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the whole distribution of exposure in a favorable direction,” typically by “altering some of society’s norms of behavior” (Rose, 1985, p. 371). Accordingly, we emphasize the population-oriented tools of primary prevention, rather than the individually oriented methods of secondary or tertiary prevention. Thus, identification and treatment of youths with drinking problems, or at high risk for developing such problems, and the challenge of instilling habits of responsible drinking as young people mature are addressed only incidentally in this report. These issues are important for improved policy and practice, but they are peripheral to our basic charge—delaying underage drinking and reducing its prevalence.

In developing a strategy to delay and reduce underage drinking, the committee has tried to understand the problem from two angles. First, we looked at the problem from the viewpoint of a young person deciding whether and under what circumstances to use alcohol. Our framework draws on the developing literature regarding adolescent decision making, especially in relation to health and risk behaviors. We pay particular attention to youthful decision-making abilities at various ages in the context of the changing social realities of teenage alcohol use. Some components of a comprehensive strategy must aim to help young people make the right decisions, depending on their age and developmental stage, taking account of the dangers of alcohol use at varying points in development.

It is not enough, however, to try to persuade young people to make the right choices. If the strategy relied exclusively on tools directed at changing the attitudes and behavior of underage youths, it would not have much chance of succeeding. To complement a youth-centered decision-making perspective, the committee also drew on the multidisciplinary perspective used by public policy analysts. This framework combines the disciplines of epidemiology, economics, health communications, law, and other social sciences to envision the array of policy instruments that can be brought to bear on the problem and to assess their probable effectiveness and costs, used alone or in combination.


Although the committee’s recommended strategy responds to a congressional request, the report is intended for a broad audience, including parents, businesses, alcohol companies, educators, state and local policy makers and legislators, healthcare producers and retailers, practitioners, and community organizers. Our work is presented in two parts.

Part I, Chapters 2 through 4, provides important contextual information about underage drinking and its consequences and determinants. Chapter 2 discusses key definitions and presents pertinent demographic and epidemiological data regarding the scope of underage drinking and the

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