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DUBUQUE, Iowa (AP) — Wherever Sue Greene looks, she sees alcohol ingrained into the fabric of Dubuque's culture and history.
At high school graduation parties, college gatherings, the county fair, sporting events and fundraisers.
"It's ever-present," Greene said.
Name the event or social function, and chances are Dubuquers are having a drink.
And it's not just one or two.
Nearly 31 percent of adults in Dubuque County reported binge or heavy drinking in the past 30 days, according to the 2015 County Health Rankings. That rate is the third-highest in the state, behind only neighboring Clayton and Jones counties. And only 10 counties in the entire country reported a higher rate, according to the data, which were compiled by the Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute.
Using that data, financial news and opinion company 24/7 Wall St. determined Dubuque had the highest rate of excessive drinking among metropolitan areas in the U.S.
The U.S. Centers for Disease Control and Prevention defines binge drinking as having at least four alcoholic drinks in one sitting for women and at least five drinks in one sitting for men. Heavy drinking is at least 15 drinks per week for men and at least eight drinks per week for women, per the CDC.
In Iowa, about 20 percent of the adult population reported excessive drinking, outpacing the national average of about 17 percent, according to state and federal health data.
Dubuque County youth also report rates of alcohol use that far exceed state and national averages. And police records document a high rate of alcohol-related deaths and arrests in Dubuque.
"The statistics don't lie," Greene, community prevention specialist with Helping Services of Northeast Iowa, told the Telegraph Herald (http://bit.ly/20totQ5).
The organization provides services in a nine-county area, including substance abuse prevention in Dubuque and Delaware counties.
"Dubuque County continues to be a high runner compared to other counties in Iowa (and outside of Iowa) for both underage and adult binge-drinking rates," Greene said.
Both the Iowa Department of Public Health and local health officials said the numbers reinforce long-held concerns about a pervasive drinking culture in a state that's among the top in the nation in excessive drinking, along with Illinois and Wisconsin.
In Dubuque, specifically, state and local health officials have noted alcohol has been a focal point of social life, where it is accepted and expected that drinking will take place.
It's a historically blue-collar brewing town of German and Irish heritage where attitudes and traditions center around drinking and where underage consumption in particular is seen as a rite of passage and heavy use as a source of pride, according to recent county health assessments and a 2014 survey of residents' attitudes about underage and binge drinking.
For at least the past two decades, health officials have identified heavy drinking as a top concern in Dubuque County.
A steering committee of county health and human services officials last year solicited questionnaires asking respondents to identify which health issues have the greatest impact on them individually and the community.
The report lists "reduction in alcohol abuse in particular and substance abuse in general" as the second of seven "significant health needs."
Art Roche, director of planning at Mercy Medical Center-Dubuque, told TH Media in November that Dubuquers' alcohol consumption is "a real problem" and that binge drinking "is a real culture in Dubuque."
From accidental injuries to liver and heart disease, cancer, stroke and unintended pregnancy, binge drinking has been linked to a host of serious health problems.
And it affects spatial awareness and memory in teenagers and can cause other changes in brain development that can have lifelong effects, according to the CDC. The agency estimates excessive alcohol consumption is responsible for an average of 88,000 deaths each year.
Dubuque has had a long history with alcohol, dating back to the beginnings of the city's brewing industry in the 1840s. The city boasted 17 breweries from circa 1860 to around the turn of the century -- with nearly another dozen commercial breweries in Jo Daviess County, Ill., and several in southwest Wisconsin -- making Dubuque and the tri-state area a brewing mecca that rivaled Milwaukee, according to local brewery historians and American Breweriana Association.
Dubuque Brewing & Malting Co., located in a castle-like structure at 30th and Jackson streets, was considered the largest and most modern brewery in the U.S. in the late 1890s. It turned out 300,000 barrels of beer per year and employed about 200 people.
Before Prohibition began in Iowa by state law in 1915, the state claimed 138 breweries. After Prohibition ended nationally in 1933 with the passage of the 21st Amendment, Dubuque's Star Brewery was the only small brewery left in Iowa.
During Prohibition, Dubuque was labeled as a "bootleggers' and moonshiners' paradise," according to a May 1925 Associated Press article published in the Telegraph Herald.
The Anti-Saloon League issued a report based on a survey of Prohibition in Iowa, directed primarily at the Mississippi River towns of Burlington, Clinton, Davenport, Dubuque and Muscatine.
Enforcement conditions in the three northern-most cities were described as "deplorable," the report said, noting that in Dubuque residents made no qualms about breaking the law and their proclivity for drinking, with the "open sale of intoxicating liquors at Dubuque over the bars of saloons masked as 'near-beer parlors.'"
According to the AP article, the report found Dubuque boasted 1,000 bootleggers and "countless moonshiners" among its 41,000 citizens
"So keen has the competition become among the hundreds of moonshiners living on the jungle-like isles of the Mississippi and the vastness of the heavily wooded bluffs that the largest manufacturer cut his whole-sale price in half a short time ago," according to the report. "The islands and bluffs are swarming with stills, some of which turn out large quantities of liquor each week. It is believed that more stills exist in a given area around Dubuque than in any other place in the United States, including the mountains of Kentucky."
Longtime Dubuque resident and former Dubuque police officer Jim Massey, who collects Dubuque and Potosi, Wis., beer and liquor memorabilia, said Dubuque historically long has been a drinking town.
Massey, who was interviewed by author Ken Wells for his 2007 book "Travels with Barley: A Journey Through Beer Culture in America," said Dubuque's tradition as a predominantly Catholic factory town of Irish and German immigrants historically allowed for more leisurely attitudes toward drinking.
"There were several taverns in every neighborhood," he said of the 1960s. "It was a blue-collar town, and when the factories let out, the taverns filled up. Some of these factory guys went out and drank half a case a night. They'd sit in a tavern four or five hours after work and probably drink four or five beers an hour.
"It was an industrial, river town ... where the Germans made it and the Irish drank it right along with them," Massey said. "There was a lot of drinking in Dubuque back then, just as there was in Davenport and other river towns."
In the early 1990s, Dubuque substance abuse and addiction counselors noted a disparity between a growing number of drunken-driving cases filed in Dubuque County and the relatively low number of people who sought alcohol and substance abuse treatment.
One in every 139 people in Dubuque sought county-funded alcohol and substance abuse treatment in 1989, far fewer than other area counties of similar size, according to a 1991 Telegraph Herald analysis.
At the same time, the number of drunken-driving cases in the county doubled from 506 in 1984 to 1,055 in 1990.
Dubuque-area counselors quoted in the article said the numbers were a reflection of a denial of the problem and a cultural acceptance of alcohol tied to its tradition of beer drinking and easy availability.
The article noted that in 1991 the Dubuque metropolitan area, which included East Dubuque, Ill., boasted one liquor license establishment for every 298 people, according to records from the Iowa Department of Commerce and local city clerks.
"It's normal at any social event. There is always alcohol available," said Ruth Turnis, then-director of Mercy Health Center's Turning Point treatment facility, at the time.
Today, while Dubuque County ranks 20th overall in the state in terms of per-capita alcohol consumption, access to booze in the city still abounds, according to the Iowa Alcoholic Beverages Division.
State records show Dubuque as a leader in the state in terms of the number of liquor-licensed establishments per capita, with more than 3.5 establishments for every 1,000 residents, surpassing both Iowa City and Ames. That equates to 1 license for every 279 people.
Fundraisers, too, rely on alcohol to drive attendance, and it is present at functions held by numerous civic organizations, including county fairs and community festivals.
Epworth, Iowa, native and Dubuque resident Mary Jo Kluesner, 61, first started drinking at age 14 or 15. By 16, she was going to the bars in western Dubuque County with older friends.
"It just didn't seem like there were a whole lot of other options for things to do than to score some beer and go get drunk or go get feeling good," she said.
And family functions -- whether a baptism, first communion, picnics, graduations or family reunions -- involved drinking, she said.
"There was always alcohol around," Kluesner said.
For kids who couldn't get alcohol from home, they always could find someone who was of legal drinking age willing to buy, she said.
"It was a 'kids will be kids' type of attitude,'" she said. "People looked the other way."
Decades later, she feels little has changed.
"At one time, Dubuque was the blue-collar, hard-working folks that would have a few drinks to relax," Kluesner said. "There's enough suit-and-tie jobs in the area, but that mentality still seems to stick. The culture is it's acceptable. It's just kind of what people do."
Sheila Harjehausen, 64, grew up in Elizabeth, Ill. She moved to Dubuque in 1970 and was surprised by how prominently and freely alcohol flowed.
"When my kids were in grade school, I talked to other parents who had kids who knew how to tap a keg," Harjehausen said. "My adult sons recently told me stories of going to the (Dubuque) Walmart parking lot and getting people to buy alcohol for them while they were in high school."
She said she is worried about Dubuque's tolerance of underage drinking but she feels Dubuque gets an unfair rap being labeled the "drunkest" city in the state, a designation bestowed on it based on self-reported rates of binge drinking.
It is a designation she feels is more apt for the state's more prominent college towns of Iowa City and Ames.
"I think people in Dubuque like to drink," Harjehausen said. "Binge drinking may be acceptable, but I feel people are much more responsible about their drinking today. I see Dubuque as a great place to raise a family. Dubuque should be known for hard workers who like to enjoy a beer once in a while."
Attitudes about underage and binge drinking seem to be changing in Dubuque.
While Dubuque County youth still binge drink at a high rate, the county has seen a gradual decline in underage drinking.
The percentage of 11th-graders who reported binge drinking in the past 30 days fell from about 40 percent in 2005 to more than 20 percent in 2014, according to results of the Iowa Youth Survey. That compares to about 14 percent statewide.
Nationally, about 5 percent of eighth-graders, 11 percent of high school sophomores and 17 percent of high school seniors binge drink, according to a 2014 survey released by the National Institute on Drug Abuse and University of Michigan. The survey used data from more than 41,000 students from 377 public and private schools throughout the U.S.
Overall, the percentage of sixth, eighth and 11th graders in Dubuque County who reported drinking -- not necessarily binge drinking -- in the past 30 days fell from 16 percent to about 14 percent from 2012 to 2014. Statewide, 10 percent of students reported drinking.
"We are seeing some signs of improvement." said Rhonda Ramler, health and wellness coordinator for Dubuque Community School District. "We are narrowing the gap."
Ramler said the district has stressed the consequences of underage drinking and alcohol's effects on adolescent brain development in middle and high school health curriculum, as well as how to spot the signs of binge drinking and alcohol poisoning.
Recent grant funding from the Iowa Department of Public Health also helped the Dubuque Police Department crack down on underage drinking.
City officers, in partnership with Helping Services for Northeast Iowa, have conducted special foot and vehicular patrols and enforcement focused on underage, alcohol-related social gatherings. The project was developed as part of the agencies' ongoing effort to address underage alcohol consumption and illegal activity often associated with springtime celebrations such as high school and college graduations.
The grant also focuses on prevention strategies relating to adult binge drinking, marijuana use and prescription drug abuse.
City and county public health, school and law enforcement officials said they continue to partner with Helping Services, Dubuque County Safe Youth Coalition and Substance Abuse Services Center and other agencies to reduce binge drinking and increase enforcement and awareness of the severity of alcohol use by adults and teens.
Alcohol-related crashes and injuries also have fallen in Dubuque County in recent years and are lower than the state average. Nineteen percent of driving deaths in the county were alcohol-related in 2014, according to county and Iowa health data.
"I think it's still embedded in the culture and activities of the community," said Mary Rose Corrigan, City of Dubuque public health specialist. "But I do think there's been a shift to more responsible consumption. ... In general, there's a much higher awareness of the need to be safe and responsible.
Greene, of Helping Services of Northeast Iowa, agreed.
While there still remains pressing safety and health concerns, awareness about the lifelong health and safety repercussions of underage and adult binge drinking has increased, she said.
"Through community events, presentations, stepped-up enforcement and media advocacy, Dubuque County residents have become aware of the underage and adult binge drinking problems facing this community," Greene said. "Underage drinking remains ever-present on our radar screen, but the needle is moving in the right direction, and we hope increased awareness of adult binge drinking will do the same over time."
Information from: Telegraph Herald, http://www.thonline.com
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