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do not have a hard time getting it, and they often get it from adults. More than 90 percent of twelfth graders report that alcohol is “very easy” or “fairly easy” to get. And when underage youths drink, they drink more heavily and recklessly than adults. They report that they “usually” drink an average of four and a half drinks, an amount very close to the threshold of five drinks typically used to define heavy drinking (also referred to as binge drinking). In contrast, adult drinkers report usually drinking fewer than three drinks.

In response to a congressional request in the HHS fiscal 2002 appropriations act, the Board on Children, Youth, and Families of the National Research Council and the Institute of Medicine formed the Committee on Developing a Strategy to Reduce and Prevent Underage Drinking. The committee was directed to review a broad range of federal, state, and nongovernmental programs, from environmental interventions to programs focusing directly on youth attitudes and behaviors, and to develop a cost-effective strategy to reduce and prevent underage drinking. In conducting this review, the committee relied on the available scientific literature, including a series of papers written for the committee, public input, and its expertise.

The committee conducted its work within the framework of the current national policy establishing 21 as the minimum legal drinking age in every state. We concentrated more on population-based primary prevention approaches rather than on individually oriented approaches.

STRATEGY OVERVIEW

The committee reached the fundamental conclusion that underage drinking cannot be successfully addressed by focusing on youth alone. Youth drink within the context of a society in which alcohol use is normative behavior and images about alcohol are pervasive. They usually obtain alcohol—either directly or indirectly—from adults. Efforts to reduce underage drinking, therefore, need to focus on adults and must engage the society at large.

The preeminent goal of the recommended strategy is to create and sustain a broad societal commitment to reduce underage drinking. Such a commitment will require participation by multiple individuals and organizations at the national, state, local, and community levels who are in a position to affect youth decisions—including parents and other adults, alcohol producers, wholesalers and retail outlets, restaurants and bars, entertainment media, schools, colleges and universities, the military, landlords, community organizations, and youths themselves. The nation must collectively pursue opportunities to reduce the availability of alcohol to underage



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