cents who associate with alcohol-using peers encourage continual use and can be resistant to change. In addition, adolescents tend to overestimate their peer’s drinking, which leads to heavier drinking to conform to the perceived norm.

Public policy in the form of drinking-age laws and their enforcement also influences alcohol use. Lowering the drinking age is associated with increases in teen drunk driving and teen traffic fatalities, while raising it is associated with less teen drunk driving (Wagenaar and Toomey, 2002; National Research Council and Institute of Medicine, 2004b). A higher drinking age (and its enforcement) may decrease underage drinking because it limits access to alcohol, but also by communicating social norms against drinking generally and underage drinking specifically (Hawkins, Catalano, and Miller, 1992). In addition, alcohol consumption decreases with price increases from taxation, particularly among young people with less disposable income (Coate and Grossman, 1988; National Research Council and Institute of Medicine, 2004b).

The risk factors for underage drinking suggest that prevention efforts can be formulated to influence the availability of alcohol, norms about alcohol, and alcohol use expectancies. Limiting media exposure of even young children may decrease normative perceptions of drinking and decrease the development of positive alcohol expectancies (National Research Council and Institute of Medicine, 2004b). Within the family, interventions may be designed particularly around limiting exposure to models of excessive drinking in the home, at family events, and through media sources. Family-based efforts may also target adolescents by monitoring exposure to alcohol-using peers and involvement in alcohol-related activities.

Targeting Risk and Protective Factors for Multiple Disorders

Some risk and protective factors are associated with a broad spectrum of MEB disorders and related problem behaviors for young people, either directly or indirectly through their influence on other risk or protective factors. As a result, preventive strategies may be aimed at these especially important risk and protective factors rather than at specific disorders. Biglan, Brennan, and colleagues (2004) spell out the implications of common and linked risk factors for prevention. First, with common risk factors for multiple problems, intervening in any single risk factor should contribute to preventing multiple outcomes, including externalizing problems, sexual activity, substance use, and academic failure. Second, with multiple risk factors across the developmental course, there should be multiple plausible routes to prevention. Third, with developmentally early risk factors influencing later ones, preventive interventions should be timed to protect



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