Tobacco use and the abuse of alcohol and other drugs can lead to many short-term and long-term issues for the individual and surrounding community. Excessive alcohol consumption increases the risk of accidents, injuries, fetal alcohol spectrum disorders, and acts of violence and other traumas in family life (navigate to the youth experiences section of the Respect & Social Inclusion page to see alcoholism's effect on the household). Chronic alcohol abuse can lead to learning and memory problems, liver disease, mental health problems, unemployment and other social problems. Both excessive alcohol use and tobacco use can lead to chronic conditions including heart disease and certain cancers  — the top two causes of death in Napa County; and smoking can lead to respiratory diseases (visit the Health Outcomes page to read more about tobacco and other key behaviors that contribute to the top three causes of death). 

Regulating alcohol accessibility and availability has been effective in curbing excessive and illicit drinking behaviors and consequences (e.g., underage or irresponsible drinking, driving under the influence and alcohol-related crimes). Restrictions include enforcing the minimum legal drinking age (21 in the US), limiting the times allowed for alcohol sales (6AM to 2AM in California) and reviewing the suitability and location of alcohol outlets through licensing. In California, the Department of Alcohol Beverage Control (ABC) regulates the manufacture, distribution and sale of alcohol beverages while the Board of Equalization (BOE) administers taxes on this process to further fund alcohol control activities.

Limiting the density and overall number of tobacco retailers, especially near schools or where youth congregate and in low-income areas, has been a promising strategy to lower use, minimize exposure to tobacco marketing, and promote health equity in the population. Decreases in the number of tobacco retailers has been linked to lower rates of youth smoking, fewer cigarettes smoked per day and a higher likelihood of quitting among current smokers. Nevertheless, tobacco companies continue to sell new products, such as electronic smoking devices, that undermine prior control efforts and require new prevention approaches. The California Tobacco Control Program (CTCP), under the California Department of Public Health, is the longest running, most comprehensive program in the nation and leads the fight against tobacco statewide. For local information, visit the Napa County Tobacco Control main page (link will be provided when available).

Substance use among teenagers and young adults can lead to physical and mental health problems, including increased risky and/or violent behavior, impaired brain development and academic performance, substance dependence later in life, traumatic injuries and even death. Youth who use one substance (e.g. alcohol) are more likely to use other substances (e.g. illicit drugs). Multi-substance use can often have a synergistic, or additive effect, on adverse health outcomes. 

The 2017 California Healthy Kids Survey (CHKS) asks students in grades seven, nine, and eleven about their use and perception of accessibility of alcohol, cigarettes, e-cigarettes and cannabis — the most common substances used by youth. Overall, students in higher grade levels reported more use and availability. Substance use was highest among non-traditional students (i.e., those in alternative public education settings/pathways, who frequently do not fall into clearly designated grade levels). Although CHKS data at the state level was unavailable, CHKS data is comparable to 2017 data from the national Youth Risk Behavior Surveillance System (YRBSS), which surveys high school students (grades 9-12), and will be used as a benchmark in this section.

For traditional schools, the percent of students who drank at least one alcoholic beverage in their lifetime was 6% (about 1 in 17) for 7th graders but jumped considerably to 24% (about 1 in 4) for those entering high school (9th graders) and 43% (nearly 1 in 2) for 11th graders. The percent of students who drank at least one alcoholic beverage in the past month was 4% (about 1 in 25) for 7th graders and rose to 12% (about 1 in 10) for 9th graders and 22% (about 1 in 5) for 11th graders (graph above). Generally, Napa's percentages were below the state and national levels, which was about 60% for any use and 30% for current use. The exception was non-traditional students; 66% have tried alcohol and 41% drank alcohol in the past month. Compared to tobacco and cannabis, alcohol was perceived as one of the most accessible substances — 1 in 4 7th graders and more than 1 in 2 high school (grades 9 and 11) and non-traditional students reported that it was easy to obtain. 

The graphs above show cigarette and e-cigarette use among Napa County students. Although many students found cigarettes to be easy to obtain, less than 5% of students in 7th, 9th and 11th grades reported that they currently smoke traditional cigarettes (graph above on the left); this is lower than the statewide (5%) and nationwide (9%) averages for cigarette use among students of the same age. While cigarette use is relatively low among youth, vaping is becoming more widespread. Indeed, County percentages for current and past use of electronic smoking devices were more than twice that of cigarettes. Among 11th grade students, 9% reported currently vaping and 31% had tried vaping. Among non-traditional students in Napa, use of both cigarettes and vaping devices was above that of California and the US — about 1 in 4 currently smoke/vape and about 1 in 2 have tried smoking/vaping. For more local information, visit Napa County Tobacco Control's E-Cigarettes and Vaping page (link will be provided when available). 

By 11th grade, nearly 1 in 3 (32%) students in Napa County have tried cannabis and about 1 in 6 (17%) have used cannabis in the last month. While these percentages were below state and national levels (35% and 20% for ever and current use respectively), non-traditional students in Napa County had higher levels of use (66% have tried cannabis and 41% used in the last month) (graph above). A large percentage of students believe that cannabis is easy to obtain (e.g., 1 in 2 9th graders and nearly 3 in 4 11th graders) and reported that their peers who use it usually buy it at dispensaries (e.g., about 1 in 2 9th and 11th graders). For more local information, visit Napa County Tobacco Control's Cannabis page (link will be provided when available). 

According to the CHKS data for the 2013-2015 time period, alcohol and drug use among youth varies by ethnicity. In Napa County, a higher proportion of Hispanic/Latino students reported currently using alcohol or drugs (24%) than white students (18%).  While there was little variation in level of current traditional cigarette use among ethnic groups (less than 5% of students among both groups); a higher proportion of Hispanic/Latino students reported currently using electronic smoking devices (11%) than white students (7%). [Data Not Shown]

Driving "under the influence" (DUI), of either drugs or alcohol, is dangerous and can lead to accidents, injuries and death. For alcohol, a person is considered impaired if they have a blood alcohol concentration (BAC) of 0.08% or more, with stricter standards for commercial drivers (0.04%+) and a zero tolerance for those under 21 (0.01%+). For drugs (inclusive of all types: prescriptions, over-the-counter, cannabis or illicit), a law enforcement officer can legally require a blood or urine test if a driver is suspected to be impaired. Visit the CA Driver Handbook for laws on other drugs and further information. Those charged with a DUI face varying penalties depending on each case's circumstances, including jail time, fines, a driving record and license suspension. 

Due to data availability constraints, the measures below focus more on alcohol-related DUIs; however, there have been increasing efforts statewide to educate the public that "DUI Doesn't Just Mean Booze" and develop measures to track and reduce all substances that impair driving. 

In 2017, among 9th and 11th graders in Napa County, about 1 in 10 reported drinking and driving or riding with an inebriated driver (i.e., friends or parents); in contrast, among non-traditional students (i.e., those in alternative public education settings/pathways, who frequently do not fall into clearly designated grade levels), 1 in 3 reported drinking and driving or riding with an inebriated driver. Across all grade levels, students were less likely to drive while under the influence of cannabis, but a larger percentage rode with someone who was high. State data for 2017 is not readily available for comparison; however, data for alcohol from previous years shows slightly higher levels for Napa County than the State. Multi-component interventions, including media campaigns, checkpoints and school-based instruction teaching teens not to ride with intoxicated drivers, are key strategies to combating this issue.

Deaths related to drunk driving have been steadily increasing statewide from 2.2 deaths per 100,000 residents in the 2009-2011 time period to 2.7 in the 2015-2017 time period. While Napa's rates were about 20% lower than the State for the 2012-2014 time period, the County experienced a spike to 3.3 deaths per 100,000 in the 2015-2017 time period— which is an additional 1 to 2 preventable fatalities annually. The CA Office of Traffic Safety's (OTS) 2017 Annual Report states that this upward trend may be attributed to an improvement in the economy and more people driving, as well as a decrease in law enforcement resources throughout the nation. However, regardless of the specific reason, CA OTS urges ongoing strategies to raise awareness and prevent unsafe driving behaviors.

Proximity to tobacco retailers influences smoking and vaping behaviors, especially among youth. Efforts to reduce tobacco access and advertising, especially near schools, complements existing tobacco prevention strategies. 

California requires all retailers to have a license to sell cigarettes and tobacco. As of 2016, this definition of tobacco includes "nicotine products, electronic nicotine or other vaporized liquid delivery devices, and any component, part or accessory of a tobacco product" (e.g cigarettes and e-cigarettes). The map below displays all licensed tobacco retailers (as red dots) in Napa County in 2018 and the location of both private and public K-12 schools (as black triangles) in the County.

In Napa County, there are about 8 tobacco retailers per 10,000 people, slightly below the state level (9 per 10,000). Among the 108 retailers where information is available, about 1 in 15 retailers were within 500 feet of a school and 1 in 6 were within 1,000 feet of a school. 


For more information on tobacco retailers and local control efforts, click on the links to the right:

(links will be added as soon as they are available)

• Napa County Tobacco Control main page

• Retail and further information on e-cigarettes and vaping

License requirements for tobacco retailers

CA cigarette & tobacco product licensee listings

The location, density, type of alcohol outlets and level of advertising influences drinking behaviors and their related consequences. On-premise retailers are those that sell alcoholic beverages for consumption on the premises (e.g., bars, restaurants, breweries and wineries) and may sell certain products for consumption off the premises. Off-premise retailers are those that only sell alcoholic beverages for consumption off the premises (e.g., drug, grocery, and general stores). These off-premise locations are more likely to encounter youth attempts of alcohol purchase, either directly or indirectly, due to cheaper prices and volume of beverages (e.g., large displays like those in chain stores). Greater densities of off-premise retailers have been associated with higher rates of frequent drinking and alcohol-related accidents, injuries and complaints. Greater densities of on-premise retailers have been linked to the perceived availability and tolerance of drinking, especially among youth (e.g., consumption in public settings). Certain types of on-premise establishments (e.g., clubs and bars) are more likely to affect drinking behavior and perceptions than others (e.g., restaurants). A strategy used to reduce harmful alcohol consumption is limiting the licenses of certain types of off-site retailers that sell a variety of liquors (drug and grocery stores).

The map series below displays the percent of the population in a census tract (neighborhood) residing within a quarter mile of an alcohol outlet. Because of the link between certain off-premise retailers (e.g. drug stores and corner markets) and youth drinking behavior and the efforts to reduce alcohol access by limiting the licenses of certain off-site retailers that sell many types of alcohol, two maps are displayed side-by-side with a "slider" function— one excluding and another including wineries. The map on the left side (pink) excludes wineries. The neighborhoods with the highest percent of the population are in the urban areas of the county: Calistoga, St. Helena, and the City of Napa. Neighborhoods with 100% of the population living near an alcohol outlet is in the area between Fuller Park and Imola Avenue and south of downtown Napa. The map on the right side (purple) includes wineries. With the exception of American Canyon and Lake Berryessa, at least 75% of the population of Napa County neighborhoods live near an alcohol outlet.

To explore more data on alcohol retailer licenses statewide, visit the CA Department of Alcohol Beverage Control's Map Query System.

The American Lung Association (ALA) releases an annual report, State of Tobacco Control, which grades jurisdictions on their policies to reduce tobacco use and exposure. In 2019, California ranked among the top states nationwide for tobacco control policy; however, at the local level, Napa County received grades of D or F across all categories (table on the right). While the grades are low, efforts at improvement are underway. In 2015, American Canyon was the first city statewide to adopt a policy prohibiting any tobacco-only stores, vape shops and other similar establishments. In 2018, St. Helena updated their municipal code to incorporate electronic smoking devices and expand the definition of "smoking" to include e-cigarettes and cannabis. The Coalition for a Tobacco Free Napa is leading efforts to adopt policies that provide comprehensive definitions of smoking and tobacco products, restrict smoking in multi-unit housing, and prohibit tobacco retailers within 1,000 feet of schools.

For more information, visit the ALA's State of Tobacco Control page and Napa County Tobacco Control's Smoke Free Environments page (link will be provided when available).

In the US, tobacco use, poor nutrition, and excessive alcohol use are among the leading causes of preventable illness. In many places, residents lack access to fruits and vegetables, but can find tobacco and alcohol easily. The ideal retail environment makes fruits, vegetables, water, and other nutritious products more accessible, and tobacco, sugary drinks, non-nutritious foods, and alcohol less accessible. Napa County Public Health is working with community partners to conduct the Healthy Stores for a Healthy Community Survey in 2019. This survey assesses products, placement, promotions, pricing and prevalence of tobacco, alcohol, foods and beverages in Napa County. Data from this survey will be compared to results from the 2016 survey to measure our progress in creating healthier retail environments.

For more information, visit the HSHC website and Napa County Tobacco Control page (link will be provided when available)

The Coalition for a Tobacco Free Napa is made up of a diverse group of community stakeholders who strive to protect Napa County residents from the harmful effects of smoking and tobacco products. To accomplish this, the coalition provides education, advocacy, and support for tobacco control activities in Napa’s communities. The coalition focuses on the harmful effects of tobacco products, secondhand smoke, emissions form electronic smoking devices, and preventing youth initiation. This work is supported by Napa County Public Health, who receives funds to implement a local Tobacco Control Program through tobacco taxes implemented by Proposition 99 in 1988 and Proposition 56 in 2016.

For more information or find out how to get involved, visit the Coalition for a Tobacco Free Napa page (link will be provided when available).

The Napa Youth Council's mission is to bring youth together to discuss and bring forth issues, ideas, concerns and awareness related to the effects of tobacco products in the community. The council is funded through Napa County Tobacco Control funds and supported by Napa County Public Health staff. Youth get involved with community projects and campaigns, work with local officials to decrease the access and use of tobacco, and essentially work to ensure that youth voices are heard. Currently, they are working with the City of Napa to update the Municipal Code pertaining to age restrictions and definitions of tobacco products. In the future, they are also looking to restrict smoking during public events, especially where youth are present, and reduce youth access to tobacco (including all forms of vapes).

Read more about the Youth Council in their Letter to the Editor on the Napa Valley Register.

Friday Night Live (FNL) is a youth development program across many counties statewide that engages youth as active leaders and resources in their communities — particularly in standing up against alcohol, tobacco and drug issues. In Napa County, FNL is supported by staff from Napa County Public Health. Youth from Valley Oak High School and River Middle School recently invited school administrators, prevention staff, city and county officials, and the police department to an honest conversation about the issue of vaping in schools and the broader community. The goal is to collectively find solutions to reduce availability and use of vaping devices among students at school, which will be a on-going project for FNL youth.

For more information, visit FNL's website.

As a response to the high rates of substance use among Napa County youth, the Catalyst Coalition formed in 2005, with a federal grant, to focus on reducing alcohol and cannabis use. One of their accomplishments was working with Napa Valley Unified School District to implement protocols for students who get caught with vaping devices, alcohol and other drugs. Following the success of the Catalyst Coalition, but the end of its grant in 2015, another coalition was subsequently formed in partnership with UpValley Family Centers to specifically target the northern areas of the County. The UpValley Partnership for Youth — with a grant set through 2020 — works to raise awareness about the harms of underage drinking and reduce youth access through local control. Their current achievements include adding marijuana and other drugs to the Social Host Ordinance (i.e., making it illegal to provide a venue for underage drinking) in Calistoga and St. Helena. 

For more information, visit the following websites — Catalyst Coalition & UpValley Partnership for Youth 

References


Overview

American Addiction Centers. (2018). The Laws & Regulating Bodies Controlling How Beer, Wine, and Liquor Is Sold. Retrieved February 29, 2019 from https://www.alcohol.org/laws/regulating-bodies/

California Department of Alcoholic Beverage Control. (2019). Mission Statement. Retrieved February 29, 2019 from https://www.abc.ca.gov/mission.html

California Department of Public Health. (2017). California Tobacco Control Program Overview. Retrieved February 29, 2019 from https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/CTCB/CDPH%20Document%20Library/AboutUS/ProgramOverview/AboutUsProgramOverview081216.pdf

California Department of Public Health. (2012). Tobacco in the Retail Environment. Retrieved February 29, 2019 from https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/CTCB/CDPH%20Document%20Library/ResearchandEvaluation/FactsandFigures/TobaccoRetailEnvironmentFactSheetEasyPrint.pdf

California State Board of Equalization. (2019). Alcoholic Beverage Tax Program. Retrieved February 29, 2019 from http://www.boe.ca.gov/sptaxprog/alcoholic_bev_tax.htm

Change Lab Solutions. (2016). How to Reduce Tobacco Retailer Density and Why. Retrieved February 29, 2019 from http://www.changelabsolutions.org/publications/infographic-tobacco-retailer-density

Graham, K., & Livingston, M. (2011). The relationship between alcohol and violence–population, contextual and individual research approaches. Drug and Alcohol Review, 30(5), 453.

National Institute on Alcohol Abuse and Alcoholism. (1997). Alcohol Alert. Retrieved February 29, 2019 from https://pubs.niaaa.nih.gov/publications/aa38.htm


Youth Substance Use

Centers for Disease Control and Prevention. (1991). Alcohol and other drug use among high school students — United States. Morbidity and Mortality Weekly Report, 40(45), 776.

Centers for Disease Control and Prevention. (2018). Adolescent and School Health — Data by Topic. Retrieved March 15, 2019 from https://www.cdc.gov/healthyyouth/data/topics/index.htm

Centers for Disease Control and Prevention. (2018). Teen Substance Use & Risks. Retrieved March 15, 2019 from https://www.cdc.gov/features/teen-substance-use/index.html

Johns Hopkins, Bloomberg School of Public Health. (2007). Consequences of Underage Drinking. Retrieved from March 15, 2019 from http://www.camy.org/resources/fact-sheets/consequences-of-underage-drinking-surgeon-general/index.html

Leslie, K. (2008). Youth substance use and abuse: Challenges and strategies for identification and intervention. CMAJ, 178(2), 145-148.

Substance Abuse and Mental Health Services Administration (SAMHSA). (2014). Link Between Underage Substance Use and Problems in Adulthood. Retrieved March 15, 2019 from https://www.samhsa.gov/samhsaNewsLetter/Volume_22_Number_4/link_between_underage_substance_use_problems_adulthood/


Drinking & Driving

California Office of Traffic Safety. (2017). 2017 California Annual Report. Retrieved April 17, 2019 from https://www.ots.ca.gov/wp-content/uploads/sites/67/2018/09/CA_OTS_2017_Annual_Report.pdf

Centers for Disease Control and Prevention. (2014). Sobering Facts: Drunk Driving in California. Retrieved March 8, 2019 from https://www.cdc.gov/motorvehiclesafety/pdf/impaired_driving/Drunk_Driving_in_CA.pdf

MacLeod, K. E., Karriker-Jaffe, K. J., Ragland, D. R., Satariano, W. A., Kelley-Baker, T., & Lacey, J. H. (2015). Acceptance of drinking and driving and alcohol-involved driving crashes in California. Accident Analysis & Prevention, 81, 134-142.

National Institutes of Health. (2010). Alcohol-related Traffic Deaths. Retreived March 8, 2019 from https://report.nih.gov/nihfactsheets/ViewFactSheet.aspx?csid=24&key=A

State of California Department of Motor Vehicles. (2019). California Driver Handbook - Alcohol and Drugs. Retrieved March 29, 2019 from https://www.dmv.ca.gov/portal/dmv/detail/pubs/hdbk/actions_drink


Alcohol Outlets

California Department of Public Health, Office of Health Equity. (2017). Proximity to Alcohol Outlets. Retrieved February 29, 2019 from https://www.cdph.ca.gov/Programs/OHE/CDPH%20Document%20Library/HCI/ADA%20Compliant%20Documents/HCI_Alcohol_Outlets_774_Narrative_and_examples-7-15-14-ADA.pdf

Chinman, M., Burkhart, Q., Ebener, P., Fan, C. C., Imm, P., Osilla, K. C., ... & Wright, A. (2011). The premises is the premise: understanding off-and on-premises alcohol sales outlets to improve environmental alcohol prevention strategies. Prevention Science, 12(2), 181-191.

Gruenewald, P. J. (2011). Regulating availability: how access to alcohol affects drinking and problems in youth and adults. Alcohol Research & Health, 34(2), 248.

Kuntsche, E., Kuendig, H., & Gmel, G. (2008). Alcohol outlet density, perceived availability and adolescent alcohol use: a multilevel structural equation model. Journal of Epidemiology & Community Health, 62(9), 811-816.

Morrison, C., Smith, K., Gruenewald, P. J., Ponicki, W. R., Lee, J. P., & Cameron, P. (2016). Relating off‐premises alcohol outlet density to intentional and unintentional injuries. Addiction, 111(1), 56-64.

Ransome, Y., Luan, H., Shi, X., Duncan, D. T., & Subramanian, S. V. (2018). Alcohol outlet density and area-level heavy drinking are independent risk factors for higher alcohol-related complaints. Journal of Urban Health, 1-13.

Stockwell, T., Somerford, P., & Lang, E. (1992). The relationship between license type and alcohol-related problems attributed to licensed premises in Perth, Western Australia. Journal of Studies on Alcohol, 53(5), 495-498.

Young, R., Macdonald, L., & Ellaway, A. (2013). Associations between proximity and density of local alcohol outlets and alcohol use among Scottish adolescents. Health & Place, 19, 124-130.


Policies & Initiatives

American Lung Association. (2019). State of Tobacco Control 2019 - California. Retrieved March 29, 2019 from https://www.lung.org/local-content/california/our-initiatives/state-of-tobacco-control/2019/state-of-tobacco-control-2019.html

California Friday Night Live Partnership. (2018). About Us Overview. Retrieved March 29, 2019 from https://fridaynightlive.tcoe.org/about-us/cfnlp-overview

California Tobacco Control Program. (2013). Healthy Stores for a Healthy Community: Marketing Surveillance Manual. Retrieved April 2, 2019 from https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/CTCB/CDPH%20Document%20Library/ResearchandEvaluation/SurveyInstrumentsTrainingManualsAndProtocols/2013HSHCMarketingSurveillanceTrainingManualCTCP.pdf

Healthy Stores for a Healthy Community. (2019). Facing the Facts - Main Page. Retrieved March 29, 2019 from https://healthystoreshealthycommunity.com/

Healthy Stores for a Healthy Community. (2019). Napa County. Retrieved March 29, 2019 from https://healthystoreshealthycommunity.com/counties/napa/#whats-changed

Napa County Office of Education. (2018). Catalyst Coalition – Up-Valley Partnership for Youth. Retrieved March 29, 2019 from https://www.napacoe.org/prevention-health-and-wellness/catalyst-coalition-up-valley-partnership-for-youth/