MARK S. GOLDMAN, Ph.D. Department of Psychology, University of South Florida, BEH 339, 4202 Fowler
Avenue, Tampa, Florida 33620-8200
AWARENESS OF alcohol use and misuse on college
campuses is not new. Anecdotal reports go back many
years, and there is documentation in the United States for
at least 50 years. Available research indicates that approximately
80% of college students drink and that half of college
student drinkers engage in heavy episodic drinking.
Excessive alcohol intake among college students is associated
with a variety of adverse consequences: fatal and nonfatal
injuries; alcohol poisoning; blackouts; academic failure;
violence, including rape and assault; unintended pregnancy;
sexually transmitted diseases, including HIV/AIDS; property
damage; and vocational and criminal consequences that
could jeopardize future job prospects. Students who engage
in excessive drinking impact not just themselves. Fellow
students experience secondhand consequences ranging from
disrupted study and sleep to physical and sexual assault.
Furthermore, the institutions they attend expend valuable
resources to deal with institutional and personal consequences
of their behavior.
To address these serious consequences of alcohol consumption
by college students, the National Advisory Council
to the National Institute on Alcohol Abuse and
Alcoholism (NIAAA) established the Task Force on College
Drinking in 1998. The composition of the Task Force
was novel. College presidents and research scientists were
put together to ensure that the product would at the same
time contribute to the scientific basis for addressing college
drinking and would be relevant to the practical challenges
faced by college administrators. The Task Force was
charged with integrating available scientific research with
experiences reported by administrators, service providers
and students.
Because of the breadth of information to be considered,
two panels were formed: Panel 1 reviewed the Contexts
and Consequences of College Drinking, and Panel 2 focused
on Prevention and Treatment of College Alcohol
Problems. Additional information about the structure and
composition of the Task Force and its two panels is available
in their individual reports, which are on the NIAAA
web page (www.niaaa.nih.gov). Each of the two panels commissioned
review papers to inform discussions and to lead
to construction of the overall Task Force Report (which is
to be released in tandem with this supplement). The 18
articles appearing in this supplement are adapted from the
review papers. Each panel's research recommendations follow
that panel's introduction.
It must be noted that the extent and quality of the research base in each
of the areas reviewed varied considerably. In fact, this very variation was
a primary impetus for the initiation of the Task Force on College Drinking.
Although college drinking has been a concern for some time, amelioration of
the problem has been hampered by inconsistent attention from both college administrators
and researchers. And, when attention is given, it is too often short lived and
based on current fads, rather than on solid empirical evidence. The fundamental
rationale for the Task Force on College Drinking is to organize and integrate
existing information but, most importantly, to have the product of these efforts
serve as a foundation for future research that will advance our ability to impact
the problems in question. To this end, the articles in this supplement are offered
as a foundation for the next generation of inquiry into this serious societal
problem. Drinking on college campuses may seem to be entrenched and impervious
to intervention; however, it is potentially modifiable with carefully targeted
approaches endorsed by all stakeholders—including students—who truly
value the institution.
Overview
GAYLE M. BOYD, Ph.D., and VIVIAN FADEN, Ph.D.† Prevention Research Branch, National Institute on Alcohol Abuse and Alcoholism,
Willco Building, 6000 Executive Boulevard, Suite 505, Bethesda, Maryland 20892-7003
The articles in this supplement were commissioned by the
two panels of the National Advisory Council on Alcohol
Abuse and Alcoholism Task Force on College Drinking
(see Introduction, this supplement). They are organized and
discussed below according to panel.
Panel 1: The Contexts and Consequences of College Drinking
The ten Panel 1 articles on college drinking fall into three major categories:
(1) the statistics of drinking in college; (2) the factors involved in college
drinking—individual, developmental and institutional; and (3) the consequences
of drinking, including theoretical ideas applied to the connection between alcohol
consumption and three particularly serious consequences (risky sexual behavior,
sexual assault and aggression.) Dowdall and Wechsler ("Studying College
Alcohol Use: Widening the Lens, Sharpening the Focus") outline how to select
the types of institutions to be included, specify the population to be studied,
choose the sample and decide on the methods of data collection and analysis
when designing a study of drinking among college students. The authors indicate
that advancing this field will require complex study designs, new variables
and the incorporation of new data accrual and analytic methodology. They argue
for future studies to investigate college drinking as a phenomenon that takes
place in a larger social, economic and political context than just the college
itself.
O'Malley and Johnston ("Epidemiology of Alcohol and
Other Drug Use among American College Students") examine
the results of several large national studies on college
student drinking: (1) the Harvard School of Public
Health College Alcohol Study, (2) the Core Institute, (3)
Monitoring the Future, (4) the National College Health Risk
Behavior Survey and (5) the National Household Survey
on Drug Abuse. Some studies were designed specifically to
evaluate college drinking, whereas others had a broader
focus. Despite different strengths and weaknesses, all obtain
strikingly similar findings: About 80% of college students
drink, about 70% have had a drink in the past 30
days and about 40% engage in heavy episodic drinking.
Racial/ethnic and gender effects are also consistent across
studies; male students drink more than female students, and
white students drink more than black or Hispanic students.
Many biological, social and psychological factors have
been studied to explain the wide variation in drinking among
individual college students. Baer ("Student Factors: Understanding
Individual Variation in College Drinking") reviews
this literature, which is of varying quality, is largely dependent
on questionnaire responses from cross-sectional convenience
samples and has tended to focus on student
personality characteristics. Nonetheless, a number of themes
emerge. Drinking among college students is often associated
with impulsivity/sensation seeking or the regulation of
negative emotional states including depression and anxiety.
Many students are heavily influenced by social factors, however.
Studies have also indicated that religiosity is inversely
related to drinking and sociability positively related to drinking
and that members of Greek organizations and students
involved in athletics drink more that other students. Studies
on expectancies and individual perceived norms have indicated
a relationship with drinking, although more work is
needed. Also needed are more longitudinal studies, more
investigations representative of the broader college population,
additional work on the genetics of alcohol-related problems
in this population and studies that use multivariate
approaches.
Schulenberg and Maggs ("A Developmental Perspective
on Alcohol Use and Heavy Drinking during Adolescence
and the Transition to Young Adulthood") examine alcohol
use during adolescence and young adulthood in a developmental
framework, which considers the tasks and challenges
of adolescence. These fall within the broad domains of biology,
cognition, identity, affiliation and achievement. The
authors indicate a number of differing alcohol use trajectories
at this time of life, some of which are more troublesome
than others. They also examine risk and protective
factors from a developmental perspective and within a sociocultural context.
Five conceptual models that relate
developmental transitions to substance use are offered: Overload,
Developmental Mismatch, Increased Heterogeneity,
Transition Catalyst and Heightened Vulnerability to Chance
Events. Like other researchers represented in this supplement,
Schulenberg and Maggs recognize the complexity of
the influences on drinking among college students and recommend
multiwave, contextually sensitive, longitudinal research.
Finally, they suggest that a developmental
perspective can inform and enhance intervention.
College students typically begin their collegiate careers
in late adolescence, a time of continued development of the
brain. Two important questions arise, therefore. First, is
there something about the adolescent brain that affects sensitivity
to alcohol's effects, or that intensifies the adolescent's
inclination to drink? Second, does drinking during
this period of brain development have enduring effects on
the brain? Spear ("The Adolescent Brain and the College
Drinker: Biological Basis of Propensity to Use and Misuse
Alcohol") examines animal and human studies relevant to
these critical questions. Although more work is needed, recent
evidence indicates that adolescents may show reduced
sensitivity to alcohol's effects and increased sensitivity to
stressors, both of which may influence drinking behavior.
In addition, alcohol exposure during adolescence may
disrupt brain development and functioning. For example,
hippocampal volume has been associated with alcohol consumption
in human adolescents (De Bellis et al., 2000),
and neuropsychological studies of adolescents have indicated
a connection between drinking and memory deficits
(Brown et al., 2000; Tapert and Brown, 1999). If supported
by further research, such information might be disseminated
to adolescents as part of an integrated intervention
strategy.
Presley, Meilman and Leichliter ("College Factors That
Influence Drinking") consider the relationship of collegiate
environments to student drinking. The authors note, however,
that the existing literature in this area is sparse and
typically has examined institutional variables one at a time,
rather than in multivariate models. In general, studies indicate
that the following institutional variables are related to
student alcohol consumption: affiliations (e.g., historically
black institutions, women's institutions), presence of a Greek
system, role of athletics on campus, 2- or 4-year designation,
type of residence hall, institution size, location, overall
quantity of drinking on campus, the pricing and availability
of alcohol and outlet density. The authors conclude that, at
this time, research is insufficient to indicate which factors
most affect student drinking. Additional as yet unstudied
and/or unrecognized aspects of collegiate environments also
may be important predictors of student drinking on particular
campuses. Colleges and universities are themselves embedded
in larger environments at the same time that they
comprise smaller social and cultural environments. In conclusion,
these authors emphasize the importance of a cogent
model of student drinking that incorporates the environment,
student campus culture and individual factors.
The consequences of college drinking were addressed in
four papers commissioned by Panel 1. The first article presents
an overview; those that follow offer more detailed
analyses of three specific consequences: risky sexual behavior,
alcohol-related sexual assault and alcohol-related
aggression. Panel 1 decided that these three consequences
warranted additional attention because of their potential to
cause serious and long lasting problems.
Perkins ("Surveying the Damage: A Review of Research
on Consequences of Alcohol Misuse in College Populations")
reviews the literature on the nature, extent and patterns
of negative consequences that result from alcohol
consumption by college students. These consequences impact
the individuals who drink, their fellow students and
the institutions they attend. They range widely in severity
and may have short, longer term or even lifetime sequelae.
The consequences of student alcohol consumption include
fatal and nonfatal injuries; hangover and vomiting; alcohol
poisoning; blackouts; academic impairment or failure; violence,
including rape and assault; unintended sexual activity;
unintended pregnancy; sexually transmitted diseases,
including HIV/AIDS; litter and property damage; and vocational
and criminal consequences that could jeopardize
future job prospects. One caveat is that the literature in this
area is of mixed quality and has significant gaps such as a
paucity of information on patterns of consequences among
different racial/ethnic groups or on individual and global
time trends. Nonetheless, this body of work indicates substantial
adverse consequences, with patterns of damage that
appear to follow patterns of drinking. Generally, more consequences
are found among men than women and among
whites and Native Americans than Hispanics and blacks.
Research in this area also has shown that most students do
not believe that they have a drinking problem, regardless
of the alcohol-related consequences they experience.
Cooper ("Alcohol Use and Risky Sexual Behavior among
College Students and Youth: Evaluating the Evidence") explores
alcohol consumption and risky sex among college
students and youth. The existing literature indicates a strong
association between alcohol consumption and having multiple
or casual sexual partners as well as alcohol use and
the decision to have sex in the first place. There was an
inconsistent relationship between alcohol consumption and
the use of condoms and birth control. Available data indicate
that a large percentage of college students drink, many
are sexually experienced, and a substantial minority have
experienced one or more adverse consequences of sexual
risk taking. The author explores the effect of alcohol on the
instigatory and inhibitory cues controlling sexual behavior,
the role of alcohol expectancies in sexual risk taking and
the extent to which an individual's life situation may ex-
plain both drinking and risky sexual behavior. She concludes
that each of these models may explain some aspects
of the association between alcohol and sexual risk taking.
Drinking alcohol in sexual situations may increase the likelihood
of intercourse depending on what drinking means to
the individual. Alcohol consumption also increases the likelihood
of indiscriminate sexual behaviors, but this may be
moderated by the individual's stage in a relationship. The
author concludes that historical context, developmental stage
and chronological age confound the link between alcohol
consumption and the use of protective measures in a sexual
situation. In sum, a range of models plausibly relates alcohol
to risky sex; consequently, research should be directed
to understanding under what circumstances and for what
individuals or subgroups of individuals different causal processes
operate.
Abbey ("Alcohol-Related Sexual Assault: A Common
Problem among College Students") focuses on sexual assault
involving female victims and male perpetrators. She
defines sexual assault to include the full range of forced
sexual acts, including rape. Cross-sectional studies have used
varying definitions and time periods, but consistently indicate
25-50% of women report such an experience. Fewer
college men report committing sexual assault than women
report experiencing it; according to Abbey, this discrepancy
is likely related to gender differences in understanding
of a woman's nonconsent. Of the sexual assaults on
campus, at least half are associated with alcohol use by the
perpetrator or the victim, but most often by both. In most
cases, the victim knows the perpetrator, and about half of
the time the assault occurs on a date. The strong association
between alcohol and sexual assault does not demonstrate
causality, however, and a number of causal pathways
may explain some sexual assaults. Abbey presents a conceptual
model of alcohol-related acquaintance sexual assault
and reviews the studies that examine the factors that
may interact with alcohol to make sexual assault more likely.
These factors include expectations about the effects of alcohol;
stereotypes about drinking women; alcohol's effects
on cognition, behavior and motor skills; perceptions of control
and responsibility; and peer environments that encourage
heavy drinking and sexual activity. The author suggests
that future studies include students of varying racial, cultural
and ethnic backgrounds; ascertain the amount of alcohol
consumed (and not just whether it was consumed); and
follow students longitudinally. The review concludes that,
because of the strong association of alcohol use and sexual
assault, programming and intervention on campuses in these
two areas should be coordinated.
Giancola ("Alcohol-Related Aggression during the College Years: Theories,
Risk Factors and Policy Implications") examines research on prevalence
and patterns of alcohol-related aggression and indicates there is a serious
problem on college campuses. A large number of experimental studies (often,
but not exclusively, conducted with college students) also link alcohol and
aggression. Despite some limitations, this body of work indicates that the consumption
of alcohol significantly increases the likelihood of aggressive behavior. Giancola
reviews general theories of aggression and the theoretical formulations that
have been advanced to explain the alcohol-aggression relationship. These conceptual
models include disinhibition and expectancy models and a number of cognitive
models that focus on processing of cues, self-awareness and executive functioning.
Not all people become aggressive when they drink, however, nor do people become
aggressive in all situations. Studies have suggested that individual differences
in dispositional aggressivity; expectancies about the effects of alcohol on
aggression; drinking history; executive functioning; hostile attributional biases;
individual biochemistry and gender; and contextual variables such as blood alcohol
concentration limb effects, alcohol type and dose, social pressure and provocation
affect the relationship of alcohol consumption and aggression. Giancola concludes
that alcohol consumption is not a factor in behavior for which there is no predisposition
in the sober state.
Recommendations
After reviewing and discussing the material in this volume,
the panel made recommendations to college administrators,
funding agencies and the research community. The
research recommendations were based on the panel's conclusion
that sound, thoughtfully designed research studies
are likely to have an impact on excessive and underage
alcohol use among college students. The key research recommendations
of the Panel on Contexts and Consequences
follow:
Characterize better the extent of clinical level problems (alcohol abuse
and dependence) and alcohol-related comorbidity in the college population.
Understand the relationship between clinical levels of drinking and student
consumption indicators (e.g., heavy episodic drinking).
Examine the predictive value of college drinking for later alcohol-related
problems.
Identify the economic consequences of college drinking, including the cost
to colleges of damage to the physical plant.
Assess the impact of community pricing policies on drinking among college
students.
Understand more completely the academic consequences of college drinking,
including the mechanism(s) through which alcohol may influence academic outcomes.
Refine understanding of the heterogeneity of heavy drinking trajectories
in adolescence and early adulthood, through longitudinal studies, with a particular
focus on what factors determine moving from a heavy drinking or high episodic
drinking pattern to a lower one, and vice versa.
Focus on how developmental transitions to college, to work afterward, to
a new intimate partner or to a new friendship can serve as windows of opportunity
for effecting change in behavior, including drinking.
Examine the relationship between the prior drinking histories of incoming
students and their use of alcohol in college and consider what other variables
moderate this relationship.
Assess whether alcohol use by college students interferes with their social
and emotional development (both short- and long-term).
Assess how institutional consequences (e.g., dismissal or other sanctions)
impact drinking behavior.
Identify those problem-related, individual-level variables (e.g., drinking
motivations) that are potentially modifiable; use this information to point
to opportunities for intervention.
Discern how individual-level variables interact with the larger environment
to identify possible environmental interventions that might reduce the risk
of hazardous drinking for especially vulnerable individuals.
Improve understanding of the association between alcohol consumption and
both acute and chronic problems, recognizing the complexities of the relationships,
the influence of other variables at the individual and situational levels
and bidirectional causation; high priority research areas include the effects
of alcohol consumption on sexual behavior, sexual assault and other aggression,
academic performance and compliance with academic norms.
Assess more carefully the validity of self-report measures of student alcohol
use and explore the use of alternative data collection methods including observational,
archival and biomedical methods.
Panel 2: Prevention and Treatment of College Alcohol Problems
The Panel on the Prevention and Treatment of College Alcohol Problems commissioned
the eight articles appearing in this section. To place subsequent reviews in
context, an overall review of practices currently in place to reduce alcohol-related
problems on college campuses was completed by DeJong and Langford ("A Typology
for Campus-Based Alcohol Prevention: Moving toward Environmental Management
Strategies"). College administrations are under pressure, due both to public
opinion and potential legal liability, to take action to prevent problems. Historically,
these prevention efforts have focused on educational strategies, but accumulating
research has indicated these strategies do not appear to be effective in isolation
(Larimer and Cronce, this supplement). More likely to have significant impact
are comprehensive interventions that include prominent environmental components.
This position is entirely consistent with the recommendations of other authors
in this supplement (see especially Toomey and Wagenaar; Hingson and Howland),
the Panel Report on Prevention and Treatment of College Alcohol Problems and
the full Report of the Task Force on College Drinking.
To reflect this position, DeJong and Langford adopt a
social ecological framework that recognizes that health behaviors,
including drinking, are affected through multiple
levels of influence. A simple typology for describing intervention
approaches is presented that crosses the levels of
influence in the social ecological model (individual, group,
institution, community and public policy) with intervention
targets and methods (knowledge, attitudes and intentions;
environmental change; health protection; and intervention/
treatment). This sort of typology is useful in making comparisons
among researched interventions, and it informed
the final recommendations made by the panel. When such
a typology is applied to ongoing prevention efforts, it becomes
clear that the majority of work has been directed
toward individual and group programs that target knowledge,
attitudes and behavioral intentions; environmental
change has been relatively neglected. In fact, a 1998 random
sample survey of 2- and 4-year colleges in the United
States indicates the existence of barriers to the institution
of comprehensive programs. Many campuses do not have
in place basic infrastructures and resources needed to implement
and evaluate prevention strategies with an environmental
management focus. Clearly, both research and
dissemination efforts are needed in this regard.
Not all prevention and intervention strategies are directed
toward the general college population, however. Population
subgroups, based on risk for alcohol-related problems,
were also considered by the panel in assessing the potential
impact of specific intervention approaches, how they should
be implemented, to whom delivered and the appropriate
level of resources that should be allocated. The campus
population includes approximately 19% abstainers, 37% "social"
drinkers who do not engage in heavy episodic drinking,
21% higher risk drinkers who occasionally consume
five or more (four or more for women) drinks on a single
occasion and 23% who frequently consume five or more
drinks. Approximately 47% of drinkers do so "to get drunk"
(Wechsler et al., 2000). Drinkers who fall near the extreme
end of this continuum are likely to need more intensive
intervention, and such services should be available to this
subset of the population. Lighter drinkers may be responsive
to less costly approaches. It is critical that students
who have chosen not to drink at all are also acknowledged
and supported. Any successful comprehensive approach will
ensure that these students are helped to resist pressures to
drink if they so choose and will provide the means for
minimizing the untoward effects of other students' drinking
(e.g., on their ability to study).
The following seven articles review and evaluate the
research literature underlying intervention approaches for
specific groups, make recommendations regarding future
research and discuss effective implementation of the interventions
studied. Each provided valuable information for
the panel's deliberations.
Larimer and Cronce ("Identification, Prevention and Treatment: A Review
of Individual-Focused Strategies to Reduce Problematic Alcohol Consumption by
College Students") review research on interventions directed toward individuals
published between 1984 and 2000. Such interventions have long dominated campus
efforts to reduce alcohol-related problems, but surprisingly few have been rigorously
evaluated; fewer yet have been tested using randomized control designs. Hence,
only 32 prevention studies were identified that met minimal methodological criteria
for inclusion in the review.
The initial response to campus alcohol-related problems is generally educational.
If only students understood the risks involved, they would certainly
modify their alcohol use behavior. But in accord with earlier reviews, Larimer
and Cronce report little evidence for the effectiveness of informational programs
that do not also include other approaches. Much stronger support exists, however,
for the effectiveness of skills-based and motivational enhancement programs.
These approaches also provide alcohol information, but presented within a context
that emphasizes its relevance to specific alcohol-related situations and decisions.
For example, factual information about alcohol effects may be used to challenge
erroneous alcohol expectancies held by many college students that are known
to predict their drinking.
Multicomponent programs typically include some combination of expectancy challenge,
self-monitoring, drink refusal skills, moderate drinking techniques, lifestyle
skills/ balance, normative feedback and motivational enhancement. Good evidence
is reported for the effectiveness of multicomponent skills-based programs, as
well as for some of their components that have been tested in isolation. These
programs involve multiple sessions with trained leaders. Even when delivered
in groups, however, they are resource intense, making them less attractive for
large-scale implementation. Brief motivational interventions are a practical
alternative that may be equally effective for many at-risk students, and current
research suggests they may not always require one-on-one interaction with a
provider. In contrast, little research has been carried out on treatment approaches
for college students.
Emerging across all the prevention and treatment literature
is the issue of identifying, recruiting and retaining students
who are in need of alcohol programs. This issue
remains a major challenge for both campus service providers
and researchers. Larimer and Cronce emphasize the need
for campus level coordination among multiple campus service
systems (e.g., student health centers, emergency rooms,
police) and for research on alcohol services delivery. This
integration will require organizational changes. To date, no
research exists on how such changes can be promoted and
supported.
Perkins ("Social Norms and the Prevention of Alcohol Misuse in Collegiate
Contexts") reviews theory and research on an intervention approach that
spans the individual versus environmental distinction. Campus norms for alcohol
use, perceived or real, are a strong predictor of individual student drinking.
He distinguishes attitudinal norms, which describe attitudes about acceptable
or expected behavior, from behavioral norms, which describe what members of
the group actually do. Perkins argues that, for college students, peer group
and campus norms exert a stronger influence on behavior than do family expectations.
It should be noted, however, that some recent research suggests parents may
not be completely without influence if they make a concerted effort to moderate
drinking by their older teens (Turrisi et al., 2001). Nevertheless, social norms
are powerful. To potentially influence these norms, Perkins goes on to argue
that faculty expectations about alcohol and academic standards be emphasized
to incoming freshmen and that faculty become involved in outreach activities
to direct problem drinkers into campus services. Resident advisers are identified
as another potential reference group that could and should convey clear normative
standards to students. The strongest and most immediate normative influence
remains other students, however. Students appear to overestimate other students'
actual drinking and approval for heavy drinking and to underestimate fellow
students' support for drinking restrictions. The correction of these misperceived
norms underlies normative feedback components in individual-focused interventions
and is the goal of some campus-wide programs, including most social marketing
campaigns (see DeJong, this supplement). Although this approach has become widespread,
and some limited evaluation has been supportive, no rigorous research trials
utilizing randomized control designs are yet available. Research of this nature
is needed to justify allocation of limited campus resources to the approach
and to explore more fully intervention characteristics and campus conditions
that affect success.
In a related vein, a link between advertising and alcohol consumption is intuitively
compelling, but has not been consistently supported by research. Saffer ("Alcohol
Advertising and Youth") reviews the research and varying methodologies
used to study the relationships among advertising, brand capital (name recognition
and perceived value), market share and total market size (consumption). The
concept of diminishing marginal return is key to understanding these relationships.
It describes the response function of changes in a product's consumption in
response to increases (or decreases) in its advertising. At low levels of advertising,
an increase is followed by a measurable increase in consumption. At higher levels
of advertising, however, this function flattens, and consumption is no longer
responsive to increases in advertising. A similar but inverted function describes
the relationship between counter-advertising and consumption. That is, at low
levels of background counter-advertising, increases should result in a marked
decrease in consumption. At higher levels of counteradvertising, increases or
decreases may not result in changes in consumption. Hence, because alcohol advertising
is pervasive, econometric studies may not be sensitive to change or assess in
a range where change actually makes a difference. In dealing with advertising,
partial bans are not likely to be effective, and total bans are not practical.
Advertising bans in one medium also are weakened by substitution of increased
advertising in alternative media and/ or other promotions. No data are available
on campus-specific advertising and its potential role in conveying exaggerated
campus drinking norms or in reinforcing positive drinking expectancies, however.
Research in this area is clearly needed. Evidence for the effectiveness of counteradvertising
with regard to tobacco use indicates a potentially effective strategy; additional
research is needed on effective message content and placement.
Many college campuses have indeed employed counteradvertising
to reduce college drinking. DeJong ("The Role
of Mass Media Campaigns in Reducing High-Risk Drinking
among College Students") reviews these campus media
campaigns. Many have been informational and may be considered
a form of counteradvertising. Some have been designed
to correct misperceived social norms (social norms
marketing campaigns). Others have sought support for particular
policies or policy change (advocacy campaigns). Unfortunately,
empirical evaluation of these campaigns has
been limited. Most media messages on college drinking
also have focused on negative consequences of drinking,
an approach previously found to be ineffective and sometimes
counterproductive. Instead, guidelines are presented
for the development of media campaigns based on established
practices in commercial marketing and public health
campaigns, as well as experience with college populations.
Most campus alcohol prevention efforts have not drawn on
this material. A planning approach is described in which
message design does not take place until broader questions
regarding campaign strategy have been addressed. These
campaigns should also expand their focus to the broader
social and policy environment. The importance of formative,
process and outcome evaluation is emphasized.
Toomey and Wagenaar ("Environmental Policies to Reduce
College Drinking: Options and Research Findings")
review environmental policies used or recommended to reduce
college alcohol-related problems. Many of these policies
have proven effective in the general population; their
extension to college environments, including surrounding
communities, is a logical next step. The authors acknowledge
the importance of the social environment in individual
drinking behavior, but suggest that the social environment
is substantially shaped by public and institutional policies.
They identify four general types of environmental strategies
used at the community level that are theoretically
appropriate for the college population. The importance of
the first, enforcement of the minimum legal drinking age
(MLDA) law, is addressed in depth in the article by
Wagenaar and Toomey (this supplement). Because many
undergraduate students are under age 21, this strategy is
especially relevant for campuses. Two sources of alcohol
for underage drinkers must be addressed: social providers
and commercial providers. The former includes parents,
other adults, older siblings, friends and social environments
where alcohol is provided freely without regard to age of
the consumer; the latter refers to licensed alcohol establishments.
Strategies to reduce social access for college students
include decreasing the number of large drinking
parties, preventing underage access to alcohol at parties,
increasing awareness of laws and enforcing laws against
social provision. Commercial availability can be minimized
through reduction of false identification, training of alcohol
establishment management and staff, restriction of certain
kinds of sales and vigorous enforcement of laws banning
sales to minors.
A second group of environmental strategies is directed
toward reducing overall consumption and risky alcohol use
in the college population, regardless of drinker age. These
efforts include restrictions on where, when and how alcohol
is sold (e.g., outlet density, hours of operation), decreasing
alcohol flow at parties (e.g., eliminating
self-service), increasing the price of alcohol and restricting
where alcohol can be sold. A third group of strategies has
addressed specific alcohol-related problems, such as drunk
driving. The final group of strategies de-emphasizes the
importance of alcohol on campus. Examples include establishing
alcohol-free residence halls, scheduling core courses
on Fridays and establishing alcohol-free social venues. The
authors provide some logical guidelines for how college
administrators and other leaders might select policy goals
for their particular campus. They caution, however, that
most of these strategies have not been evaluated for college
populations, and some are not well evaluated in the
general population. The need for research is clear.
Wagenaar and Toomey ("Effects of Minimum Drinking
Age Laws: Review and Analyses of the Literature from
1960 to 2000") review the extensive research literature on
the relationship between MLDA, alcohol consumption by
young persons and highway traffic fatalities. Although the
federal government passed the Uniform Drinking Age Act
in 1984, which prompted all states and the District of Columbia
to establish age 21 as the MLDA, there are periodic
calls to reconsider this policy, especially in light of campus
drinking problems. Wagenaar and Toomey persuasively argue
for the effectiveness of the current law, based on evidence
from more than 100 studies utilizing a variety of
outcome measures and study designs.
Fluctuations in the MLDA by state during the 1970s
and the subsequent uniform shifts to age 21 in the late
1980s provided the opportunity for a variety of "natural
experiments." Longitudinal studies of increases and decreases
in MLDA were possible, as well as cross-sectional
comparisons of states with different MLDAs. These studies
are summarized by design, methodology, outcome measures
and findings in a series of tables that will be an excellent
reference for others doing research in this field. Although
findings are not always consistent, the preponderance of
the data indicate inverse relationships between the MLDA
and alcohol-related outcomes in the age group affected by
the policy (i.e., ages 16-20). Outcomes include alcohol sales,
self-reported consumption, fatal traffic crashes, alcohol-related
crashes and injuries, drunk driving offenses, emergency
hospital admissions, juvenile crime, nontraffic injuries
and fatalities and self-reported alcohol-related problems.
The authors also review evidence regarding mediating
factors that may influence whether an MLDA effect is observed.
Most prominent is that the law has not been rigorously
enforced. It is, in fact, striking that effects have been
observed at all because implementation of the law in most
locales has been minimal. Because few of the studies were
specific to college populations, research directed toward
this area would be useful to policy-makers. Such research
is especially important because the MLDA law is frequently
criticized. Doubts remain about its effectiveness, and some
critics hypothesize that drinking by persons ages 18-20 could
be better controlled if it were legal, especially in the college
environment. In response, the authors list the most
frequently raised criticisms and provide research-based responses.
This section should be useful for policy-makers at
all levels, as well as those that advocate for responsible
alcohol-control policies.
These types of large-scale environmental interventions,
particularly those involving policy change, require involvement
of both community and campus leaders and their constituencies
as well as interaction between the two. For
example, regulation and limitation of alcohol availability
cannot be accomplished by either campuses or communities
in isolation. Similarly, enforcement of campus alcohol
regulations and community ordinances will be more effective
with formal communication and coordination between
the two. Hence, colleges and communities must work together
through "town-gown" coalitions to tackle the complex
alcohol-related problems that plague them both.
Hingson and Howland ("Comprehensive Community Interventions to Promote
Health: Implications for College-Age Drinking Problems") review the research
literature on just this sort of community-based approach. Comprehensive community
interventions already have been promoted to address a variety of health risks,
including high blood pressure and cholesterol levels, lack of exercise, smoking,
drug use, unsafe sex practices and alcohol-related problems. No rigorous evaluations
have been undertaken of campus- community coalitions, however, and campus populations
have not been included in the existing studies. Twenty community interventions
have been well evaluated in the general population. Although all programs evaluated
were considered to be "comprehensive community interventions," they
varied considerably in approaches actually used, populations targeted, type
of community and intended outcome. Some were primarily policy oriented (Communities
Mobilizing for Change), whereas others relied most heavily on educational approaches
(Midwestern Prevention Project). For some intervention targets, such as blood
pressure or exercise, there were no obvious policy options. The community interventions
reviewed had varying degrees of success, and in this review the authors seek
common characteristics that predict effectiveness and can inform future efforts
to reduce underage drinking, excessive drinking and related problems among college
students.
Recommendations
Based on discussions of the material presented in this
supplement and on other sources, the panel made recommendations
to college administrators, funding agencies and
the research community. Key research questions from the
Panel on Prevention and Treatment follow:
Promoting health behaviors through individual- and group-focused approaches
What are the campus-wide effects of providing individual- and group-focused
interventions?
How well do these interventions work with different campus
populations, including students in Greek-affiliated organizations;
incoming students; mandated students; adult children of
alcoholics; athletes; students at various risk levels based on
current alcohol practices; students living on- and off-campus;
and members of different ethnic, religious and cultural
groups?
How effective are student-to-student interventions?
What are the most effective uses of computer-based technologies
in college alcohol initiatives?
Should approaches be tailored to the needs and situations of
underage students versus those age 21 and over?
What are the most effective and cost-effective ways to
conduct outreach for alcohol services?
What criteria are appropriate for diagnosing college student
alcohol problems? Do they differ from the general population
criteria used in currently available instruments?
How well do pilot programs work when taken to scale on
different campuses?
Creating a healthy environment
What is the effect of banning or stringently regulating alcohol
on campus? Do problems simply move off campus? How are
on-campus and off-campus cultures affected?
Are parental notification policies effective? If so, what are the
characteristics of effective parental notification programs? At
what point should parents be notified for optimal results?
What is the most effective type of campus disciplinary system
for alcohol offenses? Should campus alcohol disciplinary
systems and standards be extended to students who live off
campus and in what circumstances? Should infractions be
handled differently for those under age 21?
How does the academic environment affect student drinking
patterns? For example, would high-risk drinking be reduced if
more classes were scheduled on Fridays or academic expectations
were increased (e.g., reducing grade inflation, increasing
difficulty of classes and requirements)?
What is the impact of substance-free housing on alcoholrelated
problems?
What approaches effectively reduce alcohol-related problems
within the Greek system? Does the presence of a live-in
resident adviser reduce drinking? Does delaying rush reduce
alcohol-related problems? Do risk management efforts make a
positive difference?
What are the key environmental characteristics that influence
drinking? How should environmental characteristics and
environmental change be measured?
Do alcohol-free activities and venues reduce college alcoholrelated
problems? What factors (e.g., frequency, timing, type,
planning) influence effectiveness?
How are social norms campaigns most effectively used (e.g.,
in combination with other activities, to set the stage for more
comprehensive initiatives)?
Are comprehensive college-community interventions to
reduce high-risk college drinking effective? What is the most
effective mix of policy and program elements? What are the
assets and liabilities for colleges and communities?
Is it more effective to focus such efforts on drinking practices
or on the health and social problems high-risk drinkers cause
for themselves and others?
Where should decision-making responsibility be focused: in
city government, the college and university, another group or
institution or a combination of players?
What are the best strategies for mobilizing and optimizing the
effectiveness of college-community coalitions?
Do effects of college-focused programs extend to others in the
community?
What is the best way to enforce community alcohol-related
ordinances?
How can the results of alcohol research be effectively
disseminated to community audiences, such as chiefs of
police, parents and legislators?
How effective are state-level coalitions that support individual
campus-community collaborations.
What planning structure or process is most effective in
developing campus alcohol policies and programs?
What is the relative effectiveness of different accountability
structures for managing college alcohol programs?
What are the costs and effects of alcohol prevention interventions, including
campus-based and comprehensive campus-community efforts? How can programs
be made more cost effective?
Which alcohol policies and programs most benefit the college
and university in terms of student recruitment, student quality
and academic performance, student diversity, student
retention, faculty behaviors, fund-raising and alumni relations?
What are the most effective strategies for involving presidents,
administrators, faculty, students, other staff and boards of
directors in alcohol-related problem prevention programs?
Is it effective to make prospective students aware of alcohol
policies during the marketing or admissions process?
What are the most effective ways of engaging, optimizing and
maintaining the involvement of different student subgroups,
including ethnic and racial minorities?
How can higher education and secondary education work
together on alcohol issues, including the transition from high
school to college?
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