ventions, most of the committee’s recommendations are based on qualitative judgments about likely cost-effectiveness.

In designing the strategy, the committee also had to consider the extent to which the problem of underage drinking can be separated from the larger context of drinking in the general population. As noted in Chapter 4, the level and patterns of adult drinking importantly affect the level of underage drinking in the society. For example, the level of adult drinking determines how many liquor stores and bars exist in a particular area, how much alcohol is in home drinking cabinets, and, therefore, how conveniently available alcohol is to underage drinkers. The level of adult drinking also has a big effect on the level of advertising for alcohol products and, therefore, on the prevalence of mass media messages that expose young people to images and ideas about the virtues of drinking and also on the credibility of parents and others seeking to discourage it. The fact that the level and patterns of adult drinking shape the level and character of underage drinking in the society creates two important issues and concerns in relation to our charge.

First, given the potential influence of the adult drinking patterns on underage drinking, it is possible that the adult patterns sharply limit how much underage drinking can be reduced without also doing something to affect the adult drinking. The issue is the degree to which the problem of underage drinking can be disentangled or disaggregated from the overall pattern of drinking in the society. One possibility is that the level of underage drinking is nearly always more or less proportional to all drinking in the society: if adult drinking changes, underage drinking changes; if adult drinking does not change, underage drinking does not change very much, even with specific policies that try to discourage underage drinking while leaving adult drinking untouched. The implication of this analysis is that the only effective way to reduce underage drinking is to reduce the level of adult drinking; it would accordingly raise complex questions about the strength of the public commitment to reduce underage drinking. Another possibility is that the two phenomena are at least partly separable, that can have policies that focus explicitly on underage drinking that can be strong enough to produce a separate effect on underage drinking even when the aggregate patterns of adult drinking do not change.

Ultimately, the separability of underage drinking from general drinking patterns is an empirical question. The only way to answer the question definitively is by trying policies that are specific to underage drinking and measure their effects for prevention and reduction. However, as indicated in Chapter 4, the available evidence shows that the level of underage drink-