Although there is a substantial logic favoring a youth campaign approach, there are also some contrary arguments. First, the hypothesis that increasing the proportion of youths who perceive great risk in heavy drinking will reduce heavy drinking among youths by an equivalent amount may be unfounded. The hypothesis rests on the assumption that the oft-demonstrated relationship between risk perception for heavy drinking and actual heavy drinking is a causal one. However, since most of the available data are cross-sectional, one cannot be confident of that causal relationship. Not being a drinker and not perceiving increased risk are correlates, but neither may “cause” the other; to some extent, at least, they are both manifestations of an underlying set of causal influences that tend to produce both decisions about drinking and positive or negative attitudes toward alcohol use. Thus, to the extent that a youth-focused campaign would aim mainly to increase perception of drinking-related risks, it might not rest on a strong foundation.

A second, and related, concern is that the recent survey data may not be as persuasive as they seem in supporting a risk-oriented campaign. Although the recent decline in drinking is worth attention, the decline may be merely an anomaly (see Chapter 5). And even if the decline is real, it may not reflect the influence of changes in perceived harmfulness. Indeed, the data about harmfulness of heavy drinking do not show a consistent parallel improvement (Johnston et al., 2003). Thus, any decline in behavior may reflect the influence of changes in the environment around drinking, rather than a change in underlying beliefs about drinking.

Strikingly, the long-term stability in heavy drinking rates contrasts with the sharp reduction in one form of harm associated with such behavior—fatal alcohol-related crashes among teenage drivers. The Centers for Disease Control and Prevention reports that such crashes have declined by nearly 60 percent for 16- to 17- year-olds and 55 percent for 18- to 20-year-olds between 1982 and 2001. However, the decline ended in 1997. Since that time the levels are stable or perhaps rising slightly (Elder and Shults, 2002). These data suggest that preventing alcohol-related harms may have more potential to be effective than those aiming to discourage drinking (or even heavy drinking) per se. This finding parallels the evidence for adult drinking and adult drinking and driving.

The lack of any longer-term downward trend in drinking or heavy drinking, despite the presence of a wide variety of public efforts to address these issues, is then one concern about initiating a major campaign against youth alcohol use, though not by itself sufficient to reject such an effort. If there have been negative alcohol messages directed toward youth, they likely pale before the pro-alcohol onslaught that surrounds youth (see Chap-