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1. Introduction: The Challenge
Pages 13-32

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From page 13...
... Indeed, so many underage drinkers die in car crashes that this problem, by itself, is a major national concern. In relation to the number of licensed drivers, young people under age 21 who have been drinking are involved in fatal crashes at twice the rate of adult drivers (National Highway Traffic Safety Administration, 2002a)
From page 14...
... A telling measure of the current societal response is the large gap in the federal government's investment in discouraging illicit drug use among teenagers and in discouraging underage drinking, given that the social damage from underage alcohol use far exceeds the harms caused by illicit drug use. In fiscal 2000, the nation spent approximately $1.8 billion on preventing illicit drug use (Office of National Drug Control Policy, 2003)
From page 15...
... Advocacy groups have also urged Congress to include underage alcohol use in the major media campaign being waged against illegal drug use under the auspices of the Office of National Drug Control Policy. THE COMMITTEE STUDY In 2001 Congress responded to the increasing level of public concern about underage alcohol consumption by appropriating funds for a study by The National Academies.
From page 16...
... Topics explored in these papers include the demographics of underage drinking; its economic and social costs; adolescent decision making and risk and protective factors; and the effectiveness of various prevention programs and approaches, including media campaigns, school-based education, pricing, and access. Draft papers were presented at public meetings in October and November 2002 (see Appendixes B and C)
From page 17...
... The judgments provided through this process regarding effectiveness of particular programs or interventions were primarily subjective or based on informal evaluations. Industry representatives provided extensive materials that were reviewed by the committee on the multiple activities they fund to reduce underage drinking.
From page 18...
... Based on its expertise, consideration of public input, and review of the available scientific literature, including the papers written for the committee, the committee identified eight categories of programs or interventions and presents the evidence for each in the relevant chapter: · media campaigns designed to discourage underage drinking directly, to affect the behavior of adults, and to build a broader public awareness of the nature and magnitude of the problem (Chapter 6 for adult-oriented campaigns and Chapter 10 for youth-oriented campaigns) ; · measures to curtail or counteract activities by individuals or businesses, including alcohol marketing practices, that tend to encourage or facilitate underage drinking (Chapters 7 and 8)
From page 19...
... These programs include educational interventions, media campaigns, and activities to support enforcement of minimum drinking age laws. Young people themselves have organized efforts to discourage drinking among their peers.
From page 20...
... Need for Consensus An effective strategy to reduce a behavior as pervasive and widely facilitated as underage drinking will depend on a public consensus about both goals and means, which will require an unequivocal commitment from a broad array of public and private institutions. If the nation is to succeed in promoting abstention or reduced consumption by minors in a country
From page 21...
... If parents, animated by a national media campaign, join local police and school boards in concerted efforts to discourage underage drinking and if alcohol distributors join with regulatory agencies to find means to deny underage drinkers easy access to alcohol, then the impact of government policies will be increased. In short, a public consensus to deal determinedly and effectively with underage drinking is needed not only to generate support for adopting strong policies, but also to make them effective.
From page 22...
... Unlike the goals for illegal drugs and tobacco, the nation does not aim to discourage or eliminate alcohol consumption by adults. It is probably a fair characterization to say that the implicit aims of the nation's current alcohol policy are to discourage excessive or irresponsible consumption that puts others at risk, while being tolerant of moderate consumption (at appropriate places and times)
From page 23...
... All states generate revenue from the sale of alcohol, either through excise taxes or product mark-ups, and 18 states participate in the alcohol market through retail and/or wholesale monopolies over distribution of certain alcoholic beverages. A strategy to suppress underage alcohol use must somehow be implemented in the very midst of a society replete with practices and messages promoting its use, and with a strong sector of deeply vested economic interests and the accompanying political and economic power.
From page 24...
... Alcohol experts generally assume that the level of adult demand for alcohol products will not be substantially affected, over the long term, by reducing underage consumption -- although getting young people to wait will obviously reduce the overall level of consumption. Thus, while the commercial interests of the alcohol industry are not perfectly aligned with the public health, they are not as antagonistic to the public health as the interests of the tobacco industry.
From page 25...
... Whatever the merits of this view, the committee believes that Congress intended us to work within the framework of current law, anchored in the National Minimum Drinking Age Act of 1984, and that reconsideration of the 21-yearold drinking age, and of the premises on which it is predicated, is beyond our mandate. Moreover, as a practical matter, the current policy framework, though disputed by some, rests on a strong scientific foundation, is widely accepted, and is certain to be preserved for the foreseeable future.
From page 26...
... . In 1984 Congress enacted the National Minimum Drinking Age Act, as recommended by the Presidential Commission on Drunk Driving, using the threat of withholding 10 percent of federal highway funds to induce states to set the minimum drinking age at 21 for all alcoholic beverages.
From page 27...
... The Instrumental Role of the Law Our earlier comparison among alcohol, tobacco, and illegal drugs raises another important preliminary question -- about the role of the law in the prevention of underage drinking. It is possible to imagine an official policy aiming to delay and discourage underage drinking that does not rely in any way on the coercive authority of the state to implement this policy: instead of banning underage access to alcohol by law, society might rely entirely on parenting, education, community expectations, and other mechanisms of social control to suppress youthful drinking and, for older teens, to transmit the desired drinking-related norms and to encourage adults to refrain from supplying youths with alcohol or otherwise facilitating their drinking.
From page 28...
... from harmful consequences, one might wonder whether it is possible to implement an underage alcohol policy by focusing exclusively on the dangerous behavior rather than the drinking itself. In theory, it might be possible to define the prohibited conduct exclusively in relation to the magnitude of the risk: for example, "don't drive a car after having had alcohol" or "don't give alcohol to a youth who intends to drive a car or is
From page 29...
... and where young people have large periods of time outside parental supervision and outside the reach of formal social controls. It is also relevant to note that at least one of the risks associated with underage drinking is intrinsic to the drinking itself -- the permanent damage of alcohol consumption on the adolescent brain (see Chapter 3)
From page 30...
... 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. OVERVIEW OF THE REPORT 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.
From page 31...
... Within that constraint, however, there is substantial room for preventing and reducing underage drinking in the United States, and this part of the report explores various tools that can be used in this effort. At the heart of the committee's proposed strategy is the effort to foster a collective societal acceptance of responsibility for reducing underage drinking.
From page 32...
... Chapter 11 reviews the potential advantages of mobilizing communities to implement locally specific efforts to reduce underage drinking. Chapter 12 identifies several ways in which the federal and state governments can help implement the proposed strategy, including through increases in excise taxes.


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