Environmental Policies to Reduce College Drinking: Options and Research Findings
TRACI L. TOOMEY, Ph.D.,† and ALEXANDER C. WAGENAAR,
Ph.D. Division of Epidemiology, School of Public Health, University of Minnesota,
1300 South Second Street, Suite 300, Minneapolis, Minnesota 55454-1015
ABSTRACT.Objective: The goal of this article is to provide an
overview of environmental strategies that may reduce college drinking. Drinking
behavior is influenced by many environmental factors, including messages in
the media, community norms and attitudes, public and institutional policies
and practices and economic factors. College student drinking may be influenced
by environmental factors on and off campus. Method: A comprehensive search
of MEDLINE, ETOH, Current Contents and Social Science Abstracts databases was
conducted to identify research studies evaluating effects of environmental strategies
on college and general populations. Results: The identified environmental
strategies fall into four categories: (1) increasing compliance with minimum
legal drinking age laws, (2) reducing consumption and risky alcohol use, (3)
decreasing specific types of alcohol-related problems and (4) deemphasizing
the role of alcohol on campus and promoting academics and citizenship. Although
the extant research indicates that many environmental strategies are promising
for reducing alcohol-related problems among the general population, few of these
strategies have been evaluated for effects on the college population. Conclusions:
Further research is needed to evaluate effects of alcohol control policies on
alcohol consumption and its related problems among college students. (J.
Stud. Alcohol, Supplement No. 14: 193-205, 2002)
CONCERN OVER drinking practices among college students has grown recently,
in part because of well-publicized, alcohol-related tragedies that have occurred
on campuses in the last few years. Because of this publicity, many people ask,
"What has happened to our college campuses? Why are we seeing so many alcohol-related
deaths?" In fact, the primary change may not be drinking levels or patterns
among college students but rather society's increased awareness of the role
alcohol plays in many problems, both on campus and off. Alcohol has been an
integral part of many campuses for years—playing a role in campus celebrations,
social functions and academic activities. Until recently, however, we had not
quantified the contribution of alcohol to dropout rates, assaults, property
damage and deaths and injuries occurring on and around campus. Colleges and
universities are now struggling to identify effective strategies to address
college drinking in an attempt to reduce alcohol-related problems among this
population.
A parallel search for effective strategies to reduce alcohol-related problems
is occurring in communities and states throughout the nation. A recurring discussion
revolves around the types of approaches that are most effective in reducing
alcohol use and its related problems. Traditional approaches have focused on
individuals—providing interventions or treatment to individuals who are
at highest risk of alcohol-related problems, educating youth to resist peer
pressure or fining and arresting those who break the law. These individually
based approaches may be complemented by changing the broader environment, increasing
the likelihood of long-term reductions in alcohol use and related problems (Bangert-Drowns,
1988; Moskowitz, 1989; Perry and Kelder, 1992; Rundall and Bruvold, 1988; Tobler,
1992). Individual drinking behavior is influenced by a myriad of environmental
factors, such as messages in the media, community norms and attitudes, public
and institutional policies and practices and economic factors (Wagenaar and
Perry, 1994). Reductions in alcohol use and related problems may be achieved
by changing such environmental factors (Edwards, 1994; National Institute on
Alcohol Abuse and Alcoholism, 1997; Toomey et al., 1993).
Individually based strategies such as early intervention or treatment programs
are designed to target individuals at highest risk—that segment of the
population who are clinically identifiable as dependent on alcohol or those
approaching dependence. A focus on treatment, however, is unlikely to achieve
sizable, sustained reductions in alcohol-related problems at a population level
because the majority of alcohol-related deaths, disability and damage is attributable
to moderate drinkers who engage in occasional risky drinking, not those who
are dependent on alcohol (Kreitman, 1986; Lemmens, 1995; Saunders, 1989). Risk
is not a dichotomy, such that some drinkers are "high risk" and others
are "safe." Instead, risk is a continuum. Drinking patterns in the
general population are often not reflective of addictive psychopathological
behavior, but rather are the results of social policies, institutional structures
and social norms concerning alcohol in our society (National Institute on Alcohol
Abuse and Alcoholism, 1997).
One promising individually based approach—social norms interventions—attempts
to influence drinking behavior of a broad segment of the population by confronting
misperceptions about normative drinking levels and attitudes toward alcohol
use (Haines, 1996; Haines and Spear, 1996). Many individuals, particularly on
college campuses, overestimate levels of alcohol consumption and permissiveness
toward alcohol use among their peers. Awareness campaigns are used to adjust
these misperceptions and to create awareness of true consumption rates and attitudes
toward alcohol use. One problem with this type of approach by itself, however,
may be that actual consumption rates on college campuses are unacceptably high,
just not as high as perceived by many students. Social norms interventions,
along with individually focused approaches, may be enhanced by combining them
with environmental strategies that are effective in lowering consumption rates
on campus. As environmental strategies are implemented, awareness campaigns
could be used to make students aware of the changing drinking behaviors and
norms on campus.
Researchers and practitioners have begun to identify numerous
environmental strategies to reduce alcohol-related
problems. The social environment that facilitates or encourages
risky drinking practices is substantially shaped by public
and institutional policies that can be changed to create
healthier and safer communities. Wide arrays of alcohol
policies have been identified (Toomey and Wagenaar, 1999). Research has shown
that changes in many of these policies,
by reducing the availability of alcohol, decrease alcohol
consumption and related problems (Edwards, 1994;
National Institute on Alcohol Abuse and Alcoholism, 1997;
Toomey et al., 1993).
College student drinking is influenced by the broader
community as well as the campus environment. College
leaders shape campus policy. Many constituencies influence
community and state-level policies. Campus leaders
need to work with a variety of other institutions and community
leaders to change the broader environment in which
their students live, work and play. In this article, we identify
strategies that can be implemented directly by college
leaders on their campuses as well as community and statewide
strategies that campus leaders can work toward in
collaboration with others.
Our primary goal is to describe several types of environmental
strategies. First are those aimed at increasing
adherence to minimum drinking age laws. Second are those
that focus on reducing overall levels of consumption and
risky alcohol use among the general college population.
The third group of strategies focuses on reducing the incidence
of very specific alcohol-related problems, such as
drinking and driving. The fourth group of strategies works
to de-emphasize alcohol as a necessary part of college life
and to increase expectations about academics and
citizenship.
Descriptions of these four types of environmental strategies
are useful to campus and community leaders seeking
potential approaches to use to reduce alcohol use on and
around campuses. These descriptions also are useful to researchers
formulating new research questions and designing
studies. Although alcohol control policies have been
identified and implemented at local and state levels, many
of the policies have not been evaluated to determine their
effectiveness in preventing alcohol-related problems on or
off campus (Wagenaar and Toomey, 2000). We provide a
summary of relevant research of the effect of specific alcohol
control policies on the general and college populations
when available.
Increasing Effectiveness of the Minimum Legal Drinking Age
The minimum legal drinking age (MLDA) is the most
widely studied alcohol control policy (Wagenaar and
Toomey, 2000). Many studies using the most robust research
designs show that a higher MLDA results in lower
alcohol use and fewer traffic crashes among 18- to 20-year
olds (Toomey et al., 1996; Wagenaar, 1993; Wagenaar and
Toomey, this supplement). The National Highway Traffic
Safety Administration (1998) estimates that since 1975, the
age-21 MLDA has prevented more than 17,000 traffic crash
fatalities among youth. Other studies also show that the
age-21 MLDA may also reduce other alcohol-related problems
such as suicide and vandalism among young people
(Jones et al., 1992; New York State Division of Alcoholism
and Alcohol Abuse, 1984; Toomey et al., 1996).
Although the age-21 MLDA is saving thousands of lives,
adolescents and young adults continue to drink alcohol and
experience alcohol-related problems. One reason is that the
age-21 MLDA has not been well enforced (Wagenaar and
Wolfson, 1994, 1995). Wagenaar and Wolfson (1995)
showed that enforcement of the MLDA in the early 1990s
was low across the nation. When enforcement did occur,
enforcement activity was most likely directed at the underage
consumer, not the adult who illegally sold or provided
alcohol. As a result, underage youth easily obtain alcohol
from commercial and social providers.
Social providers include parents, siblings, coworkers and
even strangers. Social providers may be over the age of 21,
purchase alcohol legally and then illegally provide alcohol
to an underage person. A social provider may also be an
underage person who, once obtaining alcohol, then illegally
provides alcohol to another underage person. Social provision
of alcohol may occur at parties, in residences, at campus
or community events or in public areas such as parks
or beaches. In addition, youth may approach adults outside
alcohol establishments and ask adults to purchase alcohol.
A recent multicommunity intervention trial has demonstrated
that mobilized communities that change multiple institutional
policies can significantly reduce social provision of
alcohol to teens (Wagenaar et al., 2000).
Commercial providers are licensed alcohol establishments
such as restaurants, bars and liquor stores. Such licensed
establishments often exist on and around college campuses.
Research shows that underage youth can purchase alcohol
without age identification in half or more of purchase attempts
(Forster et al., 1994, 1995; Preusser and Williams,
1992). Although social sources are where most underage
youth obtain alcohol, the likelihood of purchasing their own
alcohol increases as youth get older (Wagenaar et al., 1996).
Rates of usage of specific types of alcohol sources specifically
among college students are not known (Hingson et
al., 1997).
The issue of underage alcohol use is particularly salient
to college campuses where a large percentage of the student
population is under age 21. Campus policies can be
changed and enforced to ensure that the campus environment
does not support underage drinking. The campus environment
is also influenced by local and state policies;
therefore, campus leaders may need to work with other
community leaders to create changes in the broader environment
to prevent illegal alcohol sales and provision of
alcohol to underage people (Table 1).
Reducing social access to alcohol
A variety of community policies are used to decrease the prevalence of large
drinking parties—situations where underage youth can easily obtain alcohol
(Jones-Webb et al., 1997; Wagenaar et al., 1993, 1996). First, some communities
prohibit alcohol use in public places such as parks and beaches, or restrict
the hours that alcohol can be consumed in these locations. In addition, law
enforcement officers patrol public areas to ensure that parties are not occurring
despite the restrictions. To reduce the number of parties occurring in hotels
and motels, some hotels restrict the age of room renter and number of guests
allowed per room.
Within the borders of college campuses, underage individuals may attend parties
in residence halls, fraternities and student centers and sometimes obtain alcohol
at departmental and college events and celebrations. To decrease the number
of parties where underage students have access to alcohol on campus, campus
leaders may choose not to serve alcohol at all events or parties or at events
where underage individuals are present. In addition to obtaining alcohol at
large parties and events, underage individuals may get alcohol in their place
of residence. Colleges and fraternity systems may create alcohol-free residence
halls and Greek houses to decrease younger residents' exposure to alcohol. Some
colleges have completely banned alcohol from residence halls, whereas others
have prohibited alcohol in certain areas of residence halls (Finn, 1996).
When alcohol is served at parties and events on and off
campus, alcohol may be free flowing and not well monitored.
Policies can be developed to ensure underage attendees
do not have access to alcohol. One type of drinking
party that may increase underage access to alcohol is a
"kegger," where people have access to large quantities of
very low cost or free alcohol. States and communities may
ban sales of beer kegs to individuals in an effort to decrease
the amount of alcohol at parties. College campuses
may also regulate use of beer kegs; specifically, beer kegs
can be prohibited on campus. Banning kegs, however, does
not prevent event organizers from bringing in large quantities
of cans or bottles of alcohol, and a ban at the state or community level may
be opposed by alcohol retailers and
some consumers.
An alternative approach used to prevent underage access
to beer from kegs is registration of kegs. Keg registration
involves alcohol retailers placing a unique identifier
on a keg and recording the purchaser's name and address
at the time of sale, enabling law enforcement agents to
identify and hold responsible the adult who provided the
keg. Although college campuses cannot mandate local retailers
to register kegs, campus leaders can encourage state
or local policy-makers to implement such a policy or work
with retailers to register beer kegs voluntarily.
At some community or campus events, an individual
who is of age may legally acquire alcohol and then give it
to an underage friend or colleague. To decrease the likelihood
that this type of social provision will occur at an
event, alcohol service can be limited to only one drink per
person per request. At some events, specific areas are created
where alcohol can be consumed; entrance can then be
limited to individuals over age 21.
Another strategy to reduce underage access to alcohol
on college campuses is to monitor the serving of alcohol at
campus events, with no self-service allowed. Individuals
designated to serve alcohol on campus can be trained how
to check age identification and how to refuse alcohol service
to underage individuals.
Many people throughout communities and campuses, including
students, staff and faculty, are not even aware that
the law prohibits provision of alcohol to people under age
21. Simply learning the MLDA law exists and awareness
of potential legal liability or other consequences may deter
provision of alcohol to underage people. Awareness campaigns
can be used to educate people about this law and
about potential consequences for not complying. As part of
the Communities Mobilizing for Change on Alcohol Project
(Wagenaar et al., 1994, 1999, 2000), local alcohol retailers
distributed warning fliers to all customers purchasing alcohol.
On college campuses, warning fliers or educational
material can be distributed at orientation sessions, in published
residence hall rules and regulations, in campus newspapers
and via email.
Educating adults about consequences may not be sufficient
to create a deterrent effect, however. Research shows
that the most effective element of deterrence is perceived
certainty of facing penalties for not complying with a law
(Decker and Kohfeld, 1990; Grogger, 1991; Grosvenor et
al., 1999; Ross, 1984, 1992). Therefore, to be effective,
laws prohibiting provision of alcohol to underage people
must be enforced. Few adults face penalties for supplying
alcohol to underage persons (Wagenaar and Wolfson, 1994).
Communities and campuses can develop enforcement
systems to identify and modestly penalize individuals who
illegally provide alcohol. One type of enforcement effort is
"shoulder tap" campaigns. Underage people, under the supervision
of law enforcement, approach an adult outside an
alcohol establishment and ask the adult to purchase alcohol
for them. If the adult purchases alcohol for the underage
person, the adult is warned, cited or arrested. As shown by
research in areas of drinking and driving, awareness campaigns
connected to enforcement efforts can increase the
effectiveness of these efforts (Blomberg, 1992).
Campus police can conduct random spot checks of events
and parties on campus to ensure that serving of alcohol is
monitored and that age identification is being checked. Enforcement
policies can also be developed by specific units
on college campuses. For example, residence halls can develop
systems to enforce no-alcohol-provision laws as well
as no-alcohol-use rules. However, a preliminary investigation
in three residence halls at one college suggests that
level of enforcement may vary by resident assistant and
director of the residence hall (Rubington, 1991). To avoid
placing resident assistants in the difficult role of being an
enforcer at the same time that they are charged with developing
close, supportive relationships with students, residence
halls might hire security monitors or charge others to act as
hall enforcers.
Enforcement agents in communities also face challenges when enforcing underage
drinking laws—particularly when dealing with parties held in private residences.
To reduce underage drinking at these parties, communities have passed ordinances
to hold property owners responsible for underage parties on their property and
to restrict level of noise emitted from parties (Minneapolis, MN Ord. §385.110;
Farmington Hills, MI Ord. §80.455). Noisy assembly ordinances allow enforcement
agents to enter a private residence under very specific circumstances; if underage
drinkers are present, the enforcement agents can take action against the individual
drinkers and attempt to identify the supplier of alcohol.
Although certainty of detection is most critical for creating
a general deterrent effect (Decker and Kohfeld, 1990;
Grogger, 1991; Grosvenor et al., 1999; Ross, 1984, 1992),
many people focus instead on the severity of punishment,
believing that if the punishment is severe enough, people
are more likely to comply with a law or policy. Research
indicates, however, that severe penalties do not deter people
from breaking the law (Ross, 1984, 1992). If penalties are
perceived as too severe, they become less well enforced,
leading to less certainty of detection.
In addition to law enforcement efforts, social providers
can also be deterred by changes in civil liability law. Through
state statutes or case law, some states have created social
host liability. If a person illegally gives alcohol to an underage
person, and the underage person injures him- or
herself or someone else, a third party can sue the provider
for damages. Media campaigns concerning civil and criminal
cases can increase the perceived risk of consequences
and thus improve the deterrent effect of these efforts.
Reducing commercial access to alcohol
Several research studies show that the majority of licensed
alcohol establishments will sell alcohol to someone
who appears under age 21, without looking at age identification
(Forster et al., 1994, 1995; Preusser and Williams,
1992). Underage students also have access to alcohol from
commercial or licensed alcohol establishments on some campuses.
Although many colleges prohibit alcohol sales on
campus, some college campuses have obtained licenses to
sell alcohol in student centers, stadiums and auditoriums.
Research on rates of illegal sales to underage people on
college campuses is not available.
Community and campus leaders can work with alcohol
merchants to establish outlet policies to increase the rate of
age identification checking among servers and sellers. A
standard recommendation in most outlets is to check age
identification of everyone who looks under age 30. On college
campuses, however, a simple policy of checking age
identification of all customers may be most prudent.
Owners and managers need to communicate clearly the
expectation that age identification is consistently checked.
Some establishments provide monetary incentives to staff
when they identify false identification. Management may
also set up monitoring systems to observe alcohol sales,
decreasing the likelihood of alcohol sales to underage individuals
(Wolfson et al., 1996).
Owners and managers of alcohol establishments need
training to learn how to develop, communicate and enforce
policies. A recent focus group study of owners and managers
of bars and restaurants suggests that many owners and
managers never receive such training and many establishments
do not have written policies (Gehan et al., 1999).
Support of management is necessary to change server behavior
(Saltz, 1987).
Alcohol servers also need training to learn how to detect and handle false
age identification and how to refuse alcohol service. The quality of existing
server training programs varies, with few programs adequately covering underage
sales issues and even fewer using science-based behavior-change techniques to
improve server skills and confidence to refuse alcohol sales (Toomey et al.,
1998). Although current training programs apparently improve server knowledge
and attitudes about responsible alcohol service, training programs by themselves
do not significantly reduce illegal alcohol sales rates (Howard-Pitney et al.,
1991; McKnight, 1991).
Typically, management arranges such training; however,
in some areas the burden is placed on the server, and they
cannot be hired until they have been trained and have received
a serving license (analogous to a hair stylist license).
Although this process ensures that a server is trained prior
to serving alcohol and can facilitate statewide minimum
standards for training programs, it does not ensure support
by management for responsible alcohol service.
Once age identification is routinely being checked, communities
may also need to reduce the availability of false
age identification. In a survey of high school seniors and
18- to 20-year olds in the Midwest, only a few respondents
reported using false age identification to purchase alcohol
(Wagenaar et al., 1996). False age identification might be
more prevalent among college populations, however. Using
a convenience sample from one university, Durkin et
al. (1996) reported that 46% of 272 respondents indicated
using false age identification to obtain alcohol. Students
who belonged to fraternities and sororities were more likely
to use false age identification than were other students. Communities
may apply penalties to those caught using false
age identification. To increase detection of false age identification,
states are making new identification cards that are
more difficult to duplicate (e.g., use of holograms) and that
more clearly identify an underage person versus a person
over 21 (e.g., use of different colors and location or profile
of photograph for underage).
To prevent sales to underage people, training programs
need to be combined with other strategies. To increase both
servers' and management's perceived certainty of facing
penalties for illegally selling alcohol to underage people,
and thus create a stronger deterrent effect, law enforcement
officers conduct compliance checks. An underage person
attempts to purchase alcohol; if the sale is made, penalties
may be applied to both the server and the license holder.
Applying penalties to just the server will not increase
management's support for responsible alcohol service.
Graduated administrative penalties or fines may be applied
to license holders whose establishments make illegal alcohol
sales. Fines increase with each offense; multiple offenses
should result in the license to sell alcohol being
suspended or revoked. Studies indicate regular compliance
checks substantially reduce illegal alcohol sales (Grube,
1997; Preusser et al., 1994), a result well established in
literature on tobacco sales to teens (DiFranza et al., 1992;
Hinds, 1992; Hoppock and Houston, 1990).
In addition to compliance checks, law enforcement officers
may conduct a walk through of alcohol establishments,
increasing their visibility. Serving practices may also
be altered by potential dram shop liability, which enables
individuals to sue alcohol establishments for injuries sustained
after illegal alcohol sales. Wagenaar and Holder
(1991b) found a 6.5% decrease in injury-producing, singlevehicle,
nighttime traffic crashes following the well-publicized
filing of a liability suit in Texas. Traffic crashes
decreased another 5.3% after a second liability suit.
One type of risky, unmonitored sale that may particularly
increase the likelihood of an alcohol sale to an underage
person is home delivery of alcohol. More than half the
states in the United States allow home delivery of alcohol
(Fletcher et al., 2000). In mid-sized, Midwestern communities,
7% of 18- to 20-year olds and 10% of 12th graders
indicated that they had drunk alcohol that had been delivered
to the home from retail establishments. In addition to
retail home deliveries, concern has also recently increased
over deliveries of alcohol ordered from the Internet. To
prevent delivery to underage people, communities can ban
or restrict home deliveries of alcohol. Law enforcement
officers can also conduct compliance checks where the cooperating
underage person arranges for alcohol to be delivered
to a home, rather than attempting to conduct purchase
attempts in alcohol establishments.
In addition, establishments and communities can restrict
the age of those who deliver or serve alcohol. Forster et al.
(1994, 1995) found that younger servers were more likely
to sell alcohol to an underage person.
Reducing Consumption Levels and Risky Alcohol Use among the General College
Population
While many campuses are struggling to reduce underage drinking, they are also
attempting to find ways to reduce high-risk drinking among students over age
21. To reduce overall levels of alcohol consumption and change patterns of risky
alcohol use, states, communities, colleges and other institutions can place
restrictions on where and how alcohol is sold and distributed, how much alcohol
costs and where alcohol is consumed (Table 2). Research studies show that restricting
availability of alcohol leads to decreases in alcohol consumption among the
general population (for a review, see Edwards, 1994). As consumption rates go
down within a population, so do many alcohol-Frelated problems.
Where, when and how alcohol is distributed
Studies suggest that factors related to licensed establishments, such as density
of businesses, hours and days of sale and responsible service of alcohol, affect
levels of alcohol consumption and related problems throughout communities. Studies
of the density or the number of alcohol licenses per population size have found
a statistically significant relationship between density of alcohol outlets,
consumption and related problems such as violence, other crime and health problems,
although many of these studies are weaker cross-sectional designs (Gliksman
and Rush, 1986; Gruenewald et al., 1993; Harford et al., 1979; Ornstein and
Hannsens, 1985; Scribner et al., 1995; Smith, 1989; Stitt and Giacopassi, 1992).
Chaloupka and Wechsler (1996) specifically studied college students and found
higher levels of drinking, drinking participation and high-risk drinking among
underage and older college students when a larger number of businesses were
selling alcohol within one mile of campus.
Numbers of outlets may be restricted directly or indirectly
through policies that make licenses more difficult to
obtain (e.g., through increasing the cost of a license). Several
states limit the number of alcohol outlets and control
the price of alcohol by maintaining state-run (rather than
privately owned) outlets. A trend in the last few decades
has been to privatize such state monopolies. Several studies
show substantial long-term increases in alcohol sales
following privatization (Holder and Wagenaar, 1990;
Wagenaar and Holder, 1991a, 1995), although others only
found short-term increases (Mulford et al., 1992). Until effects
of such privatization are fully evaluated, states should
consider preventing privatization because reversal of the
privatization process is not politically feasible.
Availability of alcohol may also be affected by hours
and days of sale. Evaluations of the effect of hours and
days of sale of alcohol are mixed. Changes in hours of sale
may not affect consumption levels (Hoadley et al., 1984;
McLaughlin and Harrison-Stewart, 1992). A few studies
suggest that changes in hours may affect rates of problem
drinking, cirrhosis mortality and some types of alcohol-related
problems (e.g., traffic crashes, violence) (Duffy and
Pinot de Moira, 1996; Hooper, 1983; Smith, 1986). Other
studies indicate no changes in problems or simply a shift in
timing of problems (e.g., from the old closing to the new
closing hour) (De Moira and Duffy, 1995; Duffy and Plant,
1986; Raymond, 1969). An inverse relationship may exist
between days of sale and alcohol use and alcohol-related
problems (Ligon and Thyer, 1993; Northridge et al., 1986;
Ornstein and Hannsens, 1985; Smith, 1988). However, some studies have found
no significant relationship (Duffy and
Plant, 1986; Hoadley et al. 1984; Ligon et al., 1996). Hours
and days when alcohol may be served at campus events
can be regulated, limiting alcohol service to weekends or
after regular work hours to help separate alcohol use from
activities that more closely align with the campus' core
academic mission.
As with preventing illegal alcohol sales to underage students,
owners and managers of alcohol establishments can
implement policies that instruct staff how to prevent patrons
from becoming intoxicated and refuse sales to obviously
intoxicated customers (Toomey et al., 2001). One
recent study found that 79% of alcohol establishments will
serve alcohol to patrons who appear obviously intoxicated
(Toomey et al., 1999), despite laws prohibiting such sales.
Examples of policies that management can implement are
serving alcohol in standard sizes, limiting sales of pitchers
of alcohol, cutting off service of alcohol to intoxicated patrons,
promoting alcohol-free drinks and food and eliminating
last call announcements. Although some of the existing
server training programs have led to interventions such as
offering food and alcohol-free beverages, training by itself
has not led to cutting off sales to intoxicated individuals
(Howard-Pitney et al., 1991; McKnight, 1987, 1991; Saltz,
1987).
Another strategy to reduce overall availability of alcohol
is to restrict the flow of alcohol at parties and other
events on and off campus. Many policies described earlier
for preventing underage access to alcohol at parties can
also be used to decrease the amount of drinking among
older students. Overlapping community policies include banning
beer kegs and prohibiting home deliveries of large
quantities of alcohol. Overlapping policies for campus events
include limiting the quantity of alcohol per person and monitoring
or serving alcohol rather than allowing self-service.
At one fraternity party, Geller and Kalsher (1990) found
that attendees who obtained beer through self-service consumed
more beer than those who got alcohol from a bartender.
Event and party planners could also be required to
serve food and offer a large selection of alcohol-free beverages.
Another strategy is to serve low-alcohol content
beverages. Geller et al. (1991) found that students attending
a fraternity party where only low-alcohol content drinks
were served consumed the same number of drinks but had
a lower blood alcohol concentration (BAC) than did students
at parties where regular alcohol content beer and
mixed drinks were served.
Price of alcohol
After the MLDA, alcohol control policies affecting price
of alcohol are the next most-studied alcohol policies
(Wagenaar and Toomey, 2000). Studies of price effects in
the general population indicate that as the price of alcohol
goes up, consumption rates go down (Clements and
Selvanathan, 1991; Duffy, 1981; Gao et al., 1995; Leung
and Phelps, 1993; Levy and Sheflin, 1983; Österberg, 1995;
Selvanathan, 1991). However, the level of effect on consumption
varies by culture, drinking level, age group and
type of alcohol (Coate and Grossman, 1988; Cook and
Tauchen, 1982; Manning et al., 1995; Selvanathan, 1988,
1991). All types of drinkers appear to be affected by price,
but the heaviest drinkers may be less affected by variations
in price than other consumers (Manning et al., 1995). However,
heavier drinkers in young populations are more affected
by price than heavy drinkers in the general population
(Chaloupka and Wechsler, 1996; Godfrey, 1997; Kenkel,
1993; Sutton and Godfrey, 1995). Inverse relationships are
also seen between price of alcohol and several types of
alcohol-related problems, including motor vehicle fatalities,
robberies, rapes and liver cirrhosis mortality (Cook and
Moore, 1993b; Cook and Tauchen, 1982; Ruhm, 1996).
Grossman and Markowitz (1999) evaluated the effect of
price of beer on violence among college students. Using
self-report data from 122,416 students from 191 colleges
and universities from 29 states, they found that higher price
for beer was associated with a lower incidence of (1) getting
into trouble with police or college authorities, (2) damaging
property or pulling a fire alarm, (3) having an
argument or fight and (4) being taken advantage of or taking
advantage of someone sexually.
Several types of policies affect price of alcohol. One
type of policy is restrictions on happy hours or price promotions
(e.g., two drinks for the price of one, women drink
for free). Babor et al. (1978) found that happy hours were
associated with higher consumption among both light and
heavy drinkers. Although not specific to college populations,
the study has clear implications for college students;
many bars surrounding campuses attract students by promoting
drink specials. Restrictions on happy hours can be
implemented by individual outlets, campuses (if a licensed
establishment is on campus), local communities (if communities
are not preempted by state law) and the state. In
nonlicensed settings on campus where alcohol is served,
event planners may want to limit the amount of free alcohol
available.
Placing excise taxes on alcohol is another type of policy
that affects price. Using national samples of youth, several
studies indicate that raising alcohol excise taxes has particularly
large effects in reducing youth drinking. Higher
beer taxes are associated with less frequent drinking among
16- to 21-year olds (Coate and Grossman, 1988; Grossman
et al., 1994); effects of tax increases are stronger among
frequent and fairly frequent drinkers than among infrequent
drinkers. Cook and Moore (1993a) found that students who
went to high school in states that had higher taxes and
higher MLDAs were more likely to graduate from college.
Using a nationally representative sample of college students,
Chaloupka and Wechsler (1996) found that indexing the
federal beer tax to the rate of inflation since 1951 could
lead to a 15% reduction in drinking participation among
underage women, and a 17% and 21% reduction in highrisk
drinking among underage women and women over 21,
respectively.
Where alcohol is consumed
States, communities and campuses can also limit where
alcohol is consumed. For example, at community events or
festivals, alcohol sales and consumption can be restricted
to certain areas to make alcohol less available and to prevent
alcohol from becoming the main focus of the event.
Colleges can choose to have "dry" campuses, not allowing
any alcohol consumption on campus. Colleges may decide
to allow alcohol to be used only in certain locations, such
as banquet rooms. Alternatively, colleges may allow alcohol
use throughout most of the campus, but restrict consumption
in certain locations on campus where heavy
drinking often occurs. For example, the University of Iowa
has banned alcohol use in campus parking lots so that tailgating
parties will be alcohol free (Mitka, 1998). The University
of Arizona prohibits patrons from bringing alcohol
into its sport stadium. Alcohol sales are also not allowed in
the stadium. Spaite et al. (1990) found no change in injuries
among patrons following the ban. However, no comparison
group was used in this study, and there was
anecdotal evidence that patrons continued to bring alcohol
into the stadium even after the ban was passed.
Strategies to Affect Specific Alcohol-Related Problems
Environmental strategies can also target specific types
of alcohol-related problems such as traffic crashes or violence.
A goal of policies setting limits on BACs is to create
a general deterrent effect among the entire population of
drivers, lowering the aggregate levels of drinking and driving.
Research studies indicate that coordination, vision, attention
and driving performance are affected at BACs lower
than 0.10% (Mortimer and Sturgis, 1975; Moskowitz and
Burns, 1990; Moskowitz et al., 1985). As a result, many
states have lowered the BAC limit to 0.08% (Hingson et
al., 1997). BAC limits of 0.02% to 0.05% are not uncommon
in other countries (Noordzij, 1979). Studies of these
policy changes suggest that lower BACs may be effective
in decreasing traffic crashes (National Highway Traffic
Safety Administration, 1991).
Recognizing that youth are particularly at risk of a traffic
crash while drinking and driving, states began creating
youth-specific BAC laws. Currently all 50 states have a
youth BAC law, with most states setting BAC limits of
0.00% to 0.02% for individuals under age 21. One study
found significant decreases in single-vehicle, nighttime fatal
crashes involving young drivers following implementation
of youth BAC laws in 12 states (Hingson et al., 1994).
Another study across 30 states found a 19% reduction in
driving after drinking following the new laws (Wagenaar
et al., 2001).
Depending on their age, college students may be affected
by either adult or youth BAC limits. Although BAC laws
are set at the state level, awareness campaigns could be
implemented on college campuses to make these policies
more effective. Blomberg (1992) found that an intensive
awareness campaign designed to educate youth about the
BAC law for their age group resulted in fewer alcohol-related
traffic crashes compared with areas that were not
exposed to the awareness campaign.
Another type of alcohol-related problem that can be targeted
by environmental strategies is aggressive behavior,
particularly in bars (Graham and Homel, 1997). Aspects of
the physical environment that frustrate customers such as
overcrowding with poor traffic flow design, bad air quality
and bad music are associated with more aggression (Graham
and Homel, 1997; Graham et al., 1980; Homel et al.,
1992). Service of food may help reduce aggressive behavior
by slowing down absorption of alcohol and also by
creating an atmosphere where alcohol is not the sole focus
of customers (Graham, 1985).
Specific strategies can be developed to prevent a wide
variety of other alcohol-related problems on and around
campus. However, campus and community leaders may need
to consider whether resources should be used to target a
specific type of problem or to target overall drinking rates,
which could potentially reduce a wide array of alcohol-related
problems.
Strategies to De-Emphasize Alcohol and Create Positive Expectations on Campus
Colleges and communities can also create other environmental
changes to de-emphasize the role of alcohol on
and around campus or change expectations about student
behavior.
Strategies to de-emphasize the role of alcohol
A discussion topic for every college campus is the appropriate
role of alcohol in an academic environment. Should
alcohol be allowed on campus? Should alcohol be allowed
at academic functions or only social functions? Does alcohol
on campus facilitate the academic mission or does alcohol
get in the way of the mission? Should the campus profit
from alcohol sales and promotion on campus? Decisions
that college campuses make about these questions may influence
perceptions and behaviors of staff and students.
Regardless of when and how alcohol is used on campus,
a variety of strategies can be used to de-emphasize alcohol
on campus. For example, colleges may elect to avoid sponsorship
of campus events by alcohol retailers or producers.
Campus newspapers can also restrict alcohol advertisements
and promotions. College newspapers can also prioritize reporting
stories about alcohol-related problems on and around
campus (Gomberg, 1999).
Campuses can also create alcohol-free residence halls
and Greek houses. Alcohol-free residences may also demonstrate
that students can be social without alcohol use,
particularly if the alcohol-free residence is in a central location
(Finn, 1996). Such residences also provide a place
for students who do not want to experience "secondhand"
effects of other students' alcohol use. In a survey of students
living in an alcohol-free residence hall on one campus,
59% of the respondents chose a substance-free hall
because of academic issues (e.g., wanting a quiet place to
study) and 78% to avoid roommate problems associated
with drinking and other drug use (Finn, 1996).
Campuses may develop other strategies to create positive
environments that students can enjoy without alcohol
use. For example, campuses can offer recreational sports
later at night and on weekends or, instead of having a campus
pub, campuses can establish a coffeehouse.
Strategies to improve citizenship/academic excellence
Changes in campus policies that increase citizenship and
promote academic excellence may also help reduce alcohol
use and problems on campus. Conceptually, these changes
may be similar to changes in communities that help reduce
crime and violence. For example, some communities have
planted gardens to provide food for communities, to increase
community involvement, to beautify the community
and to increase citizen visibility. A side product of this
activity appears to be reduced vandalism and drug trafficking
(Davis and Lurigio, 1996).
Although many students are weekend drinkers and drink
alcohol primarily on Fridays and Saturdays, some students
begin their weekends on Thursdays because many campuses
do not schedule classes on Fridays. To address this
issue, some colleges schedule core courses on Friday mornings
and mandate classroom attendance, which forces students
to prioritize academic commitments through Friday
(Rabow and Duncanschill, 1995). At the University of Vermont,
the start of the school year was changed to avoid
Labor Day. This campus wanted students to start school
with a full, 5-day week to give the message that "a student's
academic experience will be rigorous" (Mitka, 1998, p. 500).
Chaloupka and Wechsler (1996) found that working students
were less likely to be involved in high-risk drinking.
Students who have to work in addition to study may have
less time and opportunity to drink alcohol. Although the
cross-sectional design of the study does not allow causal
interpretation, a future study could evaluate whether active
job placement or volunteering programs lead to less alcohol
use among students. If so, encouraging students to work,
volunteer or complete internships may not only increase
skill levels, civic responsibility and community connections
but also decrease alcohol-related problems.
Chaloupka and Wechsler (1996) also found that students
who live on campus or in fraternities and sororities are
more likely to engage in high-risk drinking than students
who live off campus. Other studies have also found a higher
level of alcohol use among students involved in fraternities
and sororities compared with students not involved with
these organizations (Cashin et al., 1998). Students more
prone to heavy drinking may be more likely to choose to
live in sororities or fraternities or live on campus because
of the emphasis on drinking found in these settings. Another
explanation may be that students who live off campus
live among nonstudents who will not tolerate excessive
drinking, noise and disruption. To increase expectations
about responsible behavior in living situations, colleges
could encourage staff and faculty to live in on-campus
housing.
Considerations for Campus and Community Leaders
Although information about optimal implementation procedures
or effectiveness of many other environmental strategies
is limited, particularly for college-specific populations,
the existing research literature can still guide selection of
environmental strategies. Strategies that have been effective
in other contexts and with other populations may be
generalizable to college populations and campuses. However,
all new strategies, whether individually or environmentally
focused, should be evaluated to determine their
effects on targeted outcomes and to detect potential unintended
consequences.
Within a given college, policy changes may be necessary
within the Greek system, residence halls, sports organizations,
departments and student centers as well as at the
campus-wide level. Policy development across campus can
be coordinated so that all campus policies complement each
other and combine into a comprehensive package of policies
(Hingson et al., 1997). Representatives from organizations
across campus, including students, should be included
in development of policies to increase support for policies.
However, complete consensus is not necessary to achieve
successful policy changes.
Because student drinking behavior is also influenced by
the off-campus environment, local, state and national policy
changes are also necessary. Off-campus institutions such as
alcohol establishments and work sites also need to change
their alcohol policies. Campus leaders can collaborate with
other community members to achieve these changes. To
make policies most effective, people need to know that the
policy exists and believe they will face consequences if
they do not comply with the policy (Blomberg, 1992; Ross,
1992).
Examples of specific questions campus leaders can ask
when developing environmental strategies to address alcohol-related problems include:
What type of problem needs to be addressed (e.g., high rates
of heavy drinking, fights during sporting events, underage
drinking)?
What environmental strategy is most likely to address this
problem?
At what level should this strategy be implemented (e.g., at
sports stadium, campus-wide, community-wide, statewide)?
Who should be at the table when developing environmental
strategies? Who should participate at the start, and who should
be brought in only after a supportive base for action is established?
What existing environmental strategies are currently being
implemented?
How well are existing policies being enforced? Would enforcement
of existing policies be more effective than implementing
new policies?
How can environmental and individually focused approaches
complement each other?
What resources are needed to implement new strategies? Are
resources available?
How will new strategies be evaluated and fine-tuned to maximize
effect?
Considerations for Researchers
Relatively few of available alcohol prevention policies have been well evaluated.
The two most well studied alcohol control policies—MLDA and excise taxes—have
primarily been assessed for effects on alcohol consumption and traffic crashes
(Wagenaar and Toomey, 2000). Other policy issues such as alcohol outlet density
and advertising have been fairly well studied; others such as keg registration
and restrictions at community events have not been studied at all. Although
alcohol control policies can be implemented at institutional, local, state and
national levels, most alcohol policies have been evaluated only at the national
and state levels. Policies like server training have been fairly well evaluated
at one type of institution—onsale alcohol establishments (e.g., bars and
restaurants)—but not evaluated for other types of institutions (e.g., college
campuses).
Few researchers have evaluated the effects of alcohol policies on drinking
and resulting problems specifically on college campuses. Of 241 analyses assessing
the effects of the age-21 MLDA, 31 analyses specifically evaluated the effect
of MLDA on college campuses. Of these, only five were studies of high methodological
quality—that is, those that include a longitudinal design, comparison groups
and probability sampling or use of a census (Wagenaar and Toomey, this supplement).
Although several studies have evaluated effects of price of alcohol and excise
taxes on youth, we identified only two studies assessing effects specifically
on college students. One of these studies also evaluated the effects of other
environmental policies, including alcohol sales on campus and density of alcohol
outlets near campus. Although the study used a nationally representative sample
of students in 140 U.S. colleges and universities, the study was limited to
a cross-sectional design, preventing assessment of causal relationships.
Colleges have many policy options for addressing drinking
among students. However, much research is needed to
determine the most effective policy approaches on campus
and off campus to reduce underage and heavy drinking by
college students. A starting point is to implement and evaluate
effects of policies that have been proven effective with
other populations to determine their effectiveness with a
college population.
Specific examples of research questions include:
How effective is each type of campus policy in reducing college
drinking and heavy drinking?
How effective is each type of campus policy in reducing specific
types of alcohol-related problems?
How many campuses implement these policies?
How well are existing policies enforced? What factors influence
enforcement levels?
Does increased enforcement increase effectiveness? How much
enforcement is necessary?
Do awareness campaigns addressing specific policies increase
effectiveness?
What process is most effective for developing campus policies?
How do community and state alcohol policies affect college
drinking and problems?
How can colleges be most effective in collaborations to influence
local and state policy?
How effective are other environmental strategies developed by
colleges in reducing college drinking?
Conclusions
Studies using robust research designs indicate that reducing
alcohol availability through policy change reduces
alcohol consumption and related problems. Although research
evaluating the effect of alcohol policies and other
environmental strategies on drinking and related problems
among college students is limited, campus leaders can
choose from a broad list of environmental strategies, many
of which have been evaluated and found promising in other
settings. Researchers and campus leaders need to collaborate
to evaluate effects of environmental strategies and to
develop guidelines for optimal combinations of policies and
other efforts to shape the campus environment around
alcohol.
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†Traci L. Toomey may be reached at the above address
or via email at: toomey@epi.umn.edu.
