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Research Brief


Underage drinking is a significant problem in the United States. To address this problem, RAND researchers developed guides to provide key accountability questions, worksheets, tools, and examples to help communities plan, implement, and evaluate their efforts to reduce and prevent underage drinking. The framework upon which these guides are based emphasizes integrating community needs with evidence-based practices in a manner that respects cultural diversity and promotes sustainability.

Underage drinking is a significant problem in the United States.

  • Alcohol is the primary contributor to the leading causes of adolescent deaths.
  • Between 12 percent and 20 percent of all the alcohol consumed in the United States is drunk by people who are legally too young to drink alcohol at all.
  • For many individuals, the heaviest drinking period in their lives is before they reach the age of 21.
  • More than 95 percent of U.S. adults who are alcohol dependent started drinking before they were 21.
  • For some, early use of alcohol, tobacco, and illicit drugs may actually change brain development in long-lasting and detrimental ways.

Despite these facts, most communities have cultural norms, policies, and conditions that accept or promote underage drinking.

To address this important problem, a team led by RAND researchers developed a guide to help communities plan, implement, and evaluate efforts to reduce and prevent underage drinking (Preventing Underage Drinking: Using Getting To Outcomes with the SAMHSA Strategic Prevention Framework to Achieve Results). The overarching framework for the guide is the Strategic Prevention Framework (SPF) developed by the Substance Abuse and Mental Health Services Administration. The SPF is a five-step approach broadly applicable to prevention efforts, including substance abuse, HIV/AIDS, and violence. The SPF strongly emphasizes integrating community needs with evidence-based practices in a manner that respects cultural diversity and promotes sustainability.

In this guide, the operating system for how to "work" the SPF is the "Getting To Outcomes™" (GTO™) model. The original GTO manual, which also has a Spanish version, was written to help local groups develop or improve substance use-prevention programs. The GTO approach includes a participatory process that builds practitioners' prevention capacity, empowering them to address all aspects of planning, implementation, and evaluation. The recent guide, Preventing Underage Drinking, tailors the GTO model specifically for evidence-based environmental strategies shown to be effective in tackling the problem of underage drinking. The strategies target four key areas that influence alcohol problems: access and availability, policy and enforcement, community norms, and media messages.

To help bridge the gap between research and practice, Preventing Underage Drinking provides 11 accountability questions to guide communities when they are using the SPF to address underage drinking:

  1. How can we organize the community to profile community needs and resources regarding underage drinking?
  2. What are the underlying needs and conditions that must be addressed in the community to reduce underage drinking?
  3. What are the community's goals, target populations, and desired outcomes?
  4. What capacities need to be strengthened to develop and implement a plan to reduce underage drinking?
  5. What evidence-based environmental strategies will be useful in helping to achieve the goals?
  6. How will the environmental strategies to reduce underage drinking "fit" within the community context?
  7. What is the plan for reducing underage drinking?
  8. How will implementation of the plan be assessed?
  9. How well are the strategies in the comprehensive plan working?
  10. How will we ensure that the strategies to reduce underage drinking improve continuously over time?
  11. If the plan is successful, how will it be sustained?

The guide provides a general format for addressing these questions. Each chapter includes suggestions and ideas for answering the accountability question; a summary checklist for each question; and worksheets and tools for planning, implementing, and evaluating the ten evidence-based environmental strategies presented in the guide. Each chapter concludes with an example from a community that used the accountability question in its work.

The guide can be used by novice coalitions as well as by those with substantial resources and experience in using environmental strategies.

The trademarks "GTO" and "Getting to Outcomes" are owned by the University of South Carolina. These marks are used by RAND only with permission from the University of South Carolina.

This report is part of the RAND research brief series. RAND research briefs present policy-oriented summaries of individual published, peer-reviewed documents or of a body of published work.

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