Highlight on Underage Drinking
Underage drinking presents an enormous public health issue. Alcohol is the drug of choice among children and adolescents. Annually, about 5,000 youth under age 21 die from motor vehicle crashes, other unintentional injuries, and homicides and suicides that involve underage drinking. As the lead Federal agency for supporting and conducting basic and applied research on alcohol problems, NIAAA is spearheading an Initiative on Underage Drinking to intensify research, evaluation, and outreach efforts in this important area. This special Highlight section of the APIS Web site provides convenient access to APIS policy topics that pertain to underage drinking.
The APIS Web site presents information on ten policy topics that are particularly relevant to underage drinking. Although these topics are classified under several different headings on the APIS Policy Topics Index page, all of the topics that relate to underage drinking can be accessed from this page under the "Policy Topics" navigation tab.
In addition, the State Profiles section presents summary information for each policy topic by State. Maps and charts for all of these policy topics are collected on a single page to provide a more comprehensive graphical overview of underage policies.
It is frequently helpful to consider APIS Underage Drinking policy topics in connection with one another rather than in isolation. This is particularly the case regarding the Underage Possession/Consumption/Internal Possession of Alcohol policy topic when addressing questions related to the circumstances when underage drinkers may legally possess or consume alcohol. APIS presents this topic in one set of descriptive and tabular materials to assist in this comparison
Overview of Underage Drinking Policy in the United States
State laws restricting access to alcoholic beverages by young people were first enacted early in the 20th century. These laws prohibited sales of alcohol to young people but did not directly prohibit consumption of alcoholic beverages by young people or provision of alcohol to youth by adults. Underage drinking policies in the United States have become more restrictive over time.
The 18th Amendment to the U.S. Constitution, ratified in 1919, prohibited the sale of all intoxicating liquors in the United States, superseding State laws on the sale of alcoholic beverages to young people. Following the repeal of the 18th Amendment in 1933, restrictions on possession and consumption of alcoholic beverages by youth and non-commercial provision of alcohol to youth by adults became the norm. Most States applied these restrictions to those under the age of 21, making the minimum legal drinking age the same as the minimum age then required for voting in Federal elections. 
Between 1970 and 1975, 29 States lowered their minimum drinking ages from 21 to 18, 19, or 20, following the enactment of the 26th Amendment to the U.S. Constitution, which granted 18- to 20- year-olds the right to vote. In the 1980s, States began to return the minimum drinking age to 21. This reversal reflected both increased public concern about underage drinking and research findings linking lower minimum drinking ages with increases in alcohol-related motor vehicle crashes. 
In 1984, Congress enacted the National Minimum Drinking Age Act, which remains in effect. This law requires that a portion of Federal highway funds be withheld from any States that do not prohibit persons under 21 years of age from purchasing or publicly possessing alcoholic beverages. The U.S. Supreme Court held in 1987 that Congress was within constitutional bounds in attaching such conditions to the receipt of Federal funds to encourage uniformity in States' drinking ages.  By 1988, every State had passed legislation to meet the Federal funding requirements. The result is that all States currently prohibit minors (a term widely used in this context to refer to persons under the age of 21) from possessing alcoholic beverages; most States also prohibit minors from purchasing and consuming alcoholic beverages. In addition, most States prohibit adults from furnishing alcoholic beverages to minors and some States prohibit "internal possession" of alcoholic beverages by minors. These prohibitions are subject to a number of exceptions that vary from State to State. These exceptions can be seen in the information presented for the ten APIS policy topics relevant to Underage Drinking.
In addition to minimum drinking age laws, States have adopted a variety of other policies to address underage drinking. Some of these policies apply to youth directly, e.g., using false identification to purchase alcohol, loss of driving privileges for alcohol violations by minors("use/lose" laws), and lower blood alcohol concentration levels for drivers under 21 ("zero-tolerance laws"). Other policies include minimum ages for both alcohol sellers and for servers and bartenders, keg registration requirements, and criminal penalties for hosting underage parties.
In 2006, Congress enacted The Sober Truth on Preventing Underage Drinking (STOP) Act which authorized $18 million in federal funds to combat underage drinking. Provisions of the Act include: enhancement of an interagency committee to coordinate efforts by Federal agencies to address the issue; annual reporting to Congress about State level efforts to combat underage drinking, including annual state report cards; a national media campaign aimed at adults; assessments of youth exposure to media messages; increased resources for community coalitions to enhance prevention efforts; and funding for new research on underage drinking, including short- and long-term effects on adolescent brain development. For additional information about the STOP Act, including the specific State-level underage drinking prevention policies tracked in the annual Report to Congress, see the Report to Congress on the Prevention and Reduction of Underage Drinking.
In 2007, the then Acting U.S. Surgeon General Kenneth P. Moritsugu unveiled a Call to Action on Underage Drinking. Developed in collaboration with the National Institute on Alcohol Abuse and Alcoholism and the Substance Abuse and Mental Health Services Administration, the Call to Action identifies six goals to be achieved by government, school officials, parents, other adults, and young people. These goals include: (1) facilitating healthy adolescent development and preventing and reducing underage drinking; (2) engaging parents, schools, communities, government, social systems, and youth in a national effort to prevent and reduce underage drinking and its consequences; (3) promoting understanding of underage drinking across individual adolescent characteristics as well as across environmental, ethnic, cultural, and gender differences; (4) conducting research on adolescent alcohol use and its consequences; (5) improving public health monitoring of underage drinking and underage drinking policies; and (6) promoting policy consistency across levels of government. The Call to Action and related materials are available at Surgeon General.
In November of 2016, U.S. Surgeon General Dr. Vivek Murthy issued a report finding alcohol and drug misuse and severe substance use disorders, commonly called addiction, to be one of America's most pressing public health concerns. The report, Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health, marks the first time a U.S. Surgeon General has dedicated a report to substance misuse and related disorders. Among the report’s key findings is that “well-supported scientific evidence shows that adolescence is a critical ‘at-risk period’ for substance use and addiction; [a]ll addictive drugs, including alcohol and marijuana, have especially harmful effects on the adolescent brain, which is still undergoing significant development.” The full report and executive summary are available at http://addiction.surgeongeneral.gov/.
The Institute of Medicine (IOM) notes that underage drinking strategies such as those outlined here demonstrate a broad societal commitment to reduce underage drinking. The IOM further notes that "the effectiveness of laws to restrict access to alcohol by youths can be increased by closing gaps in coverage, promoting compliance, and strengthening enforcement." 
-  Mosher, J., The history of youthful-drinking laws: Implications for current policy. In: Wechsler, H. ed. Minimum-Drinking-Age Laws: An Evaluation, Lexington, MA: Lexington Books, 1980. pp. 11-38.
-  Wagenaar, A. Research affects public policy: The case of the legal drinking age in the United States. Addiction 88 (Supplement): 75S-81S, 1993.
-  South Dakota v. Dole, 483 U.S. 203 (1987).
-  National Research Council Institute of Medicine. Reducing Underage Drinking: A Collective Responsibility. Washington DC: National Academy Press, 2003.