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 Underage Drinking
A Review of Trends and Prevention Strategies
Frances M. Harding,1 Ralph W. Hingson, ScD, MPH,2 Michael Klitzner, PhD,3 James F. Mosher, JD,4
Jorielle Brown, PhD,1 Robert M. Vincent, MSEd,1 Elizabeth Dahl, JD,3 Carol L. Cannon, MA3

Underage drinking and its associated problems have profound negative consequences for underage
drinkers themselves, their families, their communities, and society as a whole, and contribute to a
wide range of costly health and social problems. There is increased risk of negative consequences
with heavy episodic or binge drinking. Alcohol is a factor related to approximately 4,300 deaths
among underage youths in the U.S. every year. Since the mid-1980s, the nation has launched
aggressive underage drinking prevention efforts at the federal, state, and local levels, and national
epidemiologic data suggest that these efforts are having positive effects. For example, since 1982,
alcohol-related traffic deaths among youth aged 16–20 years have declined by 79%. Evidence-based
or promising strategies for reducing underage drinking include those that limit the physical, social,
and economic availability of alcohol to youth, make it illegal for drivers aged o21 years to drive after
drinking, and provide mechanisms for early identification of problem drinkers. Strategies may be
implemented through a comprehensive prevention approach including policies and their enforce-
ment, public awareness and education, action by community coalitions, and early brief alcohol
intervention and referral programs. This paper focuses on underage drinking laws and their
enforcement because these constitute perhaps the most fundamental component of efforts to limit
youth access to and use of alcohol.
(Am J Prev Med 2016;](]):]]]–]]]) Published by Elsevier Inc. on behalf of American Journal of Preventive
Medicine This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).

Introduction Underage Drinking in America: Progress

U
nderage drinking and its associated problems and Challenges
have profound negative consequences for
Alcohol continues to be the most widely used substance
underage drinkers themselves, their families,
of abuse among America’s youth and young adults, and a
their communities, and society as a whole. This paper
higher proportion use alcohol than tobacco or other
discusses the epidemiology of underage drinking in the
drugs. For example, according to the 2013 Monitoring
U.S., describes the federal effort to reduce underage
the Future (MTF) study, 25.7% of tenth-graders reported
drinking, and discusses evidence-based prevention prac-
using alcohol in the past 30 days, 18.0% reported
tices that have contributed to reductions in underage
marijuana use, and 9.1% reported cigarette use in the
drinking and its consequences. The paper focuses on
same period.1
underage drinking laws and their enforcement because
Underage drinking contributes to a wide range of
these constitute perhaps the most fundamental compo-
costly health and social problems, including motor
nent of efforts to limit youth access to and use of alcohol.
vehicle crashes (the greatest single mortality risk for
youth and young adults aged 12–20 years); suicide;
From the 1Center for Substance Abuse Prevention (CSAP), Substance interpersonal violence (e.g., homicides, assaults, rapes);
Abuse and Mental Health Services Administration (SAMHSA), Rockville,
Maryland; 2Division of Epidemiology and Prevention Research, National unintentional injuries such as burns, falls, and drowning;
Institute on Alcohol Abuse and Alcoholism (NIAAA), Bethesda, Maryland; brain impairment; risky sexual activity; academic prob-
3
The CDM Group, Inc., Bethesda, Maryland; and 4Alcohol Policy Con- lems; and alcohol and drug poisoning. On average,
sultations, Felton, California
Address correspondence to: Robert M. Vincent, MSEd, Center for alcohol is a factor in the deaths of approximately 4,300
Substance Abuse Prevention (CSAP), Substance Abuse and Mental Health youths in the U.S. per year, shortening their lives by an
Services Administration, 5600 Fishers Lane, Rockville MD 20857. E-mail: average of 60 years.2 Alcohol consumption involves
robert.vincent@samhsa.hhs.gov.
0749-3797/$36.00 youth in the criminal justice system, both through arrests
http://dx.doi.org/10.1016/j.amepre.2016.05.020 for violating laws against underage possession and

Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine This is an Am J Prev Med 2016;](]):]]]–]]] 1
open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
2 Harding et al / Am J Prev Med 2016;](]):]]]–]]]
through the illegal and harmful consequences of their
actions while intoxicated.3
Binge drinking is the most common underage con-
sumption pattern, and is defined by the Substance Abuse
and Mental Health Services Administration as consum-
ing five or more drinks on one occasion on at least 1 day
in the past 30 days. Binge rates increase rapidly with age.
As age increases, the proportion of youth who binge
drink goes from about one in three (of those who have
used alcohol in the last month) at age 13 years, to half at
age 15 years, to two of three by age Z18 years.4 In 2013,
approximately 5.4 million youth and young adults aged
12–20 years (14.2%) reported binge drinking in the past Figure 2. Rates of binge drinking in the past 2 weeks among
month.5 Although youth and young adults generally male and female twelfth-graders and college students,
1991–2013.1
consume alcohol less frequently than adults and consume
less alcohol overall than adults, when they do drink they Since 1991, rates of binge drinking have been steadily
are much more likely to binge drink.6 declining for male and female students in college and
The prevalence of alcohol abuse or dependence among 12th, tenth, and eighth grade (Figures 1 and 2).1,9,10
young people is quite high. According to National Survey Across all grade groups, male binge drinking rates have
on Drug Use and Health combined 2013–2014 data, been decreasing faster than female rates. This is most
about one in ten (10.4%) of those aged 18–20 years, 4.7% easily seen in the trend data (straight dashed lines) in
of those aged 15–17 years, and 0.7% of those aged 12–14 Figures 1 and 2. In 1975, when only a minority of states
years met criteria for alcohol dependence or abuse as had a legal drinking age of 21 years, there was a 23–
defined by the DSM-IV.6 percentage point spread between the rates; in 2013, it was
8.0 points.11
Significant Progress Has Been Made Risky behaviors associated with underage drinking
By 1988, the legal drinking age was raised to 21 years in and driving also declined in the past decade. O’Malley
all states in response to increases in alcohol-related traffic and Johnston11 report longitudinal data for high school
deaths that occurred among people aged o21 years after seniors (previous 2 weeks) on driving after drinking any
the lowering of drinking ages in some states prior to alcohol and after five or more drinks, and being a
1984.7,8 Declines in past-month underage drinking and passenger when the driver has had any alcohol and has
binge drinking began when states raised the drinking age had five or more drinks. As shown in Figure 3, all four of
to 21 years. Data for the last decade indicate there have these behaviors decreased between 2001 and 2013.11
been further meaningful reductions in underage drink- According to the U.S. Department of Transportation,
ing, particularly among younger age groups. From 2004 the greatest declines in alcohol-related traffic deaths since
to 2013, youth aged 12–20 years showed statistically the early 1980s have been among those aged 16–20 years,
significant declines in both past-month alcohol use and and declines in that age group have exceeded reductions
binge alcohol use.5

Figure 3. Trends in percentage of twelfth-graders reporting

Figure 1. Rates of binge drinking in the past 2 weeks among driving after alcohol use or riding after alcohol use by the
male and female eighth- and tenth-graders.1 driver.11

www.ajpmonline.org
 Harding et al / Am J Prev Med 2016;](]):]]]–]]] 3
12
in non–alcohol-related traffic deaths. Analyses by Though 18–20-year-olds in the military were less likely
the National Highway Traffic Safety Administration than their civilian counterparts to engage in binge
indicate that minimum drinking age laws have prevented drinking (21.5% vs 33.6%), they were twice as likely
more than 30,000 alcohol-related traffic deaths (5.9% vs 2.5%) to be heavy alcohol users (14 or more
since 1975.13,14 drinks per week for men and seven or more drinks per
week for women).26
Increased alcohol outlet density (i.e., more alcohol
Challenges Remain outlets in a designated area) often occurs near college
Despite these encouraging data, challenges in addressing campuses and military bases. This exposes vulnerable
underage drinking remain. Rates of underage drinking populations to increased alcohol availability and is linked
and associated consequences are unacceptably high. to excessive alcohol consumption and related harms.
Although risky behavior related to drinking and driving Research27–30 has shown an association between retail
has decreased among underage individuals, rates remain outlet density near college and university campuses and
at a dangerous level. In 2013, of the 1,691 drivers aged military bases, and heavy and frequent drinking among
15–20 years who were killed in motor vehicle traffic college students and military personnel, including those
crashes, 492 (29%) had a blood alcohol concentration who were underage. In addition, studies31,32 have iden-
(BAC) of Z0.01.15 Each 0.02 increase in BAC increases tified associations between outlet density in college
fatal crash risk for younger drinking drivers more than communities with campus rape offense rates and public
that for those aged Z21 years. Increased fatal crash risk disturbances related to alcohol.
begins at 0.02% BAC.16 Nearly half the people who die in
crashes involving a drinking driver aged o21 years are
persons other than the drinking driver.17 The National Response to Underage
Special attention is warranted for those aged 18–20
years, as this group exhibits higher rates of alcohol- Drinking
related risky behaviors and slower progress in reducing Federal efforts to respond to this public health crisis have
these behaviors than other age groups. As discussed been growing since 1984, when the National Minimum
previously, the rates of binge drinking and alcohol abuse Age Drinking Act was enacted.7,8,33 The efforts have
or dependence increase as underage drinkers get older. intensified since the early 2000s, as the federal govern-
Overall rates of college student drinking and binge ment initiated a multipronged national effort to prevent
drinking exceed those of same-age peers who do not underage drinking that involved federal, state, and local
attend college.18 Binge drinking rates among college governments as well as community coalitions and
students have shown only modest decline since 1993.18 organizations and concerned individuals.3
Underage college students drink about 48% of the alcohol With the release of the report Reducing Underage
consumed by students at 4-year colleges.19 Drinking: A Collective Responsibility34 in 2003, the
Consequences of underage drinking in college are National Research Council and Institute of Medicine
widespread and serious.20 One study21 estimated that called for a cooperative effort to curb underage drinking
in a single year, more than 696,000 college students aged that involved all levels of government, the alcohol
18–24 years were assaulted by another student who had industry and retailers, and community organizations
been drinking and another 599,000 were injured because and parents. The Surgeon General’s Call to Action to
of drinking. Further, 474,000 students had unprotected Prevent and Reduce Underage Drinking,17 released in
sex as a result of drinking and 97,000 were the victims of 2007, also called upon governments, the private sector,
alcohol-related sexual assaults.21 About 25% of college and individuals to coordinate efforts to reduce underage
students report negative academic consequences as a drinking. In 2004, Congress mandated the formation of
result of their drinking, including missing class, falling the Interagency Coordinating Committee for the Pre-
behind, doing poorly on exams or papers, and receiving vention of Underage Drinking (ICCPUD), composed of
lower grades overall.22 Taken together, these findings representatives from 15 federal agencies. The ICCPUD
suggest that college environments have a negative influence has played a leadership role on the issue of underage
on drinking practices and related consequences.23–25 drinking by initiating biennial town hall meetings to
A Department of Defense survey of military personnel prevent underage drinking in cooperation with
in 2011 found that although nearly half (48.2%) of those community-based organizations around the country.
aged 18–20 years abstained from alcohol consumption; Meetings support community and state efforts to pro-
more than one fourth (26.6%) were infrequent or light mote, implement, and sustain science-based prevention
drinkers; and 14.5% were moderate or heavy drinkers.26 approaches shown to reduce underage drinking. Between

] 2016
4 Harding et al / Am J Prev Med 2016;](]):]]]–]]]
2006 and 2014, more than 8,000 community town hall Conceptual Framework Issues
meetings were held.35 Over the past 30 years, scientists working on the prevention
In 2006, the Sober Truth on Preventing (STOP) Underage of adolescent alcohol use and related problems have
Drinking Act, Public Law 109-422, was enacted, which broadened their focus from proximal variables, largely at
directs that the ICCPUD “shall guide policy and program the level of schools, families, and individuals, to compre-
development across the Federal Government with respect to hensive programs addressing both proximal variables and
underage drinking” and provide resources to state and local more-distal variables, including state and community
governments as well as citizen groups. To this end, the STOP policies and their enforcement, norms, price and taxation,
Act, administered by the Substance Abuse and Mental and drinking environments. This broader focus has led
Health Services Administration’s Center for Substance Abuse researchers to describe the etiology of and effective
Prevention, provides funding for annual grants to commun- responses to adolescent drinking as systems composed of
ity coalitions that work to prevent and reduce underage individual characteristics and environments interacting
drinking. In 2012, a total of 81 new grants were funded for over time. These conceptualizations have led to a greater
the upcoming 4 years. States were encouraged to form recognition of the role of limiting the availability of alcohol
committees like ICCPUD and to develop strategic plans to and increasing the safety of drinking contexts—the “social
prevent and reduce underage drinking. Thirty-eight states ecology of drinking”—on the one hand and the importance
have formed such committees and developed strategic plans.3 of a continuing emphasis on individual, family, and
Through the town hall meetings and coordination among its community risk factors on the other.36–39 The latter
member agencies, the national ICCPUD aims to ensure that suggests an emphasis on education and skills training
the efforts of the state-level interagency committees and whereas the former leads to an emphasis on changes in
community coalitions receiving STOP Act grants are com- the policy and social environments of drinking that affect
plementary and synergistic. the availability of alcohol and limit the consequences of
The STOP Act also requires the ICCPUD to submit an drinking (e.g., violence, traffic crashes). Balancing these two
annual report to Congress on federal underage drinking approaches is one conceptual underpinning of the federal
prevention programs and policies along with data on the prevention approach. To date, the risk factors approach has
prevalence and patterns of underage drinking from had greater visibility, both nationally and internationally,
federal research surveys and other sources, and an annual than the social-ecologic approach, although it is clear from
report on state underage drinking prevention and the federally sponsored research discussed below that the
enforcement activities. These two reports are produced research foundation for the social-ecologic perspective is
jointly as the Report to Congress on the Prevention and also strong.40
Reduction of Underage Drinking. Data reported in this
article derive from the work of the ICCPUD agencies and
their state partners in coordinated prevention efforts, and Federally Sponsored Research
from data collection and analyses conducted by these Four distinct federally sponsored or funded sources have
agencies for the annual Report to Congress.3 synthesized the federally sponsored research on and devel-
oped recommendations regarding specific, evidence-based
prevention research strategies:

 Community Preventive Services Task Force (Guide to

A Comprehensive Approach to Underage Community Preventive Services: Preventing Excessive
Drinking Alcohol Consumption, www.thecommunityguide.org/
Identifying Effective Underage Drinking Prevention alcohol/index.html.)41
Policies  The Surgeon General (The Surgeon General’s Call to
The identification of effective prevention strategies is a Action to Prevent and Reduce Underage Drinking, 2007)17
key aspect of the national initiative to prevent underage  Institute of Medicine (Reducing Underage Drinking: A
drinking. For the past 3 decades, the federal government Collective Responsibility, 2004)34
(with the National Institute on Alcohol Abuse and  NIAAA (Planning Alcohol Interventions Using NIAAA’s
Alcoholism [NIAAA] as lead agency) has sponsored a CollegeAIM Alcohol Intervention Matrix, 2015)42
variety of research studies to evaluate a number of Policies reviewed and recommended in these reports
prevention strategies—as single interventions and in fall into four general categories and have varying levels of
combination. Results have produced an impressive research support. Evidence-based prevention strategies
knowledge base to guide prevention efforts at the federal, identified in at least two of the reports include the
state, and local levels. following.

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 Harding et al / Am J Prev Med 2016;](]):]]]–]]] 5
Retail Availability A just-published research study provides additional
support for many of these policies. Fell et al.71 examined
 Enforcement of underage furnishing laws using the ratio of drinking to non-drinking drivers in the U.S.
regular routine compliance checks (laws, regulations, in all states from 1982 to 2012 using the Fatality Analysis
or policies under which an underage operative work- Reporting System. Structural equation modeling com-
ing with law enforcement attempts to purchase pared drivers aged r20 years versus those aged Z26
alcohol to determine merchant compliance with years. Nine laws targeting underage drinkers significantly
underage furnishing laws)43 reduced alcohol-related traffic deaths: prohibiting pos-
 Dram shop liability (laws that impose civil liability session of alcohol (–7.7%), prohibiting purchase of
upon commercial alcohol providers for harms caused alcohol (–4.2%), zero tolerance laws that make it illegal
by their intoxicated or underage drinking patrons)44,45 to drive with measurable blood alcohol levels (–2.9%),
 Mandatory/discretionary server–seller training requirements for bartenders to be aged Z21 years
(laws establishing requirements or incentives for retail (–4.1%), responsible beverage service laws (–3.8%), dram
alcohol outlets to participate in server training pro- shop liability laws (–2.5%), and social host liability laws
grams, i.e., Responsible Beverage Service)46–48 (–1.7%). Collectively, these nine types of laws prevent
 False identification (laws that ban underage use or 1,135 alcohol-related traffic deaths per year and 210 more
supply of false ID to obtain alcohol, or that assist retailers lives would be saved annually if all states passed these
in avoiding sales to buyers who present false ID)49–51 laws.71
 Keg registration (laws requiring recording of pur- In light of the evident efficacy of these and other
chaser information when selling beer kegs to discour- policies, the STOP Act directed the ICCPUD to assess the
age beer service to underage individuals)52,53 extent to which policies are being implemented across
the country. Detailed descriptions and information on
Social Availability state adoption of these policies are in Chapter 4.3 of the
annual Report to Congress.3
 Hosting of underage drinking parties (laws that
impose criminal or other liability against individuals
who allow underage drinking events on property they
Comprehensive Prevention Programming:
own, lease, or otherwise control)34,54
 Social host liability (laws that impose civil liability on A Multilevel Approach
noncommercial alcohol providers for harms caused by Identifying specific, evidence-based, individual underage
their intoxicated or underage drinking guests)45,55 drinking prevention policies is only one aspect of the
federal government’s ambitious research agenda. There
Pricing now exists a body of evidence suggesting that effective
prevention initiatives require a coordinated effort among
 Increasing alcohol tax rates (laws specifying the three a wide array of federal, state, and local organizations and
major types of taxes levied on beer—“specific excise agencies in multiple sectors including policymakers, law
taxes” (taxes levied on the quantity of a beverage) and enforcement, educational institutions, the healthcare com
“ad valorem excise taxes” and “sales taxes” (taxes munity, the mass media, and concerned citizens.72–80
levied on the price of a beverage)56–64 This multilevel approach must also be multifaceted,
 Restrictions on drink specials (laws that restrict on- employing strategies such as education, enforcement,
premises retailers from using price- or volume-related media, and early intervention in combination to max-
marketing tactics such as happy hours, two-for-one imize impact on underage drinking.3,81–83 Over the past 2
specials, and free drinks)24,65,66 decades, initiatives based on a comprehensive approach
have been sponsored by federal agencies that are part of
Drinking and Driving the ICCPUD as well as by state and local governments
and community coalitions, and evidence supporting this
 Graduated drivers’ licenses (laws designed to delay approach has continued to accumulate. These compre-
full licensure for teenage automobile drivers through a hensive programs show that the existence of potentially
minimum supervised learners’ period or an inter- effective prevention policies and laws is insufficient;
mediate license period that limits driving in high-risk action is needed to ensure their enforcement and build
situations)67 community support and knowledge of the laws through
 Youth BAC limits (laws establishing blood alcohol media programs and other community organizing
concentration limits for underage drivers)8,68–70 activities.

] 2016
6 Harding et al / Am J Prev Med 2016;](]):]]]–]]]
Research has also shown that comprehensive preven- implemented to increase public awareness of the issue.
tion initiatives are greatly enhanced when combined with Among other results, these communities showed a 42%
early intervention and referral programs.79,84 Expanding decline in alcohol-related fatal crashes relative to the rest
evidence indicates that alcohol screening and brief of the state. Awareness of enforcement notably increased
counseling interventions are not only effective with among teenagers. For example, the percentage of this
adults but also with adolescents.85 In one national survey group that believed the license of a person caught
of 15-year-olds, more than 80% were seen by a doctor in drinking and driving could be suspended before a trial
the past year and more than half were asked about their increased from 61% to 76% in the test communities,
drinking. However, only 40% were advised by healthcare compared with no change in the rest of the state.
providers about risks linked to drinking, and fewer than The Community Trials Project also combined
one in five were advised to reduce or stop drinking.86 enhanced enforcement with local media coverage.88
Highly visible enhanced enforcement, such as roadside
checkpoints, also served to increase both actual enforce-
Enforcement of Underage Drinking Laws ment and perceived risk of arrest, resulting in lower
As noted, enforcement of underage drinking laws is a volumes of self-reported drinking and fewer night-time
critical component of any comprehensive prevention crashes.73,77
effort. Studies that have tested enforcement interventions A key determinant of enforcement effectiveness is the
in relation to outcomes (e.g., incidents of drinking and resources devoted to enforcement actions. A study90 that
driving and underage drinking parties) make clear that examined the relationship among underage alcohol laws
enforcement can result in greater compliance and better in 50 California cities, enforcement of these laws, and
public health outcomes.87 adolescent alcohol use, identified an inverse relationship
Enforcement agencies have a number of strategies at between the funding of enforcement of underage drink-
their disposal, including those targeted at individuals ing laws and frequency of past-year underage alcohol use.
(minors in possession arrests, operations to arrest adults Similarly, a study91 of binge drinking among college
who buy alcohol for minors, and underage drinking party students found a significant association between binge
patrol operations) and those targeted at retailers (com- drinking rates and state ratings for resources devoted to
pliance checks, fines, and other sanctions).34 Compliance enforcement.
checks are endorsed as a best practice for preventing Enforcement of underage drinking laws is often
underage drinking by the Community Preventive Serv- uneven, inconsistent, and sporadic, and outcomes gen-
ices Task Force and in the Surgeon General’s Call to erally diminish over time.33,87,92–97 Therefore, increased
Action and the IOM Report.17,34,41 One study (The attention to enforcement is one important component of
Community Trials Project) found that a compliance ensuring progress in addressing underage drinking and
check intervention resulted in an immediate 17% reduc- related problems in the future.
tion in underage sales. However, if enforcement efforts
are not maintained, results may decay. For example, in
the previous study, when compliance checks were not Conclusions
conducted on a routine basis, the reduction of underage Data presented in this paper demonstrate that mean-
sales decayed completely for off-sale premises, and by ingful progress has been made in reducing underage
half for on-sale premises over a 3-month period.88 drinking prevalence and related problems. Passage of the
Some studies have included media campaigns to National Minimum Age Drinking Act was critical to
increase public awareness of enforcement efforts, the initiating the process. As noted, other laws targeting
perception of risk of arrest, or the perception of risk of people aged o21 years further enhanced the benefits.
sanctions. These perceptions can play an important role The process of educating the public about those laws and
in compliance. When community-based interventions to their enforcement has reinforced and strengthened the
prevent underage drinking or other alcohol-related effects of these policies.
harms include a media campaign, this may increase Factors contributing to this progress are varied and
public perception of the likelihood that the law will be complex, but one clear factor has been increased atten-
enforced, and that violators will be sanctioned.73,77,88,89 tion to this issue at all levels of society. Federal initiatives,
The Saving Lives Program was a comprehensive, together with efforts by the national media, state and
multifaceted program undertaken in six Massachusetts local governments, and interested private organizations,
communities to reduce alcohol-impaired driving and have moved underage drinking to a prominent place on
related problems.89 In addition to enhanced enforcement the national public health agenda, created a policy
and educational programs, media campaigns were climate in which significant legislation has been passed

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 Harding et al / Am J Prev Med 2016;](]):]]]–]]] 7
by states and localities, raised awareness of the impor- Volume I: Secondary school students. Ann Arbor, MI: Institute for
tance of systematic and consistent enforcement, and Social Research, University of Michigan, 2014. www.monitoringth
efuture.org/pubs/monographs/mtf-vol1_2013.pdf.
engaged communities in addressing underage drinking. 2. Centers for Disease Control and Prevention (CDC). Alcohol and Public
These changes are mutually reinforcing and have pro- Health: Alcohol-Related Disease Impact (ARDI). Atlanta, GA: CDC;
vided a framework for a sustained national commitment 2014. http://nccd.cdc.gov/DPH_ARDI/default/default.aspx.
to reducing underage drinking. 3. U.S. DHHS, Substance Abuse and Mental Health Services Administration
(SAMHSA). Report to Congress on the Prevention and Reduction of
Nevertheless, underage drinking rates are still alarm- Underage Drinking. Rockville, MD: SAMHSA, 2015. www.stopalcohola
ingly high, particularly among youth aged 18–20 years, buse.gov/resources/reporttocongress/RTC2015.aspx.
causing preventable and tragic health and safety con- 4. U.S. DHHS, Substance Abuse and Mental Health Services Administration
sequences. Evidence indicates that wider dissemination (SAMHSA). Results From the 2013 National Survey on Drug Use and
Health: Summary of National Findings. Rockville, MD: SAMHSA, 2014.
and multifaceted implementation of the strategies dis- 5. U.S. DHHS, Substance Abuse and Mental Health Services Adminis-
cussed in this paper can result in further progress in tration (SAMHSA) Center for Behavioral Health and Statistics and
reducing underage drinking and its health and social Quality (CBHSQ). Results From the 2013 National Survey on Drug Use
consequences. and Health: Special Data Analysis. Rockville, MD: SAMHSA; 2014.
6. U.S. DHHS, Substance Abuse and Mental Health Services Adminis-
To enhance this progress, future research should tration (SAMHSA). Results From the 2014 National Survey on Drug
address such issues as the following: Use and Health: Detailed Tables. Rockville, MD: SAMHSA; 2015. www.
samhsa.gov/data/sites/default/files/NSDUH-DetTabs2014/NSDUH-
 What are the most effective combinations of policies DetTabs2014.htm.
7. Hingson R, White A. New research findings since the 2007 Surgeon
and other strategies in reducing underage drinking?
General’s Call to Action to Prevent and Reduce Underage Drinking: a
 What is the minimum level of enhanced enforcement review. J Stud Alcohol Drugs. 2014;75(1):158–169. http://dx.doi.org/
required to produce greater compliance with underage 10.15288/jsad.2014.75.158.
drinking laws? 8. Dejong W, Blanchette J. Case closed: research evidence on the positive
public health impact of the age 21 minimum legal drinking age in the
 How efficacious is focusing prevention strategies on
United States. J Stud Alcohol Drugs. 2014;75(suppl 17):108–115.
particular age groups among youth? 9. Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE. Teen
 Do programs targeting both underage drinking and Marijuana Use Tilts up, While Some Drugs Decline in Use. Ann Arbor,
risky adult drinking have greater effects on unde- MI: University of Michigan News Service, 2009. www.monitoringth
efuture.org/pressreleases/09drugpr_complete.pdf.
rage drinking than just efforts to reduce underage
10. Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE. Monitoring
drinking? the Future National Survey Results on Drug Use, 1975–2011: Volume I,
 By reducing underage drinking, will there be carryover Secondary School Students. Ann Arbor, MI: Institute for Social
benefits in adult life? Research, University of Michigan, 2012. http://monitoringthefuture.
org/pubs/monographs/mtf-vol1_2011.pdf.
 How can reductions in underage drinking be sus-
11. O’Malley PM, Johnston LD. Driving after drug or alcohol use by U.S.
tained and increased in the most cost-effective way? high school seniors, 2001–2011. Am J Public Health. 2013;103
(11):2027–2034. http://dx.doi.org/10.2105/AJPH.2013.301246.
12. National Highway Traffic Safety Administration. Traffic safety facts 2014: a
compilation of motor vehicle crash data from the Fatality Analysis
This work was funded by the Substance Abuse and Mental Reporting System and the General Estimates System. Washington, DC:
Health Services Administration under Contract number U.S. Department of Transportation, 2016 Report No.: HS 812 261.
HHSS28320070008I/HHSS28342001T. 13. National Highway Traffic Safety Administration. Young drivers: traffic
safety facts: 2013 data. Washington, DC: U.S. Department of Trans-
Data reported in this article reflect the work of the federal portation (DOT), 2015 Report No.: HS 812 200.
member agencies of the Interagency Coordinating Committee 14. National Highway Traffic Safety Administration. Lives saved in 2014
for the Prevention of Underage Drinking and their state by restraint use and minimum-drinking-age laws. Washington, DC:
partners in coordinated prevention efforts, as well as the data DOT, 2015 Report No.: HS 812 218.
15. National Center for Statistics and Analysis. Special tabulations—Fatality
collection and analysis conducted by these agencies detailed in Analysis Reporting System (FARS) 2014 Annual Report File (ARF).
the annual Report to Congress on the Prevention and Reduction Washington, DC: National Highway Traffic Safety Administration; 2015.
of Underage Drinking, a mandated report under the Sober 16. Voas RB, Torres P, Romano E, et al. Alcohol-related risk of driver
Truth on Preventing Underage Drinking Act. fatalities: an update using 2007 data. J Stud Alcohol Drugs. 2012;73
(3):341–350. http://dx.doi.org/10.15288/jsad.2012.73.341.
No financial disclosures were reported by the authors of 17. U.S. DHHS. The Surgeon General’s Call to Action to Prevent and
this paper. Reduce Underage Drinking. Rockville, MD: Office of the Surgeon
General; 2007. www.ncbi.nlm.nih.gov/books/NBK44360/.
18. Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE, Miech RA.
Monitoring the Future: National Survey Results on Drug Use, 1975–2012.
References Volume II: College students and Adults Ages 19–50. Ann Arbor, MI: Institute
1. Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE, Miech RA. for Social Research, University of Michigan; 2014. www.monitoringth
Monitoring the Future: National survey results on drug use, 1975–2013. efuture.org/pubs/monographs/mtf-vol2_2013.pdf.

] 2016
8 Harding et al / Am J Prev Med 2016;](]):]]]–]]]
19. Wechsler H, Lee J, Nelson T, Kuo M. Underage college students’ 36. Stockwell T, Gruenewald P. Controls on the physical availability of
drinking behavior, access to alcohol, and the influence of deterrence alcohol. In: Heather N, Stockwell T, eds. The Essential Handbook of
policies: findings from the Harvard School of Public Health College Treatment and Prevention of Alcohol Problems. West Sussex: John
Alcohol Study. J Am Coll Health. 2002;50(5):223–236. http://dx.doi. Wiley and Sons, 2004.
org/10.1080/07448480209595714. 37. Gruenewald P. The spatial ecology of alcohol problems: niche theory
20. White A, Hingson R. The burden of alcohol use: excessive alcohol and associative drinking. Addiction. 2007;102(6):870–878. http://dx.
consumption and related consequences among college students. doi.org/10.1111/j.1360-0443.2007.01856.x.
Alcohol Res. 2014;35(2):201–218. 38. Gruenewald P. Regulating availability: how access to alcohol affects
21. Hingson R, Zha W, Weitzman E. Magnitude of and trends in alcohol- drinking and problems in youth and young adults. Alcohol Res. 2016;34
related mortality and morbidity among U.S. college students age 18– (2):. http://pubs.niaaa.nih.gov/publications/arh342/248-256.htm.
24, 1998–2005. J Stud Alcohol Drugs. 2009;16:12–20. http://dx.doi.org/ 39. Ennett ST, Foshee VA, Bauman KE, et al. The social ecology of
10.15288/jsads.2009.s16.12. adolescent alcohol misuse. Child Dev. 2008;79(6):1777–1791. http://dx.
22. Hingson R, Heeren T, Winter M, Wechsler H. Magnitude of alcohol- doi.org/10.1111/j.1467-8624.2008.01225.x.
related mortality and morbidity among U.S. college students ages 18– 40. Catalano R, Fagan A, Gavin L, et al. Worldwide application of
24: changes from 1998 to 2001. Annu Rev Public Health. 2005;26:259– prevention science in adolescent health. Lancet. 2012;379:1653–1694.
279. http://dx.doi.org/10.1146/annurev.publhealth.26.021304.144652. http://dx.doi.org/10.1016/S0140-6736(12)60238-4.
23. Hingson R, Heeren T, Levenson S, Jamanka A, Voas R. Age of drinking 41. Community Guide Branch, Division of Public Health Information
onset, driving after drinking, and involvement in alcohol related Dissemination, Center for Surveillance, Epidemiology and Laboratory
motor-vehicle crashes. Accid Anal Prev. 2002;34(1):85–92. http://dx. Services, Office of Public Health Scientific Services, CDC. The Guide to
doi.org/10.1016/S0001-4575(01)00002-1. Community Preventive Services: Preventing Excessive Alcohol Con-
24. Kuo M, Wechsler H, Greenberg P, Lee H. The marketing of sumption. Atlanta, GA: CDC, 2015. www.thecommunityguide.org/
alcohol to college students: the role of low prices and special promotions. alcohol/index.html.
Am J Prev Med. 2003;25(3):1–8. http://dx.doi.org/10.1016/S0749-3797(03) 42. National Institute on Alcohol Abuse and Alcoholism (NIAAA). Planning
00200-9. alcohol interventions using NIAAA’s CollegeAim Alcohol Intervention
25. LaBrie JW, Grant S, Hummer JF. “This would be better drunk”: alcohol Matrix. Bethesda, MD: NIH, NIAAA. NIH Publication No. 15-AA-8017.
expectancies become more positive while drinking in the college social 43. Pacific Institute for Research and Evaluation (PIRE). Reducing Alcohol
environment. Addict Behav. 2011;36(8):890–893. http://dx.doi.org/ Sales to Underage Purchasers: A Practical Guide to Compliance
10.1016/j.addbeh.2011.03.015. Investigations. Washington, DC: U.S. Department of Justice, Office
26. Department of Defense (DOD). 2011 Health Related Behaviors Survey of Justice Programs, Office of Juvenile Justice and Delinquency
of Active Duty Military Personnel. Washington, DC: DOD, 2013. www. Prevention; 2007.
murray.senate.gov/public/_cache/files/889efd07-2475-40ee-b3 44. Holder H, Janes K, Mosher J, Saltz R, Spurr S, Wagenaar A. Alcoholic
b0-508947957a0f/final-2011-hrb-active-duty-survey-report.pdf. beverage server liability and the reduction of alcohol-involved problems. J
27. Chaloupka FJ, Wechsler H. Binge drinking in college: the impact of price, Stud Alcohol. 1993;54(1):23–36. http://dx.doi.org/10.15288/jsa.1993.54.23.
availability, and alcohol control policies. Contemp Econ Policy. 1996;14 45. Mosher J, Boertzel G, Clune K, et al. Liquor Liability Law. Newark, NJ:
(4):112–124. http://dx.doi.org/10.1111/j.1465-7287.1996.tb00638.x. Lexis Nexis, 2011.
28. Weitzman E, Folkman A, Folkman KL, Wechsler H. The relationship 46. Saltz RF. Enlisting bars and restaurants in the prevention of intox-
of alcohol outlet density to heavy and frequent drinking and drinking- ication and subsequent harms: why it matters. Am J Prev Med. 2011;41
related problems among college students at eight universities. Health (3):353–354. http://dx.doi.org/10.1016/j.amepre.2011.06.028.
Place. 2009:1–6. 47. Rammohan V, Hahn RA, Elder R, et al. Task force on community
29. Moore R, Ames G, Cunradi C. Physical and social availability of preventive services—effects of dram shop liability and enhanced overservice
alcohol for young enlisted Naval personnel in and around home port. law enforcement initiatives on excessive alcohol consumption and related
Subst Abuse Treat Prev Policy. 2007;2(17):http://dx.doi.org/10.1186/ harms: two community guide systematic reviews. Am J Prev Med. 2011;41
1747-597x-2-17. (3):334–343. http://dx.doi.org/10.1016/j.amepre.2011.06.027.
30. Ames G, Moore R, Cunradi C, Stern P. Military culture and drinking 48. Wagenaar AC, Tobler AL. Alcohol sales and service to underage youth
behavior among Navy careerists. J Stud Alcohol Drugs. 2007;68(3):336– and intoxicated patrons: effects of responsible beverage service training
344. http://dx.doi.org/10.15288/jsad.2007.68.336. and enforcement interventions. Washington, DC: Transportation
31. Scribner R, Mason K, Simonsen N, et al. An ecological analysis of Research Board of the National Academies, 2007: 141–163 Trans-
alcohol-outlet density and campus-reported violence at 32 U.S. portation Research Circular No.: E-C123.
colleges. J Stud Alcohol Drugs. 2010;71(12):184–191. http://dx.doi. 49. Martinez JA, Sher KJ. Methods of “fake ID” obtainment and use in
org/10.15288/jsad.2010.71.184. underage college students. Addict Behav. 2010;35(7):738–740. http:
32. Wechsler H, Lee JE, Hall A, Wagenaar A, Lee H. Secondhand effects of //dx.doi.org/10.1016/j.addbeh.2010.03.014.
student alcohol use reported by neighbors of colleges: the role of 50. Morleo M, Cook PA, Bellis MA, Smallthwaite L. Use of fake
alcohol outlets. Soc Sci Med. 2002;55(3):425–435. http://dx.doi.org/ identification to purchase alcohol amongst 15–16 year olds: a cross-
10.1016/S0277-9536(01)00259-3. sectional survey examining alcohol access, consumption and harm.
33. Wagenaar AC, Wolfson M. Deterring sales and provision of alcohol to Subst Abuse Treat Prev Policy. 2010;5(12):1–7. http://dx.doi.org/
minors: a study of enforcement in 295 counties in four states. Public 10.1186/1747-597x-5-12.
Health Rep. 1995;110(4):419–427. 51. Yoruk BK. Can technology help to reduce underage drinking?
34. National Research Council, IOM. Reducing Underage Drinking: A Collective Evidence from the false ID laws with scanner provision. J Health Econ.
Responsibility. Washington, DC: National Academies Press, 2004. 2014;36:33–46. http://dx.doi.org/10.1016/j.jhealeco.2014.03.004.
35. U.S. DHHS, Substance Abuse and Mental Health Services Admin- 52. Ringwalt CL, Paschall MJ. The utility of keg registration laws: a cross-
istration (SAMHSA). 2012 Town Hall Meetings to Prevent Underage sectional study. J Adolesc Heal. 2011;48(1):106–108. http://dx.doi.org/
Drinking: Moving Communities beyond Awareness to Action. Rockville, 10.1016/j.jadohealth.2010.05.012.
MD: SAMHSA, 2014. http://store.samhsa.gov/product/2012-Town- 53. Wagenaar AC, Harwood EM, Silianoff C, Toomey TL. Measuring public
Hall-Meetings-to-Prevent-Underage-Drinking-Moving-Communi policy: the case of beer keg registration laws. Eval Program Plann. 2005;28
ties-Beyond-Awareness-to-Action/SMA14-4838. (4):359–367. http://dx.doi.org/10.1016/j.evalprogplan.2005.07.001.

www.ajpmonline.org
 Harding et al / Am J Prev Med 2016;](]):]]]–]]] 9
54. Ross HL. Confronting Drunk Driving: Social Policy for Saving Lives. 73. Holder HD, Gruenewald PJ, Ponicki WR, et al. Effect of community-based
Binghamton, NY: Vail-Ballou Press, 1992. interventions on high-risk drinking and alcohol-related injuries. JAMA.
55. Stout E, Sloan A, Liang L, Davies H. Reducing harmful alcohol-related 2000;284(18):2341–2347. http://dx.doi.org/10.1001/jama.284.18.2341.
behaviors: effective regulatory methods. J Stud Alcohol Drugs. 2000;61 74. Holder HD. Prevention of alcohol and drug “abuse” problems at the
(3):402–412. http://dx.doi.org/10.15288/jsa.2000.61.402. community level: what the research tells us. Subst Use Misuse. 2002;37
56. Wagenaar A, Tobler A, Komro K. Effects of alcohol tax and price policies on (8-10):901–921. http://dx.doi.org/10.1081/JA-120004158.
morbidity and mortality: a systematic review. Am J Public Health. 2010;100 75. Klitzner M. A public health/dynamic systems approach to community-
(11):2270–2278. http://dx.doi.org/10.2105/AJPH.2009.186007. wide alcohol and other drug initiatives. In: Davis RC, Lurigio AJ,
57. Wagenaar AC, Salois MJ, Komro K. Effects of beverage alcohol price Rosenbaum DP, eds. Drugs and the community. Springfield, MA:
and tax levels on drinking: a meta-analysis of 1003 estimates from 112 Charles C. Thomas, 1993:201–224.
studies. Addiction. 2009;104(2):179–190. http://dx.doi.org/10.1111/ 76. Wandersman A, Florin P. Community interventions and effective
j.1360-0443.2008.02438.x. prevention. Am Psychol. 2003;58(6-7):441–448. http://dx.doi.org/
58. Xuan Z, Nelson TF, Heeren T, et al. Tax policy, adult binge drinking, and 10.1037/0003-066X.58.6-7.441.
youth alcohol consumption in the United States. Alcohol Clin 77. Grube J. Preventing sales of alcohol to minors: results from a
Exp Res. 2013;37(10):1713–1719. http://dx.doi.org/10.1111/acer.12152. community trial. Addiction. 1997;92(2):S251–S260. http://dx.doi.org/
59. Babor T, Caetano R, Casswell S, et al. Alcohol: No Ordinary Commodity: 10.1111/j.1360-0443.1997.tb02995.x.
Research and Public Policy. 2nd ed. New York: Oxford University Press, 78. Flewelling RL, Grube JW, Paschall MJ, et al. Reducing youth access to
http://dx.doi.org/10.1093/acprof:oso/9780199551149.001.0001. alcohol: findings from a community-based randomized trial. Am J
60. Chaloupka FJ. The effects of price on alcohol use, abuse, and their Community Psychol. 2013;51(1-2):264–277. http://dx.doi.org/10.1007/
consequences. In: Bonnie RJ, O’Connell ME, eds. Reducing Underage s10464-012-9529-3.
Drinking: A Collective Responsibility. Washington, DC: National 79. Komro K, Wagenaar A, Boyd M, et al. Prevention trial in the Cherokee
Research Council, Institute of Medicine, The National Academies Nation: design of a randomized community trial. Prev Sci. 2015;16
Press; 2004: 541–564. (2):291–300. http://dx.doi.org/10.1007/s11121-014-0478-y.
61. Daley JI, Stahre MA, Chaloupka FJ, Naimi TS. The impact of a 25-cent- 80. Edwards J, Stein-Seroussi A, Flewelling R, Orwin R, Zhang L.
per-drink alcohol tax increase. Am J Prev Med. 2012;42(4):382–389. Sustainability of state-level substance abuse prevention infrastructure
http://dx.doi.org/10.1016/j.amepre.2011.12.008. after completion of the SPIF SIG. J Prim Prev. 2015;36(3):177–186.
62. Elder RW, Lawrence B, Ferguson A, Naimi TS, Brewer RD, Chatto- http://dx.doi.org/10.1007/s10935-015-0382-7.
padhyay SK. Task force on community preventive services—the 81. Office of Juvenile Justice and Delinquency Prevention (OJJDP).
effectiveness of tax policy interventions for reducing excessive alcohol Regulatory Strategies for Reducing Youth Access to Alcohol: Best
consumption and related harms. Am J Prev Med. 2010;38(2):217–229. Practices. Calverton, MD: OJJDP, Center for Enforcing Underage
http://dx.doi.org/10.1016/j.amepre.2009.11.005. Drinking Laws, Department of Justice, 1999.
63. Klitzner M. Improving the Measurement of State Alcohol Taxes. 82. National Association of Governors Highway Safety Representatives
Bethesda, MD: NIAAA, Alcohol Policy Information System, 2012. (NAGHSR), National Association of State Alcohol and Drug Abuse
http://alcoholpolicy.niaaa.nih.gov/uploads/improving_the_measure Directors (NASADAD). Promising approaches in the prevention of
ment_of_state_alcohol_taxes.pdf. underage drinking: Case studies of state activities. Final report.
64. Maldonado-Molina MM, Wagenaar AC. Effects of alcohol taxes on Washington, DC: NAGHSR, NASADAD, U.S. Department of Trans-
alcohol-related mortality in Florida: time-series analyses from 1969 portation (DOT), National Highway Traffic Safety Administration
to 2004. Alcohol Clin Exp Res. 2010;34(11):1–7. http://dx.doi.org/ (NHTSA), 1995.
10.1111/j.1530-0277.2010.01280.x. 83. Holder H. Public policies and adolescent behavior and problems. Paper
65. Chaloupka F, Grossman M, Saffer H. The effects of price on alcohol presented at: Committee on the Science of Adolescence, Board on Children,
consumption and alcohol-related problems. Alcohol Res Health. Youth, and Families, National Research Council of the Institute of Medicine
2002;26(1):22–34. of the National Academies; January 15, 2010; Washington, DC.
66. National Highway Traffic Safety Administration (NHTSA). Research 84. Klitzner M, Fisher D, Stewart K, Gilbert S. Early Intervention for
report: preventing over-consumption of alcohol—sales to the intoxi- Adolescents. Princeton, NJ: The Robert Wood Johnson Foundation;
cated and “happy hour” (drink special) laws. Springfield, VA: National 1993.
Technical Information Service, 2005. Report No.: DOT HS 809 878. 85. Tanner-Smith EE, Lipsey MW. Brief alcohol interventions for adolescents
67. Baker SP, Chen LH, Li G. Graduated driver licensing programs and and young adults: a systematic review and meta-analysis. J Subst Abuse
fatal crashes of 16 year old drivers: a national evaluation. Washington, Treat. 2015;51:1–18. http://dx.doi.org/10.1016/j.jsat.2014.09.001.
DC: NHTSA, 2006. Report No.: DOT HS 810 614. 86. Hingson RW, Zha W, Iannotti RJ, Simons-Morton B. Physician
68. Carpenter C. How do zero tolerance drunk driving laws work? J Health advice to adolescents about drinking and other health behaviors.
Econ. 2004;23(1):61–83. http://dx.doi.org/10.1016/j.jhealeco.2003.08.005. Pediatrics. 2013;131(2):249–257. http://dx.doi.org/10.1542/
69. Fell JC, Fisher DA, Voas RB, Blackman K, Tippetts AS. The impact of peds.2012-1496.
underage drinking laws on alcohol-related fatal crashes of young 87. Preusser DF, Ulmer RB, Preusser CW. Obstacles to enforcement of
drivers. Alcohol Clin Exp Res. 2009;33(7):1208–1219. http://dx.doi.org/ youthful (under 21) impaired driving. Washington, DC: National
10.1111/j.1530-0277.2009.00945.x. Highway Traffic Safety Administration, 1992. Report No. DOT HS 807
70. Fell JC, Fisher DA, Voas RB, Blackman K, Tippetts AS. The relation- 878.
ship of underage drinking laws to reductions in drinking drivers in fatal 88. Wagenaar AC, Toomey TL, Erickson DJ. Preventing youth access to
crashes in the United States. Accid Anal Prev. 2008;40(4):1430–1440. alcohol: Outcomes from a multi-community time-series trial. Addiction.
http://dx.doi.org/10.1016/j.aap.2008.03.006. 2005;100(3):335–345. http://dx.doi.org/10.1111/j.1360-0443.2005.00973.x.
71. Fell JC, Scherer M, Thomas S, Voas RB. Assessing the impact of twenty 89. Hingson R, McGovern T, Howland J, Heeren T, Winter M, Zakocs R.
underage drinking laws. J Stud Alcohol Drugs. 2016;77(2):249–260. Reducing alcohol-impaired driving in Massachusetts: the Saving Lives
http://dx.doi.org/10.15288/jsad.2016.77.249. Program. Am J Public Health. 1996;86(6):791–797. http://dx.doi.org/
72. Holder H. Alcohol and the Community: A Systems Approach to 10.2105/AJPH.86.6.791.
Prevention Cambridge, UK: Cambridge University Press; http://dx. 90. Paschall MJ, Grube JW, Thomas S, Treffers R, Cannon CL. Relation-
doi.org/10.1017/CBO9780511526787. ships between local enforcement, alcohol availability, drinking norms,

] 2016
10 Harding et al / Am J Prev Med 2016;](]):]]]–]]]
and adolescent alcohol use in 50 California cities. J Stud Alcohol Drugs. with compliance checks and Cops in Shops programs. Addic-
2012;73(4):657–665. http://dx.doi.org/10.15288/jsad.2012.73.657. tion. 2006;101(2):223–231. http://dx.doi.org/10.1111/j.1360-0443.20
91. Nelson TF, Naimi TS, Brewer RD, Wechsler H. The state sets the rate: the 06.01328.x.
relationship among state-specific college binge drinking, state binge drinking 95. Mosher JF, Toomey TL, Good C, Harwood E, Wagenaar AC. State laws
rates, and selected state alcohol control policies. Am J Public Health. 2005;95 mandating or promoting training programs for alcohol servers and
(3):441–446. http://dx.doi.org/10.2105/AJPH.2004.043810. establishment managers: an assessment of statutory and administrative
92. Ferguson SA, Fields M, Voas RB. Enforcement of zero tolerance laws in procedures. J Public Health Policy. 2002;23(1):90–113. http://dx.doi.
the United States. Proceedings of the 15th International Conference on org/10.2307/3343120.
Alcohol, Drugs, and Traffic Safety; 2000. Borlänge, Sweden: Swedish 96. Wolfson M, Wagenaar AC, Hornseth GW. Law officers’ views on
National Road Administration. enforcement of the minimum drinking age: a four-state study. Public
93. Forster JL, McGovern PG, Wagenaar AC, Wolfson M, Perry CL, Health Rep. 1995;110(4):428–438.
Anstine PS. The ability of young people to purchase alcohol without 97. Voas RB, Lange JE, Tippetts AS. Enforcement of the zero tolerance law
age identification in northeastern Minnesota, USA. Addiction. 1994;89 in California: a missed opportunity? Proceedings of the 42nd Annual
(6):699–705. http://dx.doi.org/10.1111/j.1360-0443.1994.tb00956.x. Conference of the Association for the Advancement of Automotive
94. Montgomery JM, Foley KL, Wolfson M. Enforcing the minimum Medicine; 1998 Oct 5–6; Charlottesville, VA. Washington, DC:
drinking age: state, local and agency characteristics associated National Academy of Sciences; 369–383.

www.ajpmonline.org

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