically for use by fifth- and sixth-grade students, their families, and their teachers, is another SAMHSA project.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA), a component of the National Institutes of Health, has been and remains an invaluable partnering in furthering the Call to Action goals. 

The agency is a co-founder of the Leadership to Keep Children Alcohol Free organization.  It is accurate to say the Federal effort to prevent youthful drinking would not be where it is without NIAAA’s guidance and leadership.

(Slide 16)

Underage drinking is multi-dimensional. To effect change we must approach underage drinking from many different levels.

That’s why the To facilitate this change, the Office of the Surgeon General has created Guides to Action for Families, Communities, and Educators.

These  plain-language guides  help people understand what the Call to Action says and what it means to them.

They empower families, communities, and educators with the knowledge and tools useful in delivering the underage drinking message in a way that is easy to hear…understand…embrace…and put into action.

Rather than working separately, we need to “connect the dots” from all sectors of society: federal, state, and local levels.

We need to create linkages among public health, law enforcement, public safety,  public education,   parental involvement and, always, to young people.

And by tackling an issue—a public health issue, law enforcement issue, mental health issue—from a group perspective rather than an individual perspective, we can have a greater impact.

Closing and Charge

(Slide 17)

To the parents, educators, and other adults here today: 

Underage drinking is not about spring break and it’s not about parties. 

Consider this: 

In 2005, 21.3 percent of North Carolina students reported having had their first drink of alcohol (other than a few sips) before age 13 year.  This included an estimated 25 percent of male students surveyed, and nearly 17 percent of female students surveyed.

This is unfortunate.

This is unacceptable.

This needs to stop.

Underage drinking is everybody’s problem, and its solution is everyone’s responsibility.

A perception exists that young people, adolescents will, as a matter of routine, drink alcohol – “no matter what.”

Not so.

When the American people rejected the use of tobacco and illicit drugs as a culturally acceptable behavior, the use of those substances declined, and the culture of acceptance shifted to disapproval.

The same change process is possible with underage drinking.

Parents’ opinion is actually one of the key reasons young people choose not to drink.

Parents must talk to their children.  Parents must talk with their children.  

Students perhaps should talk to your own younger brother or sister about alcohol. 

Parents need to get and remain involved with their kids’ decision-making.

Parents must send a clear, unequivocal  and consistent message that underage drinking is unhealthy, unsafe, and unacceptable.  Period. 

When parents do so, they won’t be popular.  However, they will be responsible parents.

This is tough love.

It is never too early to talk to kids about alcohol, to give them accurate information about drinking, to answer the questions, even those they do not ask. 

To the students here today:

I appreciate you being here today.  I know during this presentation several of you have had the urge to roll eyes or moan about hearing the underage drinking speech one more time.

The Office of the Surgeon General and our public health partners are not motivated by self-righteousness. 

I am not hear to make decisions for you.

 I am not here to preach or to tell you what to do. 

I am here to report the science and to explain why underage drinking is risky.

Those of us working to prevent underage drinking do not desire to “take the fun out of tailgating” at NC State or any other campus.

We are motivated to help you attain all the success possible. 

We are following the evidence where it leads.  And it points the dangers of drinking for young people. 

Alcohol’s worst consequences are not inevitable, but they are real and can be indelible.

They are contrary to what you, as college students with immense promise, want.

They are not what brought you here.

Think of the spike in violent crime, suicides, injuries, and traffic fatalities directly attributable to underage alcohol use;

Think of the increased numbers of young people taken into custody, incarcerated;

Think of the costs of addiction treatment;

The families and lives disrupted;

The futures of young people lost.

Think about it. 

Thank you.

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Last revised: September 28, 2007