Noting that alcohol "remains the most heavily abused substance by America's youth," acting U.S. Surgeon General Kenneth Moritsugu, M.D., M.P.H., called for government, school officials, parents, communities, and youth themselves to do more to prevent underage drinking.

"We can no longer ignore what alcohol is doing to our children," said Moritsugu in issuing the first Surgeon General's policy aimed at the issue of underage drinking. The "Call to Action" was developed in cooperation with the National Institute on Alcohol Abuse and Alcoholism and the Substance Abuse and Mental Health Services Administration.

"Too many Americans consider underage drinking a rite of passage to adulthood," said Moritsugu. "Research shows that young people who start drinking before the age of 15 are five times more likely to have alcohol-related problems later in life. New research also indicates that alcohol may harm the developing adolescent brain. The availability of this research provides more reasons than ever before for parents and other adults to protect the health and safety of our nation's children."

The Call to Action puts great emphasis on changing public attitudes toward youth alcohol use, while also giving a nod to some of the other factors that influence youth decisions to drink, including the "normal maturational changes that all adolescents experience; genetic, psychological, and social factors specific to each adolescent; and the various social and cultural environments that surround adolescents, including their families, schools, and communities."

"These factors -- some of which protect adolescents from alcohol use and some of which put them at risk -- change during the course of adolescence," Moritsugu noted in his introduction to the Call to Action. "Because environmental factors play such a significant role, responsibility for the prevention and reduction of underage drinking extends beyond the parents of adolescents, their schools, and communities. It is the collective responsibility of the nation as a whole and of each of us individually."

"This is a health crisis that has been fueled by denial, inaction and acceptance. The new Call to Action can help turn that around," said Hawaii lieutenant governor James R. Aiona, Jr., co-chair of the group Leadership to Keep Children Alcohol Free, a public-private coalition that includes a number of state governors' spouses.

The goals of the Call to Action include:

• fostering changes in society that facilitate 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 a coordinated national effort to prevent and reduce underage drinking and its consequences;
• 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 it relationship to development;
• working to improve public health surveillance on underage drinking and on population-based risk factors for this behavior; and
• working to ensure that policies at all levels are consistent with the national goal of preventing and reducing underage alcohol consumption.

Muted Focus on Alcohol Industry, Ads

The Surgeon General did not list the alcohol industry -- often accused by critics of marketing to underage youth -- in its list of primary target audiences, nor was alcohol advertising mentioned as one of the environmental factors affecting youth decisionmaking about alcohol. "The industry got off very easy in this pronouncement," said Kim Miller, manager of federal relations for the Center for Science in the Public Interest. "The industry's conflict of interest as a credible prevention player was not questioned, and there was only oblique reference to evidence-based policy approaches the industry most adamantly opposes -- taxation being top among them."

However, the Call to Action does say that the industry "has a public responsibility relating to the marketing of its product, since its use is illegal for more than 80 million underage Americans." The document states that the industry can fulfill its responsibilities by ensuring that:

• the message adolescents receive through the billions of dollars spent on industry advertising and responsibility campaigns does not portray alcohol as an appropriate rite of passage from childhood to adulthood or as an essential element in achieving popularity, social success, or a fulfilling life;
• the placement of alcohol advertising, promotions, and other means of marketing do not disproportionately expose youth to messages about alcohol;
• no alcohol product is designed or advertised to disproportionately appeal to youth or to influence youth by sending the message that its consumption is an appropriate way for minors to learn to drink or that any form of alcohol is acceptable for drinking by those under the age of 21; and
• the content and design of industry websites and Internet alcohol advertising do not especially attract or appeal to adolescents or others under the legal drinking age.

Center on Alcohol Marketing to Youth director David Jernigan noted that the Call to Action "states that alcohol companies have a responsibility to see that youth are not disproportionately exposed to alcohol marketing, and that ongoing, independent monitoring of the placement of alcohol advertising is the surest way to enforce this standard."

"To reduce the appeal of alcohol to young people, the alcohol industry should heed the recommendations of the National Research Council and Institute of Medicine [to limit alcohol ads to outlets with underage viewer/readership of less than 15 percent] and the Surgeon General," said Jernigan.

Former Surgeon General Richard Carmona signaled his intention to issue the statement on underage drinking in 2005, but resigned last year without doing so.

"The Surgeon General's Call to Action places a heightened national focus on the public health crisis of underage drinking in our country," said Rep. Lucille Roybal-Allard (D-Calif.), the lead sponsor of the STOP Underage Drinking Act, which calls for research on alcohol use by youth and establishes a national media campaign on underage drinking. "I commend this initiative as a way to bring more attention and explore promising solutions to the problem. I'm especially pleased that the broad-based effort complements the objectives and major elements in The STOP Underage Drinking Act which was signed into law last year."