By Tiffani Kigenyi, MPH, Public Health Analyst, ODPHP and Blythe Miller, MPH, Editor, CommunicateHealth, Inc.
Underage alcohol use (also known as underage drinking) is a serious public health problem in the United States. According to the Centers for Disease Control and Prevention (CDC), young people abuse alcohol more than any other drug — and more than 4,300 young people die from alcohol-related causes each year.
The problem of underage drinking is even more significant for American Indians, and major health disparities related to alcohol exist for this population. In addition to having higher rates of alcohol-related deaths, American Indians are more likely to start drinking alcohol at a younger age than other groups — a significant risk factor for alcohol problems later in life.
That’s why interventions that address youth alcohol use in American Indian communities are so important. In 2013, a research team led by Dr. Kelli Komro from Emory University’s Rollins School of Public Health, in partnership with the Cherokee Nation, set out to implement and evaluate different interventions to prevent youth alcohol use in northeastern Oklahoma.
Communities Mobilizing for Change on Alcohol
One of the interventions was Communities Mobilizing for Change on Alcohol (CMCA). This evidence-based intervention uses community-organizing strategies to limit youth access to alcohol — and to challenge the idea that drinking alcohol is a standard rite of passage for young people.
To implement the program, Komro and her team hired 3 community organizers whose job it was to establish citizen action teams of community members interested in joining the fight against underage drinking in 3 communities across the Cherokee Nation. Dallas Pettigrew, who oversaw program implementation, says a big part of why CMCA can be so successful is that the action teams aren’t professionals — they’re everyday citizens.
“With CMCA, you find the people in the community who care about the problem you’re trying to address, and you empower them to do something about it,” says Pettigrew. “It can be easy for people to ignore professionals who they see as just doing a job. But when you’re talking to someone who works at the library or the hardware store in your town, people pay attention. It’s really effective.”
An Emphasis on Adult Responsibility
While it might seem like CMCA would include a lot of direct work with young people — who are, after all, the ultimate target audience — the intervention focus was entirely on adults. “Adults need to take responsibility for protecting the kids,” says Pettigrew. “There’s no legal way for kids to get alcohol on their own.”
Pettigrew explains how action teams worked to reduce access to alcohol both socially and commercially. The action teams educated parents about locking up their alcohol. They worked with local vendors to make sure they were checking IDs properly. They spread the word that there are consequences if you buy alcohol for or give alcohol to people who are underage. And, critically, they put pressure on law enforcement and local courts to make sure that those consequences were realized.
Pettigrew and the teams found that a lot of this work came down to challenging how adults think about underage alcohol use. “There’s this ‘kids are going to drink so get over it’ kind of attitude that’s really damaging,” he says. The teams encountered that attitude in surprising places, too — like in prominent local law enforcement figures.
“The bottom line is that we can’t make teenagers accountable for their own safety in that way,” explains Pettigrew. “We just can’t expect them to always make healthy, safe decisions. It’s on us to protect them from risky situations, and there are laws that require that.”
Pettigrew also stresses the harm of underage alcohol use. “Alcohol is a neurotoxin. It poisons the brain. For teens whose brains are still developing, that’s dangerous. It can really affect cognition.”
Additionally, early alcohol use is a risk factor for alcohol problems, another reason why Pettigrew says addressing the problem of teen alcohol use is so important. “Even if we don’t succeed at preventing use altogether, we’re still making a difference. Every day we can delay a kid’s first drink, it becomes less likely they’ll have an alcohol problem later on.”
Alcohol use is also linked to many other problems for young people. “It’s the ultimate gateway drug,” Pettigrew says. “You see kids who drink engaging in risky sexual behaviors, having problems at school… there are so many consequences.”
The Power of Community Organizing
Pettigrew gets pretty excited when he talks about community organizing, which is the heart of CMCA. “Community organizing is where it’s at! It’s all about human empowerment,” he says. “People have the power and capacity to solve their community’s problems — they just need to realize it.”
Pettigrew, a member of the Cherokee Nation himself, says this is particularly true for American Indians. “Tribal people have been disempowered for a long time. We’ve forgotten we have power, forgotten that we can solve our problems. It’s pretty amazing to watch people in these communities remember.”