Schools are an important setting for interventions aimed at preventing alcohol use and abuse among adolescents. A range of school-based interventions have been developed to prevent or delay the onset of alcohol use, most of which are targeted to middle-school students. Most of these interventions seek to reduce risk factors for alcohol use at the individual level, whereas other interventions also address social and/or environmental risk factors. Not all interventions that have been developed and implemented have been found to be effective. In-depth analyses have indicated that to be most effective, interventions should be theory driven, address social norms around alcohol use, build personal and social skills helping students resist pressure to use alcohol, involve interactive teaching approaches, use peer leaders, integrate other segments of the population into the program, be delivered over several sessions and years, provide training and support to facilitators, and be culturally and developmentally appropriate. Additional research is needed to develop interventions for elementary-school and high-school students and for special populations.

Many efforts to prevent alcohol-related harm are aimed at reducing risk drinking. This article outlines the many conceptual and methodological challenges to defining risk drinking. It summarizes recent evidence regarding associations of various aspects of alcohol consumption with chronic and acute alcohol-related harms, including mortality, morbidity, injury, and alcohol use disorders, and summarizes the study designs most appropriate to defining risk thresholds for these types of harm. In addition, it presents an international overview of low-risk drinking guidelines from more than 20 countries, illustrating the wide range of interpretations of the scientific evidence related to risk drinking. This article also explores the impact of drink size on defining risk drinking and describes variation in what is considered to be a standard drink across populations. Actual and standard drink sizes differ in the United States, and this discrepancy affects definitions of risk drinking and prevention efforts.

Community-based efforts offer broad potential for achieving population-level reductions in alcohol misuse among youth and young adults. A common feature of successful community strategies is reliance on local coalitions to select and fully implement preventive interventions that have been shown to be effective in changing factors that influence risk of youth engaging in alcohol use, including both proximal influences and structural and/or environmental factors related to alcohol use. Inclusion of a universal, school-based prevention curriculum in the larger community-based effort is associated with the reduction of alcohol use by youth younger than 18 years of age and can help reach large numbers of youth with effective alcohol misuse prevention.

Alcohol use and related problems can be influenced by a wide variety of prevention interventions, including efforts that focus on changing the community alcohol environment-for example, by reducing underage access to alcohol, decreasing alcohol availability among adults, and increasing awareness of alcohol-related issues. Examples of environmental-based community interventions that focus on reducing alcohol use and related problems are Communities Mobilizing for Change on Alcohol, the Community Prevention Trial, the Sacramento Neighborhood Alcohol Prevention Project, Saving Lives, Operation Safe Crossing, and Fighting Back. Evaluations of these programs found that programs that change the community environment can reduce alcohol use and related problems among both youth and adults, even in communities with relatively low readiness to address alcohol issues. Research also has identified particular settings and situations where alcohol environmental changes are particularly needed as well as factors influencing the effectiveness of certain strategies. Despite the progress made, additional questions still need to be addressed in future research to maximize the benefits associated with environmental-based community interventions.

The imaging techniques magnetic resonance imaging (MRI), diffusion tensor imaging (DTI), and magnetic resonance spectroscopy (MRS) provide valuable tools for studying brain structure and neurochemistry in fetal alcohol spectrum disorders (FASD). Although the application of magnetic resonance-based methodologies to the study of FASD in animal models is in its infancy, it already has provided new clinically relevant insights and holds significant promise to further extend our understanding of alcohol's effects on the developing fetus.

Regulations on the availability of alcohol have been used to moderate alcohol problems in communities throughout the world for thousands of years. In the latter half of the 20th century, quantitative studies of the effects of these regulations on drinking and related problems began in earnest as public health practitioners began to recognize the full extent of the harmful consequences related to drinking. This article briefly outlines the history of this work over four areas, focusing on the minimum legal drinking age, the privatization of alcohol control systems, outlet densities, and hours and days of sale. Some historical background is provided to emphasize the theoretical and empirical roots of this work and to highlight the substantial progress that has been made in each area. In general, this assessment suggests that higher minimum legal drinking ages, greater monopoly controls over alcohol sales, lower outlet numbers and reduced outlet densities, and limited hours and days of sale can effectively reduce alcohol sales, use, and problems. There are, however, substantial gaps in the research literature and a near absence of the quantitative theoretical work needed to direct alcohol-control efforts. Local community responses to alcohol policies are complex and heterogeneous, sometimes reinforcing and sometimes mitigating the effects of availability regulations. Quantitative models of policy effects are essential to accelerate progress toward the formulation and testing of optimal control strategies for the reduction of alcohol problems.

Because of concerns regarding drinking among college students and its harmful consequences, numerous prevention efforts have been targeted to this population. These include individual-level and community-level interventions, as well as other measures (e.g., online approaches). Community-level interventions whose effects have been evaluated in college populations include programs that were developed for the community at large as well as programs aimed specifically at college students, such as A Matter of Degree, the Southwest DUI Enforcement Project, Neighborhoods Engaging With Students, the Study to Prevent Alcohol-Related Consequences, and Safer California Universities. Evaluations of these programs have found evidence of their effectiveness in reducing college drinking and related consequences. The most effective approaches to reducing alcohol consumption among college students likely will blend individual-, group-, campus-, and community-level prevention components.

Children exposed to alcohol prenatally can experience significant deficits in cognitive and psychosocial functioning as well as alterations in brain structure and function related to alcohol's teratogenic effects. These impairments are present both in children with fetal alcohol syndrome (FAS) and in children with heavy in utero alcohol exposure who do not have facial dysmorphology required for the FAS diagnosis. Neuropsychological and behavioral studies have revealed deficits in most cognitive domains measured, including overall intellectual functioning, attention/working memory, executive skills, speed of processing, and academic skills in children and adolescents across the range of fetal alcohol spectrum disorders (FASD). As with neuro-psychological studies, brain-imaging studies have detected differences in brain structure related to alcohol exposure in multiple brain systems and abnormalities in the white matter that connects these brain regions. Several studies have found relationships between these morphological differences and cognitive function, suggesting some clinical significance to the structural brain abnormalities. Concentrations of neurotransmitter metabolites within the brains of prenatally exposed children also appear to be altered, and functional imaging studies have identified significant differences in brain activation related to working memory, learning, and inhibitory control in children and adolescents with FASD.

College campuses in the United States may be the most electronically "wired" environments on earth. College students use the Internet not only to write term papers and receive correspondence but also to report (and keep track of) friends' personal status, download music, view classroom lectures, and receive emergency messages. In fact, college students spend considerably more time online than the average person. In a recent survey of U.S. college students (Jones et al. 2009), nearly all respondents (94 percent) stated that they spent at least 1 hour on the Internet each day, with the main tasks including social communication, entertainment, and class work. In keeping with this trend, Web-based programs that address alcohol consumption among college students have become widely available in the United States. This sidebar provides an overview of currently available programs as well as of the advantages and disadvantages of this approach and the future outlook of Web-based programs.

Alcohol consumption is prevalent among college students and can become problematic for some. Numerous randomized controlled trials have evaluated the efficacy of individual preventive interventions in reducing alcohol use and alcohol-related problems in college student populations. Consistent with earlier reviews, the balance of the evidence from studies conducted during the past 3 years strongly supports the efficacy of brief motivational interventions combined with personalized feedback interventions (PFIs) and personalized normative feedback (PNF), as well as of stand-alone PFI/PNF interventions. Recent analyses also continue to support the efficacy of alcohol expectancy challenge interventions, although the findings are less consistent. In addition, recent analyses offer mixed support for feedback-based interventions focused solely on blood alcohol concentration and for multicomponent, alcohol education-focused interventions that include elements of PFI/PNF. No evidence of efficacy was found for programs that only included alcohol education.

Impaired driving remains a significant public health problem in the United States. Although impressive reductions in alcohol-related fatalities occurred between 1982 and 1997, during which all 50 States enacted the basic impaired-driving laws, progress has stagnated over the last decade. Substantial changes in the laws and policies or funding for the enforcement of the criminal offense of driving while intoxicated (DWI) are needed for further substantial progress in reducing alcohol-related crash injuries. However, research indicates that evidence-based laws in the 50 States and current best practices in DWI enforcement are not being fully adopted or used. It seems, however, that effective operations, such as the low-staff check points that are routinely applied in many communities, could be extended to many more police departments. In addition, several enforcement methods have been proposed but never fully tested.

Over the past three decades, economists and others have devoted considerable effort to assessing the impact of alcoholic-beverage taxes and prices on alcohol consumption and its related adverse consequences. Federal and State excise taxes have increased only rarely and, when adjusted for inflation, have declined significantly over the years, as have overall prices for alcoholic beverages. Yet studies examining the effects of increases of monetary prices (e.g., through raising taxes) on alcohol consumption and a wide range of related behavioral and health problems have demonstrated that price increases for alcoholic beverages lead to reduced alcohol consumption, both in the general population and in certain high-risk populations, such as heavier drinkers or adolescents and young adults. These effects seem to be more pronounced in the long run than in the short run. Likewise, price increases can help reduce the risk for adverse consequences of alcohol consumption and abuse, including drinking and driving, alcohol-involved crimes, liver cirrhosis and other alcohol-related mortality, risky sexual behavior and its consequences, and poor school performance among youth. All of these findings indicate that increases in alcoholic-beverage taxes could be a highly effective option for reducing alcohol abuse and its consequences.

Public policies have the potential to prevent the adverse consequences of alcohol consumption on a larger scale than any other category of interventions. However, measuring the effects of specific policies on alcohol-related behaviors and health outcomes is difficult and presents a variety of daunting challenges. One important challenge stems from the nonexperimental nature of most policy research, which makes it difficult to distinguish between causal relationships and noncausal associations. Another key challenge arises from the complexity of alcohol-related behaviors and outcomes and the wide range of potential effects that specific policy interventions may have on different groups and actors in various contexts. A third important challenge involves the difficulty in accurately characterizing the policies to be studied, which can be attributed largely to the arcane legal framework of statutes and regulations in which policies are created. This challenge is magnified by the enormous variety of alcohol-related public policies that have been adopted at all levels of government and the myriad variations in specific provisions that are embedded in the laws and regulations. Valid analysis of policy effects depends on surmounting all of these challenges and accurately characterizing policies and discerning the true causal effects of those policies on well-specified outcomes of interest.

Alcohol consumption, particularly heavier drinking, is an important risk factor for many health problems and, thus, is a major contributor to the global burden of disease. In fact, alcohol is a necessary underlying cause for more than 30 conditions and a contributing factor to many more. The most common disease categories that are entirely or partly caused by alcohol consumption include infectious diseases, cancer, diabetes, neuropsychiatric diseases (including alcohol use disorders), cardiovascular disease, liver and pancreas disease, and unintentional and intentional injury. Knowledge of these disease risks has helped in the development of low-risk drinking guidelines. In addition to these disease risks that affect the drinker, alcohol consumption also can affect the health of others and cause social harm both to the drinker and to others, adding to the overall cost associated with alcohol consumption. These findings underscore the need to develop effective prevention efforts to reduce the pain and suffering, and the associated costs, resulting from excessive alcohol use.

Underage drinking is a pervasive problem in the United States, with serious consequences for youth, families, communities, and society as a whole. Family-focused preventive interventions for children and adolescents have shown potential for reducing underage drinking and other problem behaviors. Research findings indicate that clear advances have been made, in terms of both the number of evidence-based interventions available, and in the quality of the methods used to evaluate them. To fully reap the benefits of such preventive interventions and achieve public health impact, the findings of family-focused preventive intervention science must be translated into real-world, community practices. This type of translation can be enhanced through four sets of translational impact factors-effectiveness of interventions, extensiveness of their population coverage, efficiency of interventions, and engagement of eligible populations, with sustained quality intervention implementation. Findings from studies conducted by researchers at the Partnerships in Prevention Science Institute and other empirical work highlight the importance of these factors. A model for community- university partnerships has been developed that potentially can facilitate the dissemination and public health impact of universal interventions to prevent underage drinking and other problem behaviors. This model fits well within a comprehensive strategic framework for promoting effective prevention.

Recent advances in alcohol research continue to build our understanding of alcohol consumption and related consequences for U.S. ethnic minority groups. National surveys show variations across ethnicities in drinking, alcohol use disorders, alcohol problems, and treatment use. Higher rates of high-risk drinking among ethnic minorities are reported for Native Americans and Hispanics, although within-ethnic group differences (e.g., gender, age-group, and other subpopulations) also are evident for ethnicities. Whites and Native Americans have a greater risk for alcohol use disorders relative to other ethnic groups. However, once alcohol dependence occurs, Blacks and Hispanics experience higher rates than Whites of recurrent or persistent dependence. Furthermore, the consequences of drinking appear to be more profound for Native Americans, Hispanics, and Blacks. Disparities in alcohol treatment utilization are most apparent for Hispanics. Explanations for these differences are complex, likely affected by risky drinking behaviors, immigration experiences, racial/ethnic discrimination, economic and neighborhood disadvantage, and variations in alcohol-metabolizing genes. Research must maintain a systematic, strong, and growing focus on ethnic minorities. A more complete understanding of these effects for ethnic minority groups is needed to enable researchers to face the challenges of reducing and ultimately eliminating health disparities in the alcohol field.

Neurotransmitter systems have been long recognized as important targets of the developmental actions of alcohol (i.e., ethanol). Short- and long-term effects of ethanol on amino acid (e.g., γ-aminobutyric acid and glutamate) and biogenic amine (e.g., serotonin and dopamine) neurotransmitters have been demonstrated in animal models of fetal alcohol spectrum disorders (FASD). Researchers have detected ethanol effects after exposure during developmental periods equivalent to the first, second, and third trimesters of human pregnancy. Results support the recommendation that pregnant women should abstain from drinking-even small quantities-as effects of ethanol on neurotransmitter systems have been detected at low levels of exposure. Recent studies have elucidated new mechanisms and/or consequences of the actions of ethanol on amino acid and biogenic amine neuro-transmitter systems. Alterations in these neurotransmitter systems could, in part, be responsible for many of the conditions associated with FASD, including (1) learning, memory, and attention deficits; (2) motor coordination impairments; (3) abnormal responsiveness to stress; and (4) increased susceptibility to neuropsychiatric disorders, such as substance abuse and depression, and also neurological disorders, such as epilepsy and sudden infant death syndrome. However, future research is needed to conclusively establish a causal relationship between these conditions and developmental dysfunctions in neurotransmitter systems.

The workplace offers advantages as a setting for interventions that result in primary prevention of alcohol abuse. Such programs have the potential to reach broad audiences and populations that would otherwise not receive prevention programs and, thereby, benefit both the employee and employer. Researchers have implemented and evaluated a variety of workplace alcohol problem prevention efforts in recent years, including programs focused on health promotion, social health promotion, brief interventions, and changing the work environment. Although some studies reported significant reductions in alcohol use outcomes, additional research with a stronger and integrated methodological approach is needed. The field of workplace alcohol prevention also might benefit from a guiding framework, such as the one proposed in this article.

Considerable efforts to educate women not to abuse alcohol during pregnancy have failed to reduce the incidence of fetal alcohol syndrome. Therefore, other approaches to limit the effects of prenatal alcohol exposure are under consideration, including the development of prevention programs and interventions. For these strategies to be as successful as possible, it also is important to improve methods for identifying affected children. The use of animal models in prenatal alcohol exposure research is critical because of the practical and ethical limitations of using human subjects for such studies. This article reviews the use of animal models in three areas of research: addressing basic questions about alcohol exposure during development; improving the identification of affected individuals; and developing approaches to reduce the impact of prenatal alcohol exposure. The various animal-model systems that have been used to study fetal alcohol spectrum disorders, each with their own specific strengths, have provided new findings that have been successfully extrapolated to human subjects, resulting in advancement of the research field and our understanding of fetal alcohol spectrum disorders.

Harmful alcohol use and the related health effects are a global problem and therefore need to be addressed not only by individual nations but also on an international level. For example, the World Health Organization (WHO) noted that harmful alcohol use is the third leading risk factor for premature deaths and disabilities in the world, accounting for approximately 2.5 million deaths worldwide (corresponding to 3.8 percent of all deaths) in 2004 (WHO 2010). Moreover, harmful alcohol use was considered responsible for 4.5 percent of the global burden of disease as measured in disability-adjusted life-years lost in the same year. Given this scope of the impact, the WHO initiated a series of efforts that culminated in the development of a global strategy for reducing the harmful use of alcohol. This article reviews the alcohol-related activities of the WHO over the years and summarizes the central issues addressed by the global strategy.