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proach, indicated preventive measures, applies to “individuals who are found to manifest a risk factor, condition, or abnormality that identifies them, individually, as being at high-risk for the future development of a disease” (Institute of Medicine, 1994b, p. 21). For example, a young person who during an interview with a physician (or through some other screening method) indicates having used alcohol at a very young age (e.g., at 11 or 12) may not yet have a problem with alcohol (i.e., is not yet in need of treatment) but because of the risks associated with early onset of use would be a candidate for an intervention that deters further alcohol use. Thus, selective measures focus on a subgroup of the population that has an increased risk of mental health problems and indicated measures focus on individuals who clearly demonstrate a specific risk factor.

The approaches outlined in this chapter, consistent with the committee’s overall task of developing a strategy to reduce underage drinking across a wide range of youth populations, are by and large universal measures. We discuss the possible value of a youth-oriented media campaign aimed at changing youth drinking behaviors; school-based approaches; approaches at residential colleges and universities; and potential opportunities in other settings, including healthcare and faith-based institutions, the workplace, and the military. We do not discuss the literature regarding family-based interventions, although we recognize the importance of family involvement in the interventions mentioned above and in responses developed by communities to address community-specific problems.

We also do not discuss other selective and targeted interventions with specific subsets of youth who may be at increased risk of developing alcohol problems, with two exceptions: interventions on residential campuses and treatment for adolescents. The underage drinking problem on residential campuses has been well documented and a cause of public concern for years. Given the unique concentration of underage youth and the major problems of underage drinking, residential campuses are a necessary target for intervention. Our discussion of treatment recognizes that some youths have developed or will develop alcohol abuse and dependence problems. While we believe the emphasis should be on prevention, some attention must be paid to those youths.


A key element of the committee’s charge was to assess the potential effectiveness of a youth-focused media campaign built on the models of the youth components of the anti-drug campaign of the Office of National Drug Control Policy or of the American Legacy Foundation’s Truth™ Campaign. For that reason, we consider in some detail what such a youth-

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