BURDEN OF RISKY ALCOHOL USE IN LA CROSSE COUNTY - PDF Document

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  1. BURDEN OF RISKY ALCOHOL USE IN LA CROSSE COUNTY September 2017 update

  2. ACKNOWLEDGEMENTS Authors: Brenda L Rooney, PhD, MPH, Epidemiologist, Gundersen Health System Tracy Herlitzke, MPH, MCHES, Director, Safe and Healthy Schools and Communities, Cooperative Educational Service Agencies (CESA) #4 Sara A Kohlbeck, MPH, Assistant Director, Injury Research Center, Medical College of Wisconsin Editor: Catherine Kolkmeier, Executive Director, La Crosse Medical Health Science Consortium Funding: The Changing the Culture of Risky Drinking Behavior project was made possible through a series of planning and implementation grants from the Healthier Wisconsin Partnership Program at the Medical College of Wisconsin (2007-2008, 2009-2012, and 2012-2017) and the Strategic Prevention Framework State Incentive Grant from the Wisconsin Department of Health Services (2009-2012). Project Leadership (current): Jeremy Arney, PhD, Assistant Professor of Political Science/Public Administration - University of Wisconsin-La Crosse Kate Ebert, MPH, CHES, Wellness Coordinator, University of Wisconsin-La Crosse Cheryl Hancock, Executive Director, Coulee Council on Addictions, Inc. Tracy Herlitzke, MPH, MCHES, Director, Safe and Healthy Schools and Communities, Cooperative Educational Service Agencies (CESA) #4 Stephen Hargarten, MD, MPH, Director, Injury Research Center, Medical College of Wisconsin, Academic Principal Investigator Sara A Kohlbeck, MPH, Assistant Director, Injury Research Center, Medical College of Wisconsin Catherine Kolkmeier, Executive Director, La Crosse Medical Health Science Consortium, Community Partner and Fiscal Agent Chief Edward Kondracki (ret.), La Crosse Police Department, Coalition Chair Sue Lynch, Community member Brenda L Rooney, PhD, MPH, Epidemiologist, Gundersen Health System Past Project Leadership: Al Bliss, La Crosse County Health Department Ann Christensen, MPH, former Assistant Director, Injury Research Center, Medical College of Wisconsin Keri Frisch, MS, former Program Manager, Injury Research Center, Medical College of Wisconsin Keith Lease, former Executive Director, Coulee Council on Addictions Kate Noelke, former Wellness Coordinator, UW-La Crosse Donna Peterson, PhD, former Program Manager, Injury Research Center, Medical College of Wisconsin Patricia Ruda, former Executive Director, Coulee Council on Addictions i | P a g e

  3. Project Assistants: Cortney Springer Stephanie Young Kate Ebert Quinn Walraven Jenna Willems Darren Knox Other Contributors to this Report: Sue Danielson, RN, Director of Health Services, Viterbo University Lt. Pat Hogan, La Crosse Police Department Julia Sherman, Coordinator, Wisconsin Alcohol Policy Project Ge Vang, Student Activity/AODA Specialist, Western Technical College This Burden of Risky Alcohol Use is the final report for these projects, and we are grateful for the involvement of all of our many partners through the years. Many others not listed here were integral contributors to the Changing the Culture of Risky Drinking Behavior Coalition and subcommittees over the years, and we especially want to acknowledge the long-term support and partnership we have had with the La Crosse Police Department, currently led by Chief Ronald Tischer. We thank each and every team member, community supporter, and partner who helped make this project a success. ii | P a g e

  4. EXECUTIVE SUMMARY Alcohol use and misuse has long been documented as a serious concern for residents of Wisconsin, and La Crosse County is known for having one of the state’s highest binge drinking rates. After a series of alcohol-related drownings and other deaths over the past two decades, community and media attention spurred local action to address the harms arising from risky alcohol use in La Crosse County. This report will summarize some of these harms as they apply to individuals as well as their impact on the community. This is the fourth Burden of Risky Alcohol Use report for the La Crosse County community. It will update information from the previous report in 2015 as well as introduce new data on risks, harms, and progress made towards creating a safer community. Risky Alcohol Use Middle School Students. Since 2017 was the first year that middle school students were surveyed in La Crosse County, no trends over time can be determined; however, some important conclusions can be made: ○Alcohol use among middle school students is low; fewer than 5% reported 30-day use and fewer than 2% reported binge drinking. This compares favorably to high school students, 19% of whom reported 30-day use and 11% reported binge drinking. ○School performance (usually measured by grades) and assets (such as family support) were strong among middle school students, and these prove to be extremely important, as they are highly correlated to alcohol use among middle school students. Middle school students with mostly D’s and F’s were 8 times more likely to binge drink, whereas high school students with mostly D’s and F’s were 2.5 times more likely to binge drink. Middle school students who reported low instances of family or teachers caring about them were 9-10 times more likely to binge drink, compared to high school students who were 2-3 times more likely to binge drink if they reported this. High School Students. There has been a significant decline in risky alcohol use among high school students in La Crosse County since 2010. ○Driving after drinking has declined from 7.1% in 2010 to 3.9% in 2017. Driving after drinking increased with: Increasing age Other risk-taking behavior (tobacco use, drug use, violence, bullying, texting and driving, low seat belt use) Less healthy behaviors (obesity, poor sleep, low physical activity, poor nutrition) ○Binge drinking has declined from 20.4% in 2010 to 11.4%., Binge drinking rates increased with: Increasing age Gender (males have higher rates) iii | P a g e

  5. Other risk-taking behavior (tobacco use, drug use, violence, bullying, texting and driving, low seat belt use) Less healthy behaviors (obesity, poor sleep, low physical activity, poor nutrition) ○Specific groups of students with riskier alcohol behaviors include: ○Hispanic, Native American, Pacific Islander, and those of multiple races ○Students who identify as LGBTQ ○Students who are poor academic performers ○Students who perceive their teachers or family don’t care about them, or they don’t belong at their school College Students. There are many health issues affecting students at La Crosse’s college campuses; including alcohol use and its related impacts. ○Overall, 68% of college students reported drinking alcohol in the past month; 16% of males and 6% of females reported binge drinking in the past 2 weeks. ○The rates of risky drinking (binge drinking and drinking and driving) have declined since the 2015 survey. ○There are many self-reported negative consequences of alcohol use and poor mental health that affect student’s ability to learn. Other health measures suggested a less than healthy culture on college campuses. The increase in 30-day use of alcohol and binge drinking between high school and college was significant. ○19% of high school students reported 30-day use, compared to 66.7% of college students. ○11% of high school students reported binge drinking, compared to 35% of college students. Adults. Among adults, the binge drinking rate of about 28%, while on the decline, was higher than other counties in the area, and was much higher than the national rate. ○Binge drinking was highest among younger males, decreasing among both males and females with increasing age. ○Binge drinking decreased with increasing education and was highest among white, working adults in La Crosse County. ○Those with poorer health (self-rated health, excess stress, and anxiety) or poorer health habits (tobacco use, diet, physical activity, sleep, and seat belt use) were more likely to report binge drinking. The heavy drinking rate of 5% was lower than the state average of 7%, and lower than the national rate. ○Heavy drinking increased with age. Heavy drinking was higher among older females (50+) and increased 3.5 times from 2010 to 2016 in women over age 65 in La Crosse County. ○Heavy drinking was highest among white, working adults in La Crosse County but didn’t vary by education level. iv | P a g e

  6. ○Those with poorer health (self-rated health, excess stress, depression and anxiety) or poorer health habits (tobacco use, diet, physical activity, sleep and seat belt use) were more likely to report heavy drinking. Consequences of Risky Alcohol Use The rate of alcohol-related citations has declined steadily since 2007 in La Crosse County as well as the city of La Crosse. This decline was also seen at the state level, suggesting the decline was not necessarily a shift in personnel or focus, but a possible decline in illegal behavior. Underage alcohol citations have declined more significantly than all other violations, and the number has declined more for males than females. ○ ○More underage people are being cited in bars and taverns than at private house parties. This could partially be explained by the existence of a social host ordinance. ○Weekends and the months of September and October continue to be the most common times for all citations. 3.4% of all motor vehicle crashes in La Crosse County from 2011-2013 involved alcohol use by the driver of the vehicle. This was higher than the state rate for the same time period and is a slight increase from the rate for 2008-2010. ○The age group most affected by alcohol-related motor vehicle crashes was 25 to 44- year-olds, which was consistent with the rest of the state. ○Motor vehicle crashes involving alcohol happened most frequently on local roads (as opposed to county roads, state highways, or federal interstates), with more than half of alcohol-related crashes involving individuals aged 16 to 24 occurring on local roads. Risky alcohol use can lead to injuries that require medical attention, either in the emergency department (ED) setting or in an inpatient setting. ○Among individuals aged 12 to 24, injuries from alcohol-related assaults were the most prevalent seen in local EDs. This trend is consistent with inpatient admissions for this age group. ○Self-inflicted injuries that involved alcohol were the most prevalent type of injury seen in EDs for individuals aged 25 and older. This was the case in inpatient admissions for this age group as well. Alcohol-related ED visits for motor vehicle crash (MVC) injuries have declined among 12 to 24- year-olds between 2004-2006 and 2012-2014, and this trend was seen among inpatient admissions as well. There was a slight increase in alcohol-related MVC injuries among inpatient admissions from 2012-2014 for those aged 25 and older. Alcohol-related injury ED visits and inpatient admissions from falls increased among individuals aged 25 and older in 2012-2014, as compared to earlier years. Approximately 150 deaths of La Crosse County residents can be attributed to alcohol each year. This is approximately 16% of all deaths in the county. ○The rate of alcohol-attributed deaths has declined slowly since 2004. Fewer underage people are being cited for repeat offenses in more recent years. v | P a g e

  7. ○Injury death rates have increased significantly from 43.05 to 68.59/100,000 among La Crosse County residents from 2003 to 2014. ○This rate has increased significantly in those over age 65, however it is not the primary cause of death in this age group. ○Injury is most significant in the 15-24 age group. However, the rate of injury deaths in this age group has not increased significantly since 2003-2006. ○While the number of deaths due to Alcoholic Liver Disease are low overall, the rate has significantly increased in the 25-64 age group. One-quarter of violent deaths occurring in La Crosse County from 2004-2013 involved individuals who had a reported alcohol problem during their life. Males were more affected than females. ○Among those decedents who had a reported alcohol problem, the most common manner of violent death during these years was suicide. ○In La Crosse County, 16% of male suicide decedents between 2010 and 2014 had a blood alcohol content above the state’s legal limit at the time of death, while 30% of female suicide decedents during these same years had a blood alcohol content above the state’s legal limit at the time of death. The Alcohol Environment and Response to the Issue The perception of alcohol use being a major concern in the community has declined significantly since 2014. Illegal drug use, prescription drug use, and over-the-counter drug misuse have become the dominant concerns among La Crosse County residents. In general, there was moderate-to-strong support for strategies to control illegal or risky alcohol use, such as conducting compliance checks, increasing the penalty for drinking and driving, or eliminating all-you-can-drink specials. There is still moderate support for these policies; and a general agreement that underage and binge drinking is not acceptable In La Crosse County, municipal licenses to sell alcohol per 500 population varied from 0.3 to 2.0 licenses per 500 people, with the total La Crosse County average at 1.3 and the Wisconsin average of 1.5. Overall, there were minor changes in people per license or licenses per 500 people in La Crosse County from 2007 to 2016. There is strong scientific evidence to support that regulating alcohol outlet density is one of the most effective strategies for reducing excessive alcohol consumption and related harms. Overall, the number of alcohol compliance checks conducted in La Crosse County municipalities has decreased between 2012 and 2016, although the pass rates have remained steady, between 80%-88%. The annual economic cost of excessive alcohol use in La Crosse County is $105 million. Excessive alcohol use in La Crosse County costs $915.72 annually per person (all ages). State and national research reports that binge drinking is responsible for most (76%-77%) of the economic cost of excessive alcohol use. Further, 2 of every 5 dollars of these costs were vi | P a g e

  8. paid by federal, state, and local governments, demonstrating that we are all paying for excessive alcohol use. Beginning in 2007, the Changing the Culture of Risky Drinking Behavior coalition addressed the issues of underage and binge drinking in La Crosse County through a series of funded projects. oA planning effort led to the first Burden of Risky Alcohol Use Report in 2008, along with a five-year plan to address education and policy needs. oA three-year effort to address underage drinking resulted in training for bartenders, parents, and families as well as increased enforcement of underage drinking laws through compliance checks and party patrols. oDuring this same time frame, a related effort focused on binge drinking resulted in an annual assessment of safety practices at festivals, further education efforts, youth and college student engagement in marketing and leadership training, and a recognition program for area taverns engaged in safe practices. oA final five-year effort focused on policy change and resulted in Social Host ordinances being passed in all municipalities and the County, a training on alcohol policymaking for local elected officials, continued marketing to parents and families about underage access, and a City Council resolution recommending safe alcohol practices at festivals and events. A proposed ban on all-you-can-drink specials did not pass, and the coalition worked with State legislators to revise current statute to include social host language. vii | P a g e

  9. Burden of Risky Alcohol Use TABLE OF CONTENTS Acknowledgements ........................................................................................................................................ i Executive Summary ...................................................................................................................................... iii Risky Alcohol Use ..................................................................................................................................... iii Consequences of Risky Alcohol Use .......................................................................................................... v The Alcohol Environment and Response to the Issue ............................................................................. vi List of Figures ............................................................................................................................................... ix List of Tables ................................................................................................................................................. x Introduction .................................................................................................................................................. 1 Risky Alcohol Use .......................................................................................................................................... 3 Risky Alcohol Use Among Youth ............................................................................................................... 3 Middle School Student Alcohol Use ...................................................................................................... 4 High School Student Alcohol Use .......................................................................................................... 8 An In-Depth Look at Alcohol Use Among High School Students ............................................................ 12 Risky Alcohol Behavior and Demographics ......................................................................................... 13 Risky Alcohol Behavior and Other Risk-Taking Behaviors ................................................................... 14 Risky Alcohol Behavior and High Risk Populations ............................................................................. 17 Assets .................................................................................................................................................. 20 Risky Alcohol Use Among College Students ............................................................................................ 22 Risky Alcohol Use Among Adults ............................................................................................................ 29 Consequences of Risky Alcohol Use ............................................................................................................ 37 Alcohol-Related Citations........................................................................................................................ 37 La Crosse County Compared to State of Wisconsin, 2007 to 2015..................................................... 37 A Deeper Look at Citations in the City of La Crosse, 2009 to 2016 ..................................................... 40 Motor Vehicle Crashes ............................................................................................................................ 51 Medical Care for Alcohol-Related Injuries .............................................................................................. 54 Deaths Likely Due to Alcohol .................................................................................................................. 57 Violent Deaths ......................................................................................................................................... 63 viii | P a g e

  10. The Alcohol Environment and Response to the Issue ................................................................................ 65 Community Perception of the Problem .................................................................................................. 65 Community Support for Strategies to Address the Issue ....................................................................... 67 Alcohol Licenses ...................................................................................................................................... 71 Compliance Checks ................................................................................................................................. 73 Cost of Excessive Drinking ....................................................................................................................... 75 Our Response to the Problem - Summary of our efforts ............................................................................ 77 Technical Specifications/Sources of Data ................................................................................................... 79 LIST OF FIGURES Figure 1. Impact of At-Risk Alcohol Use and Abuse ...................................................................................... 2 Figure 2. Alcohol behaviors among La Crosse County Middle School Students, YRBS 2017 ........................ 5 Figure 3. Difference in Drinking Behaviors by Student Demographics. La Crosse County Middle School Students, YRBS 2017 ..................................................................................................................................... 6 Figure 4. Alcohol Use and Binge Drinking La Crosse County High School Students, YRBS 2010-2017 ......... 9 Figure 5. Drinking and Driving, La Crosse County High School Students, YRBS 2010-2017 ........................ 10 Figure 6. Perception of Harm–Moderate or Great Risk, La Crosse County High School YRBS, 2010-2017 11 Figure 7. Drinking and Driving Past 30 days, YRBS 2010-2017 ................................................................... 12 Figure 8. Risky Alcohol Consumption Past 30 days, YRBS 2010-2017 ........................................................ 13 Figure 9. Gender and Grade Differences for Drinking-and-Driving Risk, YRBS 2017 .................................. 13 Figure 10. Gender and Grade Differences for Risky Alcohol Consumption, YRBS 2017 ............................. 14 Figure 11. Race/Ethnicity by Drinking and Driving Risk, YRBS 2017 (p<0.001) ........................................... 17 Figure 12. Race/Ethnicity by Alcohol Consumption Risk, YRBS 2017 (p=0.03) ........................................... 18 Figure 13. Sexual Orientation and Driving Risk, YRBS 2017 (p=0.024) ....................................................... 18 Figure 14. Academic Success and Driving Risk, YRBS 2017 (p<0.001) ........................................................ 19 Figure 15. Academic Success and Alcohol Consumption Risk, YRBS 2017 (p<0.001) ................................. 19 Figure 16. Assets and Driving Risk, YRBS 2017 (p’s<0.001) ........................................................................ 20 Figure 17. Assets and alcohol consumption risk, YRBS 2017 (p’s<0.001) ................................................... 20 Figure 18. NCHA - Alcohol and Other Drug Use - Past 30 Days .................................................................. 24 Figure 19. NCHA - Alcohol and Tobacco Use by Gender ............................................................................. 25 Figure 20. NCHA - Consequences of Risky Alcohol Use .............................................................................. 26 Figure 21. Adult Binge Drinking, Range of State Estimates: Wisconsin, U.S. High, U.S. Median, and U.S. Low, 2006-2014........................................................................................................................................... 29 Figure 22. Heavy drinking among adults, Wisconsin compared to U.S. median, 2005-2014 ..................... 30 Figure 23. Trends in La Crosse County adult binge drinking, heavy alcohol consumption, and drinking and driving (2010-2016) ..................................................................................................................................... 32 Figure 24. Binge drinking and heavy alcohol use by age and gender ......................................................... 33 ix | P a g e

  11. Figure 25. Binge drinking and heavy alcohol use by education and race ................................................... 34 Figure 26. OWI Arrest Rate per 100,000 - La Crosse County and State of Wisconsin - 2007-2015 ............ 37 Figure 27. Liquor Law Violations1 per 100,000 - La Crosse County and State of Wisconsin 2007-2015 .... 38 Figure 28. All Alcohol Citations - City of La Crosse 2009-2016 ................................................................... 41 Figure 29. Alcohol Citations by Gender and Age, City of La Crosse ............................................................ 42 Figure 30. Alcohol Citations by Gender, City of La Crosse .......................................................................... 42 Figure 31. Alcohol Citations by Age, City of La Crosse ................................................................................ 43 Figure 32. Type of Alcohol Citation by year, City of La Crosse .................................................................... 43 Figure 33. Alcohol Related Violations by Gender, City of La Crosse 2009-2016 ......................................... 44 Figure 34. Alcohol Related Violations by Age, City of La Crosse 2009-2016............................................... 44 Figure 35. Location of Underage Citations, City of La Crosse ..................................................................... 46 Figure 36. Map of Social Host Citations, City of La Crosse 2014-2016 ....................................................... 48 Figure 37. Day of Week - All Citations, City of La Crosse ............................................................................ 49 Figure 38. Month of All Citations, City of La Crosse .................................................................................... 50 Figure 39. Percent of ED Visits for Injury Coded as Alcohol-Related, by Year and Age, La Crosse County Residents ..................................................................................................................................................... 55 Figure 40. Percent of Hospital Admissions for Injury that are Coded as Alcohol-Related, by Year and Age, La Crosse County Residents ........................................................................................................................ 56 Figure 41. WHO Alcohol-Attributable Mortality Model ............................................................................. 58 Figure 42. Number and Percent of Deaths Due to Alcohol 2003-2014 ...................................................... 59 Figure 43. Injury Death Rates (per 100,000), La Crosse County by Age 2003-2014 ................................... 60 Figure 44. Percent of Deaths Due to Injury (Intentional and Unintentional) by Age ................................. 61 Figure 45. Percent of Deaths Due to Alcoholic Liver Disease by Age ......................................................... 62 Figure 46. Support for Policies by Respondent’s Residence - 2017 ........................................................... 70 Figure 47. Cost of Excessive Alcohol Use in the United States ................................................................... 75 LIST OF TABLES Table 1. Demographics of La Crosse County Middle School Youth Risk Behavior Participants, YRBS 2017 . 4 Table 2. Alcohol Behavior by Student Assets, La Crosse County Middle School Students, YRBS 2017 ........ 7 Table 3. Demographics of La Crosse County High School Students, YRBS 2017 ........................................... 8 Table 4. Other Behavioral Risks, Risky Driving, and Risky Alcohol Consumption, YRBS 2017 .................... 16 Table 5. National College Health Assessment (NCHA)-Survey Methodology ............................................. 22 Table 6. NCHA - Survey Demographics – 2014 ........................................................................................... 23 Table 7. NCHA - Other Health Risk Behaviors (% reporting) ....................................................................... 27 Table 8. Adult Binge Drinking Rates for Wisconsin Counties ...................................................................... 31 Table 9. Health Behaviors or Outcomes ..................................................................................................... 35 Table 10. OWI Citations by Jurisdiction, 2007-2015 ................................................................................... 39 Table 11. Liquor Law Violations1 by Jurisdiction, 2007-2015 ..................................................................... 40 Table 12. Alcohol-Related Violations, City of La Crosse, 2009-2016 .......................................................... 40 x | P a g e

  12. Table 13. Description of Underage Violation, City of La Crosse, 2009 to 2016 .......................................... 45 Table 14. Description of Social Host Citations, City of La Crosse 2014-2016 ............................................. 47 Table 15. Description of Drinking and Driving Violations, City of La Crosse, 2009 to 2016........................ 49 Table 16. Motor Vehicle Crashes Involving Alcohol by Age, La Crosse County Compared to All Other WI Counties, Comparison of Years 2002-2004, 2008-2010, 2011-2013 .......................................................... 52 Table 17. Number and percent of drivers using alcohol involved in a MVC, 2008-2010 versus 2011-2013 .................................................................................................................................................................... 53 Table 18. Roadway Type and Crash Location When Alcohol Use is Involved, by Age, 2008-2010 versus 2011-2013 ................................................................................................................................................... 54 Table 19. Violent Deaths Involving Alcohol in La Crosse County, 2004-2013 ............................................. 63 Table 20. Ratings of Problems in the Community, 2011, 2014, 2016 ........................................................ 66 Table 21. Survey Demographics, Community Perception Survey, La Crosse County 2009, 2012, 2017 ... 67 Table 22. Level of Support for Alcohol Consumption in the Community (% Agree or Strongly Agree) ..... 68 Table 23. Level of Support for Aspects of Parents Supplying Alcohol to Minors (% Agree or Strongly Agree) .......................................................................................................................................................... 68 Table 24. Community Support for Items Relating to Law Enforcement and Alcohol Regulation (% mostly or completely supportive) ........................................................................................................................... 69 Table 25. Alcohol Outlet Density: Licenses per People and per 500 Population, La Crosse County, 2007- 2016 ............................................................................................................................................................ 72 Table 26. Alcohol Compliance Checks Results for La Crosse County, 2012-2016 ....................................... 74 Table 27. Cost of Excessive Alcohol Use in La Crosse County, 2013 ........................................................... 76 xi | P a g e

  13. INTRODUCTION The city of La Crosse, Wisconsin, located on the banks of the Mississippi River, has always had alcohol ingrained into its history as a community. In 1858, two German immigrants, Gotlieb Heileman and John Gund, started a small brewery in La Crosse. By 1983, G. Heileman Brewing Company was the fourth largest brewery in the United States and had become a billion-dollar company, one of the largest employers in La Crosse, employing more than 1,700 people. Wisconsin and La Crosse are approaching two centuries of brewing history. In 1960, the G. Heileman Brewing Company and the La Crosse Chamber of Commerce created Oktoberfest in La Crosse as a working-class festival to celebrate its brewing industry and encourage tourism to the area to showcase local businesses and products. These roots in brewing and celebrating its products has contributed to a culture of permissive alcohol use and tolerance of risky drinking behaviors. This is borne out in the community’s (and state’s) high rates of alcohol misuse; La Crosse County is known for having one of the state’s highest rates of binge drinking. Along with this over-consumption of alcohol comes a burden of alcohol-related injury and mortality that is much higher than what is found in the state of Wisconsin as a whole. A series of alcohol-related drownings and other deaths in the past two decades brought added community and media attention to the issue of risky alcohol use in the La Crosse area and prompted action from local citizen groups. One of these groups was the Changing the Culture of Risky Drinking Behavior Coalition, which was launched in 2007 by a partnership of the La Crosse Medical Health Science Consortium (community partner), the Injury Research Center at the Medical College of Wisconsin (academic partner), Cooperative Education Service Agency #4, Coulee Council on Addictions, and Gundersen Health System (also a Consortium partner). They were funded through a series of planning and implementation grants from the Healthier Wisconsin Partnership Program at the Medical College of Wisconsin (2007-2008, 2009-2012, and 2012-2017) and the Strategic Prevention Framework State Incentive Grant from the Wisconsin Department of Health Services (2009-2012). Alcohol use and misuse is the third leading cause of preventable deaths nationwide. Risky alcohol use is a concern to any community, as it is related to a variety of issues related to injury and violence. Up to 70% of drownings, domestic abuse and manslaughters involve alcohol use. At-risk use of alcohol is associated with 60% of rapes, 20-40% of suicides, and 40-50% of traffic fatalities (Figure 1). 1 | P a g e

  14. Figure 1. Impact of At-Risk Alcohol Use and Abuse Source: Cisler RA, Hargarten SH. Public health strategies to reduce and prevent alcohol-related illness, injury and death in Wisconsin and Milwaukee County. WMJ 2000; 99 (June): 71-78. This report will summarize some of these harms as they apply to the individual, as well as their impact on the community. This is the fourth Burden of Risky Alcohol Use report for the La Crosse community. The report will update information from previous editions as well as introduce new data on risks, harms, and progress made towards creating a safer community. 2 | P a g e

  15. RISKY ALCOHOL USE Risky Alcohol Use Among Youth Approximately every two years, La Crosse County schools have participated in the Youth Risk Behavior Survey (YRBS), which provides statistics on a variety of health behaviors among youth. This survey, which is nationally developed and state-implemented, is administered voluntarily by local schools. Survey procedures are designed to protect the privacy of students by allowing anonymous and voluntary participation. Parent permission procedures are followed before administration, including informing parents that their child’s participation is voluntary. Students complete the self-administered, anonymous questionnaire using the Wisconsin Department of Public Instruction’s Online Survey System. Data from all schools within La Crosse County are combined into one report. High school data are compared to state and national benchmarks; no such benchmarks are available for middle school data. In La Crosse County, all public and some private high schools participated in the survey in spring of 2010, 2013, 2015, and 2017. Additionally, in 2017, four middle schools also completed the survey, which was tailored especially for middle-school students. 3 | P a g e

  16. Middle School Student Alcohol Use Four La Crosse County middle schools participated in the most recent (2017) survey, with a total of 1,132 students completing the survey. Demographics of the sample are shown in Table 1. Table 1. Demographics of La Crosse County Middle School Youth Risk Behavior Participants, YRBS 2017 (N=1132) N % Grade 6th 7th 8th 249 223 657 22.0% 19.7% 58.0% Gender Female Male 554 574 48.9% 50.7% Race White 868 264 15 97 41 7 103 76.7% 23.3% 1.3% 8.6% 3.6% 0.6% 9.1% Non-white Native American Asian Black Hawaiian/Pacific Islander Other (multiple) 4 | P a g e

  17. Middle school students were asked whether they had ever ridden in a car with someone who had been drinking (HBD) as well as about their own drinking behavior. Results are shown in Figure 2. Overall, about one in five middle school students had ridden with someone who had been drinking, and the same amount had had an alcoholic drink at some point in their life. About 5% had had a drink within the past 30 days, and 2% reported binge drinking in the past 30 days. Figure 2. Alcohol behaviors among La Crosse County Middle School Students, YRBS 2017 5 | P a g e

  18. Examination of these behaviors showed an increase in high risk behavior associated with an increase in age (grade), but no major differences between males and females or between white and nonwhite students (Figure 3). Figure 3. Difference in Drinking Behaviors by Student Demographics. La Crosse County Middle School Students, YRBS 2017 25% 21 21 20 20 20 20 20% 18 18 17 16 16 16 14 14 15% Ever Ride with HBD Ever drink 10% Drink 30 days 6 5 5 5 5 5% 4 Binge 30 days 3 2 2 2 2 1 1 1 0% 6 | P a g e

  19. In general, middle school students report strong assets and risky alcohol behavior varies with these assets (Table 2). Overall, 83% of students reported getting mostly A/Bs. Those reporting mostly D/Fs were 2.8 times more likely to report ever drinking, 4.7 times more likely to report drinking in the past 30 days, and 8.1 times more likely to report binge drinking. Between 84 and 92% of middle school students also reported that family or teachers cared about them, or reported feelings of belonging at their school. If they reported this, they were much less likely to ever ride with someone who had been drinking or to report they have ever drunk alcohol, had drunk in the past 30 days, or had binge drunk in the past 30 days. Table 2. Alcohol Behavior by Student Assets, La Crosse County Middle School Students, YRBS 2017 Ever ride with someone who HBD % overall Ever drink Drink 30 days Binge 30 days Grades: Mostly A/B Mostly C/Not sure Mostly D/F Family loves you and gives you support when you need it: Strongly agree, agree, not sure Disagree, strongly disagree Teacher cares and gives you encouragement: Strongly agree, agree, not sure Disagree, strongly disagree Belong at this school: Strongly agree, agree, not sure Disagree, strongly disagree 15.7% 3.9% 1.4% 3.2% (2.3x) 83.4% 17.8% 13.7% 23.2% (1.3x)* 29.0% (1.8x) 9.0% (2.3x) 2.4% 33.3% (1.9x) 44.4% (2.8x) 18.5% (4.7x) 11.1% (8.1x) 92.3% 17.4% 7.1% 15.6% 3.3% 1.1% 38.8% (2.2x) 52.5% (3.4x) 26.3% (7.8x) 11.3% (9.8x) 84.0% 16.7% 15.3% 31.2% (1.9x) 40.5% (2.8x) 16.8% (5.9x) 7.5% (8.9x) 14.3% 2.8% 0.8% 84.4% 16.0% 14.9% 35.5% (2.2x) 36.7% (2.4x) 17.8% (6.5x) 8.9% (14.1x) 15.1% 2.7% 0.6% *number in () indicates the degree to which risk increases for youth with this response compared to the lowest-risk response (e.g., C students are 1.3 times more at risk than A/B students) 7 | P a g e

  20. High School Student Alcohol Use The 2017 La Crosse County High School Youth Risk Behavior Survey was completed by 3,265 high school students in La Crosse County in February-March, 2017, in all the public school districts and one private school district. 100% of public schools and one private school participated. The student response rate was 67%, with 3,265 of the 4,872 students enrolled in the participating schools responding to questionnaires. Demographics of those sampled are shown in Table 3. The full report (available at http://www.lacrossecpn.org/statistics.htm) summarizes findings from eight priority areas: protective assets, traffic safety, weapons and violence, suicide, tobacco use, alcohol and other drug use, sexual behavior, and nutrition and exercise. Table 3. Demographics of La Crosse County High School Students, YRBS 2017 (N= 3,265) 9th 10th 11th 12th Female Male Other Declined Number 1587 1662 907 955 783 596 15 9 Percent 49% 51% 28% 29% 24% 18% 0.5% 0.3% Multi- Ethnic Native American Pacific Islander Declined White Asian Hispanic Black Number 2518 290 159 158 66 32 14 28 Percent 77% 9% 5% 5% 2% 1% 0.4% 0.9% 8 | P a g e

  21. Risky alcohol consumption rates from 2010 to 2017 are shown in Figure 4. Overall binge drinking (5 or more drinks on one occasion), has declined from 20% in 2010 to 11% in 2017, and any alcohol use in the past 30 days has declined from 32% to 19%. Rates of drinking and driving, and riding with someone who had been drinking, are shown in Figure 5. These rates have also declined significantly since 2010. Figure 4. Alcohol Use and Binge Drinking La Crosse County High School Students, YRBS 2010-2017 9 | P a g e

  22. Figure 5. Drinking and Driving, La Crosse County High School Students, YRBS 2010-2017 10 | P a g e

  23. High school students were asked about their perception of harm to students if they drank alcohol, smoked tobacco or marijuana, or used prescription drugs. While the consumption of alcohol has declined since 2010, overall, the perception that the use of these products is harmful to students has also declined (Figure 6). Prescription drug use is perceived to be a greater harm to students than alcohol. Marijuana use is seen as the least harmful. Figure 6. Perception of Harm–Moderate or Great Risk, La Crosse County High School YRBS, 2010-2017 11 | P a g e

  24. An In-Depth Look at Alcohol Use Among High School Students For an in-depth look at alcohol use, multiple alcohol use indicators from the survey were classified into two types of risk: risky driving and risky consumption. For the figures below, if a student reported both driving after drinking and riding with someone who had been drinking (HBD), they were placed in the “drove after HBD” category. If they reported riding but not driving, they were placed in the medium risk category, “rode with someone who HBD.” Similarly, if the student reported any alcohol use in the past 30 days and binge drinking, they were placed in the highest risk category, “binge drank in the past 30 days.” If they reported alcohol use in the past 30 days but no binge drinking, they were placed in the “drank in the past 30 days” category. Driving after drinking declined from 7.1% to 3.9% from 2010 to 2017 (Figure 7). Binge drinking also declined from 20.4% to 11.4% over this timeframe (Figure 8). Percentages are given for the highest risk categories to show trends. In the paragraphs below, these risk categories for alcohol use are examined with demographics such as grade level and gender; other behaviors such as smoking, drug use, obesity, and depression risk; and characteristics that may put the student at high risk, like lack of assets, such as perceived lack of family support, or belonging at school. Figure 7. Drinking and Driving Past 30 days, YRBS 2010-2017 12 | P a g e

  25. Figure 8. Risky Alcohol Consumption Past 30 days, YRBS 2010-2017 Risky Alcohol Behavior and Demographics In the 2017 survey, males were more likely to report driving after drinking, and females were more likely to report riding with someone who had been drinking, although this difference was not statistically significant (Figure 9). This pattern has remained the same since 2010 and parallels national trends. Driving after drinking increased with grade level. In 2010, 16.5% of 12th graders reported they had driven after drinking. In 2017, 7% of 12th graders reported this. Figure 9. Gender and Grade Differences for Drinking-and-Driving Risk, YRBS 2017 13 | P a g e

  26. In 2017, binge drinking behavior was fairly similar for male and female students; however, overall, fewer females reported no alcohol consumption in the past 30 days. 81% of males reported no alcohol use in the past month, whereas 78% of females reported this (Figure 10). This gender difference hasn’t changed significantly since 2010. As was seen with drinking and driving, binge drinking increased with grade level, from 4.5% in 9th grade to 18.8% among 12th graders. Of note, in 2010, 34% of 12th graders reported binge drinking. In 2010, 76% of 9th graders reported no alcohol use in the past month. By 2017 this had increased to 88%. Figure 10. Gender and Grade Differences for Risky Alcohol Consumption, YRBS 2017 Risky Alcohol Behavior and Other Risk-Taking Behaviors Risky driving behavior and risky alcohol consumption were compared to several other behaviors or risks among students. These behaviors were found to be strongly related to risky alcohol use (Table 4). Daily tobacco users were 12.9 times more likely to drive after drinking and 7.3 times more likely to binge drink than someone who reported no tobacco use in the past 30 days. 63% of students reporting daily use of tobacco reported binge drinking in the past 30 days; 35% reported driving after drinking. Students who reported using marijuana were 11.1 times more likely to report binge drinking (35%) and 8.5 times more likely to drive after drinking (11.4%). This was similar to students reporting any drug use. Students classified as high risk for depression (made a plan for, or attempted, suicide in the past 12 months) were 3.5 times more likely to report driving after drinking (14.6%), and 2.8 times more likely to binge drink (24.4%). Students who were considered “obese” based on self-reported height and weight were 2 times more likely to drive after drinking. There was a slight increased risk of binge drinking for overweight and obese students, but this was not statistically significant. Students getting insufficient sleep were more twice as likely to drive after drinking (4.5%) and 1.7 times more likely to binge drink (12.8%). Those students who reported texting and driving in the past 30 days were nearly 10 times more likely to drive after drinking (11.8%), and 4.2 times more likely to binge drink 14 | P a g e

  27. (26.2%). Students who reported being bullied on school property or being electronically bullied were 2.6 times more likely to drive after drinking (6.6%), and twice as likely to binge drink (17%). Other risky behaviors found to be significantly related to risky alcohol use included being in a fight, feeling unsafe at school, carrying or using a weapon, engaging in risky sexual behavior, using smokeless tobacco (including e-cigarettes), consuming excess soda pop or energy drinks, spending excess screen time (3+ hours per day watching television or being on a computer or smartphone), and using laxatives or vomiting to control weight. 15 | P a g e

  28. Table 4. Other Behavioral Risks, Risky Driving, and Risky Alcohol Consumption, YRBS 2017 Rode with someone HBD % reported Drank past 30 days % reported Binge drank past 30 days % reported Drove after HBD Increased risk % Increased risk Increased risk Increased risk reported Smoking: None 30 day use Daily Marijuana use (any or past 30 day) No Yes Any other drug use No Yes Risk for depression Low risk (sad, hopeless, consider) High risk (plan, attempt, injure) Obesity status Normal weight Overweight Obese Hours of sleep on a school night 8+ hours <8 hours Texting and driving (past 30 days) Never 1+/day Bullied on school property (ever) or e-bullied (past 12 months) No 10.0% -- Yes 16.8% 1.7x 11.4% 27.6% 14.6% -- 2.8% 16.4% 35.4% -- 7.9% 20.4% 10.4% -- 8.5% 49.3% 62.5% -- 2.4x* 1.3x 6.0x 12.9x 2.6x 1.3x 5.8x 7.3x 9.8% 19.3% -- 1.4% 11.4% -- 5.5% 17.7% -- 3.2% 35.4% -- 2.0x 8.5x 3.2x 11.1x 10.7% 20.7% -- 2.0% 14.6% -- 7.2% 16.3% -- 6.6% 38.1% -- 1.9x 7.3x 2.3x 5.7x 10.5% -- 2.8% -- 7.6% -- 8.9% -- 21.4% 2.0x 9.8% 3.5x 13.8% 1.8x 24.4% 2.8x 11.9% 12.5% 13.6% -- 3.4% 3.0% 6.7% -- 9.1% 7.8% 7.6% -- 10.7% 12.5% 13.6% -- 1.0x 1.1x 0.9x 2.0x 0.9x 0.8x 1.2x 1.3x 10.9% 12.7% -- 2.2% 4.5% -- 7.0% 9.1% -- 7.4% 12.8% -- 1.2x 2.0x 1.3x 1.7x 11.6% 12.8% -- 1.2% 11.8% -- 6.8% 13.6% -- 6.2% 26.2% -- 1.1x 9.9x 2.0x 4.2x 2.6% 6.6% -- 7.7% 10.2% -- 8.5% 17.0% -- 2.6x 1.3x 2.0x *”Increased risk” indicates the degree to which risk increases for youth with this response compared to the lowest- risk response (e.g., 30-day use smokers are 2.4 times more at risk than non-smokers). 16 | P a g e

  29. Risky Alcohol Behavior and High Risk Populations Race Among La Crosse County students, drinking and driving and risky alcohol consumption varied by race (Figure 11). Students of Hispanic ethnicity were at the highest risk of driving after drinking. Native American students were also significantly more likely to report this than all other races. Figure 11. Race/Ethnicity by Drinking and Driving Risk, YRBS 2017 (p<0.001) 17 | P a g e

  30. Students of Pacific Islander, Native American, multiple races, or Hispanic ethnicity were more likely to report binge drinking in the past than students who reported being White or Asian (Figure 12). Figure 12. Race/Ethnicity by Alcohol Consumption Risk, YRBS 2017 (p=0.03) Sexual Orientation Students reporting their sexual orientation as not heterosexual were at higher risk of driving or riding after drinking. (Figure 13.) There was no difference in binge or any alcohol consumption based on sexual orientation. Figure 13. Sexual Orientation and Driving Risk, YRBS 2017 (p=0.024) 18 | P a g e

  31. Academic Success Students who report they get mostly D/F’s were more than 4 times more likely to report drinking and driving than A/B students (Figure 14). Similarly, these students were also 2.5 times more likely to report binge drinking in the past month (24%) compared to A/B students (9.5%) (Figure 15). Figure 14. Academic Success and Driving Risk, YRBS 2017 (p<0.001) Figure 15. Academic Success and Alcohol Consumption Risk, YRBS 2017 (p<0.001) 19 | P a g e

  32. Assets Students who reported that their teachers or family members didn’t care about them or encourage them, or who felt they didn’t belong in their school were much more likely to report driving after drinking or riding with someone who had been drinking (Figure 16). A similar pattern was seen for binge drinking or any alcohol use in the past 30 days (Figure 17). Figure 16. Assets and Driving Risk, YRBS 2017 (p’s<0.001) Figure 17. Assets and alcohol consumption risk, YRBS 2017 (p’s<0.001) 20 | P a g e

  33. Summary of Risk to Middle and High School Students ●Since this is the first survey of middle school students, no trends over time can be determined; however, some important conclusions can be made. ○Alcohol use among middle school students is low; fewer than 5% report 30-day use and fewer than 2% report binge drinking. This compares favorably to high school students, 19% of whom reported 30-day use and 11% reported binge drinking. ○School performance (usually measured by grades) and assets (such as family support) are strong among middle school students, and these prove to be extremely important, as they are highly correlated to alcohol use in middle school students. Middle school students with mostly D/F’s were 8 times more likely to binge drink, whereas with high school students, those with D/F’s were 2.5 times more likely to binge drink. Middle school students who report low family or teachers caring were 9-10 times more likely to binge drink, compared to high school students, who were 2- 3 times more likely to binge drink if they reported this. ●There has been a significant decline in risky alcohol use among high school students in La Crosse County since 2010. ○Driving after drinking has declined from 7.1% in 2010 to 3.9% in 2017 ○Binge drinking has declined from 20.4% in 2010 to 11.4% Binge drinking among 12th grade students has declined from 34% in 2010 to 19% in 2017. ●Driving after drinking increased with: ○Increasing age ○Other risk-taking behavior (tobacco use, drug use, violence, bullying, texting and driving, low seat belt use) ○Less healthy behaviors (obesity, poor sleep, low physical activity, poor nutrition) ●Binge drinking rates increased with: ○ ○Gender (males have higher rates) ○Other risk-taking behavior (tobacco use, drug use, violence, bullying, texting and driving, seat belt use) ○Less healthy behaviors (obesity, sleep, physical activity, poor nutrition) ●Specific groups of students with riskier alcohol behaviors include: ○Hispanic, Native American, Pacific Islander, and those of multiple races ○Students who identify as LGBTQ ○Students who are poor academic performers ○Students who perceive their teachers or family don’t care about them, or they don’t belong at their school Increasing age 21 | P a g e

  34. Risky Alcohol Use Among College Students Periodically, the three institutes for higher learning in La Crosse County participate in a national survey known as the National College Health Assessment (NCHA). It is a nationally-recognized research survey of college students covering a variety of health issues, including alcohol, tobacco, other drug use, sexual health, weight, nutrition, exercise, mental health, personal safety, and violence. Locally, college students are encouraged to complete the survey online. In 2010, data were combined from all three colleges in La Crosse County (Viterbo University, Western Technical College, and University of Wisconsin-La Crosse) to produce an all-community report on college student risk behaviors. We combined data from 2008 and 2009 and compared data to a national benchmark in 2009. Viterbo and Western repeated this survey in 2011, and these results were compared to a 2011 national benchmark. In 2014, data was combined from the Spring 2013 survey at Viterbo, Spring 2014 survey at UW-La Crosse, and Fall 2014 survey at Western and compared to Spring 2014 benchmarks (Table 5). More recent data is not available at this time. Table 5. National College Health Assessment (NCHA)-Survey Methodology 2009 2011 2014 Population Survey time frame Number responding Survey time frame Number responding Survey time frame Spring 2013 Fall 2014 Spring 2014 Number responding Viterbo University Spring 2009 Fall 2008 Spring 2008 Spring 2011 Fall 2011 541 764 687 Western Technical College University of Wisconsin-La Crosse Total – La Crosse County National Benchmark 750 1022 645 391 N/A N/A 501 1,682 1,786 1,833 Spring 2009 Spring 2011 Spring 2014 87,105 105,781 66,887 22 | P a g e

  35. The sample demographics for the 2014 combined survey, compared to the national benchmark, are shown in Table 6. Overall, respondents from La Crosse were more likely to be older and female than the national respondent group, most likely due to sampling a non-traditional 2-year technical college (an older population), and a private university (more female). Table 6. NCHA - Survey Demographics – 2014 Western Technical College 645 263 116 264 219 420 Benchmark - Spring 2014 Viterbo University 687 273 196 199 130 550 University of WI- La Crosse 501 284 188 20 141 350 Total Combined Sample 1833 820 (44.7%) 500 (27.3%) 483 (26.4%) 490 (26.7%) 1320 (72.0%) Respondents Age 66,887 55.3% 34.3% 6.8% 33.3% 65.6% 18-20 21-23 24+ Gender Male Female 23 | P a g e

  36. Alcohol and other drug use for the combined data are shown in Figure 18. Alcohol use is the most common substance use reported by all college students, with two-thirds of students reporting at least one drink of alcohol in the past 30 days; this is consistent with national data. More than one-third (35%) of students reported binge drinking in the past 14 days in La Crosse colleges, compared to 36.2% of students nationally. Drinking and driving rates were higher than national rates among La Crosse students, with nearly one in five students reporting driving after drinking in the past 30 days; however, these rates have declined since the previous survey. Tobacco use is higher among La Crosse college students as well; however, most other drug use is lower than the national rates. Figure 18. NCHA - Alcohol and Other Drug Use - Past 30 Days 24 | P a g e

  37. Alcohol use was examined for males and females separately (Figure 19). Among La Crosse college students, males were similar to females in their self-reported use of any alcohol (68% for males) or drinking and driving (19% for males). These rates were also higher than the national sample’s gender- specific data. Males in the most recent survey were much more likely to report binge drinking than females (16.4% compared to 6.3%); however, the rate of binge drinking for both males and females had significantly declined from previous surveys. Figure 19. NCHA - Alcohol and Tobacco Use by Gender 25 | P a g e

  38. Data on the negative consequences of risky alcohol use are shown in Figure 20. More than 25% of respondents reported doing something regretful as a result of their alcohol use. One in four admitted to forgetting where they were or what they had done as a result of their drinking. Unprotected sex was reported among 17% of students. Nearly 10% of students reported injuring themselves. 4% of students reported alcohol affecting their course work, either by negatively affecting their grade or having to drop a class. These negative consequences have fluctuated little over the three survey years and compare similarly to national benchmark results. Figure 20. NCHA - Consequences of Risky Alcohol Use 26 | P a g e

  39. Table 7 shows other health risks of La Crosse college students, who tend to report similar health habits compared to the national benchmark. La Crosse students were slightly more likely to report being “very overweight” and trying to lose weight. However, they were also more likely to report wearing a helmet and less likely to report being “very lonely,” feeling “hopeless,” or feeling “depressed.” La Crosse students were slightly more likely to report ever being diagnosed for depression and less likely to consider or attempt suicide, compared with national benchmarks. Table 7. NCHA - Other Health Risk Behaviors (% reporting) Combined '09 Combined '11 Combined ‘14 Benchmar k '14 Health Habits 94.4 86.8 7.2 56.6 4.8 76.4 40.0 Violence 5.3 4.2 13.7 Mental Health Issues 89.4 81.1 19.4 62.0 46.2 44.0 8.7 29.9 24.0 13.4 5.7 1.1 < 5 fruits & vegetables/day < 5 days/week exercise Very overweight Trying to lose weight Wear a seatbelt (never/rarely) Wear a helmet (never/rarely) <3 days/week get enough sleep 95.6 83.1 10.2 58.8 3.6 40.5 59.7 93.9 66.9 7.3 54.6 2.0 60.2 41.4 94.0 67.9 4.6 50.9 2.0 75.6 38.1 Physical Fight Assaulted Emotionally abusive relationship 7.1 4.2 12.8 4.6 2.8 10.4 5.6 3.7 9.4 Overwhelmed Exhausted Very lonely Very sad Hopeless Overwhelming anxiety Tremendous stress Felt depressed Ever diagnosed Current treatment for depression Considered suicide Attempted suicide 84.5 77.9 48.7 54.4 42.3 46.4 9.6 27.5 27.7 16.6 6.2 1.1 86.3 81.5 49.7 61.5 41.4 53.1 9.5 26.9 23.3 12.9 5.3 0.9 87.0 82.5 60.5 63.2 47.8 54.7 10.6 33.1 19.5 10.0 8.6 1.4 27 | P a g e

  40. Summary of Risk to College Students ●There are many health issues affecting college students at La Crosse campuses, including alcohol use and its related impacts. ○Overall, 68% of college students reported drinking alcohol in the past month; 16% of males and 6% of females reported binge drinking in the past 2 weeks. ○The rates of risky drinking (binge drinking and drinking and driving) have declined since the 2015 survey. ○There are many self-reported negative consequences of alcohol use and poor mental health that affect student’s ability to learn. Other health measures suggested a less than healthy culture on college campuses. ○The increase in 30-day use of alcohol and binge drinking between high school and college was significant. 19% of high school students reported 30-day use compared to 66.7% of college students. 11% of high school students reported binge drinking compared to 35% of college students. 28 | P a g e

  41. Risky Alcohol Use Among Adults Wisconsin has a long tradition of being one of the highest ranked states for adult alcohol consumption, binge drinking (four drinks for women and five drinks for men on one occasion), and heavy alcohol consumption (more than one drink for women and more than two drinks per day for men). According to the Centers for Disease Control and Prevention (CDC), the rate of current alcohol use among Wisconsin adults had dropped slightly since the early 2000s; however, the rate remains highest or second highest in the nation from year to year. As of 2014, Wisconsin’s binge drinking rate was 22%, dropping from a high of 25% in 2012 (Figure 21). Heavy drinking among Wisconsin adults has also declined slightly since 2011; however, Wisconsin rates are still above the national average (Figure 22). Figure 21. Adult Binge Drinking, Range of State Estimates: Wisconsin, U.S. High, U.S. Median, and U.S. Low, 2006-2014 (Figure from WI EPI Profile, 2016) 29 | P a g e

  42. Figure 22. Heavy drinking among adults, Wisconsin compared to U.S. median, 2005-2014 (Figure from WI Epi Profile, 2016) 30 | P a g e

  43. Wisconsin’s 2010 and 2016 Epidemiological Profile on Alcohol and Other Drug Use presents data on the use and abuse of alcohol (and other substances) in Wisconsin and the resulting consequences. Due to small survey samples, multiple years are combined for these reports. The rate of binge drinking for adults in La Crosse County in 2005-2007 was 18% and lowest among the surrounding counties and the statewide average for the same time (Table 8). In 2010, methodology for this survey changed, adding cell phone survey data to the sampling methodology. The rate reported for La Crosse County adults in later years is much higher, and is higher than the surrounding counties and the state average. In 2012- 2014, 28% of adults in La Crosse County reported binge drinking. Table 8. Adult Binge Drinking Rates for Wisconsin Counties 2004-20061 2005-20071 2011-20132 2012-20142 County La Crosse 19% 18% 31% 28% Monroe 26% 25% 20% 17% Trempealeau 25% 22% 29% 26% Vernon 23% 26% 24% 18% State average 23% 23% 24% 23% Source: 1WI 2010 Epidemiological Profile on Alcohol and Other Drug Use. 2WI 2016 Epidemiological Profile on Alcohol and Other Drug Use. 31 | P a g e

  44. Local data were made available from Gundersen Health System from findings of a personal health assessment given to employees since 2010 (Figure 23). Over 25,000 adults in La Crosse County have completed the survey. These findings are large enough to be generalizable to the working population in La Crosse County. The rate of binge drinking has declined from 30% in 2010 to less than 20% in 2016. Binge drinking rates in this sample are very comparable to those reported above; the average rate from 2012-2014 was 28.2%. Heavy drinking has remained the same over the past 6 years at about 5%; this is lower than the state average of about 7%. Approximately 3% have reported driving after having too much to drink. Figure 23. Trends in La Crosse County adult binge drinking, heavy alcohol consumption, and drinking and driving (2010-2016) Source: Gundersen Health System, Working Population Survey 32 | P a g e

  45. While binge drinking among men and women follows patterns found in national studies, a concerning finding in this data is the rate of heavy consumption among women being higher than among men, and especially higher among women over age 65 (Figure 24). The rate of heavy consumption among women over age 65 has increased 3.5 times from 2% in 2011 to more than 9% in 2016, and remained relatively flat for all other age and gender groups. This is problematic for older women, as alcohol is metabolized slower as one ages, can increase the risk of falls, or can interfere with medications like blood pressure medications, making them less effective. Heavy alcohol use by women can also increase the risk of breast and other cancers. Figure 24. Binge drinking and heavy alcohol use by age and gender Binge drinking Heavy drinking 60 10 50.9 50 7.8 8 7.5 40.8 6.6 40 33.8 6 5.4 4.9 Female 4.6 30 4.5 4.5 26.1 22.1 Male 4 20 14.6 12.0 2 7.9 10 0 0 < 30 31-50 51-64 65+ < 30 31-50 51-64 65+ Source: Gundersen Health System, Working Population Survey 33 | P a g e

  46. Binge drinking was found to be higher among less educated adults in this sample, and higher among white than nonwhite participants (Figure 25.) Heavy drinking was also higher among white participants, but did not vary by education. This finding for education matches national studies, however the racial difference for heavy use is counter to state and national findings (WI Epi Profile, 2016). Overall, non- white individuals were underrepresented in the survey. Figure 25. Binge drinking and heavy alcohol use by education and race Source: Gundersen Health System, Working Population Survey Similar to the findings reported by youth, adults who reported binge drinking or heavy drinking were more likely to have other negative health behaviors or poor health outcomes (Table 9). Those with fair or poor health were 1.3 times more likely to report binge drinking and 1.6 times more likely to report heavy consumption compared to those who had excellent or very good health. Those with high stress or anxiety were more likely to report binge and heavy consumption. Those with depression were more likely to report heavy alcohol use. Adults who reported daily or occasional tobacco use were 2 times more likely to binge drink and 2.7 times more likely to report heavy drinking. Low fruit and vegetable consumption, physical inactivity, poor sleep quality, and low seat belt use were also found to be related to increased rates of binge and heavy drinking. 34 | P a g e

  47. Table 9. Health Behaviors or Outcomes Binge drank Heavy consumption If adult had this characteristic: % reported Increased risk % reported Increased risk Self-Rated Health Excellent/Very good 26.0 -- 4.6 -- Good 32.8 1.3x 6.2 1.4x Fair/Poor 33.7 1.3x 7.3 1.6x Daily Stress Low stress 27.4 -- 4.8 -- High stress 31.2 1.1x 6.7 1.4x Depression No risk 28.2 -- 5.0 -- 1.0x* Yes/high risk 28.2 6.1 1.2x Anxiety No risk 27.7 -- 4.9 -- Yes/high risk 31.4 1.1x 7.1 1.5x Smoking: No use 26.1 -- 4.6 -- Daily/occasional use 52.7 2.0x 12.3 2.7x Obese Not obese 28.1 -- 5.3 -- 1.0x* 0.9x* Obese 28.3 4.9 Fruits and vegetables 5+/day 19.4 -- 4.7 -- < 5/day 31.3 1.6x 5.3 1.1x Physical Activity Active 27.1 -- 4.9 -- Sedentary 29.3 1.1x 5.4 1.1x Sleep Quality Good 27.6 -- 4.8 -- Poor 34 1.2x 8.9 1.9x Sleep hours/night 7+ hours 27.7 -- 5.2 -- 1.0x* <7 hours 30.8 1.1x 5 Seat belt use Always 27.1 -- 4.9 -- Less than always *indicates increased risk was not statistically significant 44.5 1.6x 8.1 1.7x Source: Gundersen Health System, Working Population Survey 35 | P a g e

  48. Summary of Risks to Adults: ●La Crosse’s adult binge drinking rate of about 28%, while on the decline, was higher than other counties in the area and were much higher than national rates. ○Binge drinking was highest among younger males; the rate decreased for both males and females as age increased. ○Binge drinking decreased with increasing education and was highest among white working adults in La Crosse County. ○Those with poorer health (self-rated health, excess stress, and anxiety) or poorer health habits (tobacco use, poor diet, low physical activity, poor sleep, and low seat belt use) were more likely to report binge drinking. ●La Crosse’s heavy drinking rate of 5% was lower than the state average of 7% and lower than national rates. ○Heavy drinking increased with age. Heavy drinking was higher among older females (50+) and increased 3.5 times from 2010 to 2016 in women over age 65. ○Heavy drinking was highest among white working adults in La Crosse County but didn’t vary by education level. ○Those with poorer health (self-rated health, excess stress, depression and anxiety) or poorer health habits (tobacco use, poor diet, low physical activity, poor sleep and low seat belt use) were more likely to report heavy drinking. 36 | P a g e