paigns are part of a broad effort to affect the culture. It is instructive that both of these exemplars reflect interactions between private and public entities. They are better described as social movements, in which the government’s role is to respond to, support, and stimulate private action.

In this approach, a government-sponsored communication campaign has as its goal the support of changes in social norms that relate to adult behavior insofar as it enables and facilitates underage drinking. Such efforts are not to be evaluated by their short-term effects on youth drinking, but by their effects on broad social norms about that drinking, by the willingness of adults to take actions to reduce it, and by changes in public policies known to affect underage drinking rates.

An adult-focused mass communication campaign is also meant to support local efforts to reduce drinking. It is important not only because of what it does on its own, but also because its effects provide leverage for local efforts—and vice versa. It would link its activities to the broadest group of adult stakeholders—industry, colleges and universities, the military, and community organizations. Wherever possible, a national campaign would coordinate activities with local needs and provide for the tailoring of its messages for different communities. It cannot be tested as a prototype on a very local scale because its effectiveness depends on the involvement of a wide range of constituencies and, ideally, the engagement of the entire nation’s attention.

In the end, the committee is faced with a conundrum in formulating its recommendation for developing and implementing an adult-focused media campaign. On one side, we find the idea to be highly promising, but lacking the kind of direct evidence needed for unequivocal endorsement of the high costs of such a campaign. On the other side, testing the campaign in a very limited way in order to gather more evidence is not a viable option because a small-scale effort (relying, for example, only on paid media messages delivered in one locality alone without any reinforcement by national or even regional media and other institutional partners) would almost certainly produce unimpressive results (see Institute of Medicine, 2002). In short, implementing an adult-oriented campaign in the absence of an opportunity to build the social movement around the idea would not be a fair test of the approach. Is there a middle course? We suggest a substantial effort to develop the program, with the aim of erecting circumscribed conditions of demonstrated efficacy that would have to be satisfied before the decision is made to implement a national campaign.

The proposed campaign would be developed over time on the basis of an intensive agenda of formative research designed to define the promising