National Advisory Council on Alcohol Abuse and Alcoholism

Summary of Meeting

April 3, 2002

On April 3, 2002, the National Advisory Council on Alcohol Abuse and Alcoholism convened for a special teleconference at 2:04 p.m., at the Willco Building, Rockville, Maryland, to review, discuss, and evaluate the College Drinking Task Force Report, presented by Task Force members Drs. Mark Goldman, University of South Florida, and Ralph W. Hingson, Boston University. Other Task Force members in attendance included Dr. Marilyn Aguirre-Molina, Columbia University, and Dr. Harold D. Holder, University of California, Berkeley.

Drs. Raynard S. Kington, Acting Director, and Mary Dufour, Deputy Director of NIAAA, presided during the open meeting of April 3.

Marilyn Aguirre-Molina, Ed.D.
Alpha E. Brown, Ph.D.
Raul Caetano, M.D., Ph.D.
Richard A. Deitrich, Ph.D.
Reuben A. Gonzales, Ph.D.
Harold D. Holder, Ph.D.
Linda Kaplan, CAE
Barbara J. Mason, Ph.D.
Steven M. Mirin, M.D.

Sandra A. Brown, Ph.D.
Anna Mae Diehl, Ph.D.
George F. Koob, Ph.D.
Matthew K. McGue, Ph.D.
Sheryl Ramstad Hvass, J.D.
Paul Samuels, J.D.

Raynard S. Kington, M.D., Ph.D.
Acting Director, NIAAA

Mary Dufour, M.D., M.P.H.
Deputy Director, NIAAA

Kenneth R. Warren, Ph.D.
Acting Executive Secretary for the Advisory Council
Director, Office of Scientific Affairs, NIAAA

Dr. Ralph W. Hingson and Dr. Mark Goldman of the College Drinking Task Force were also in attendance, as were approximately 23 observers, including NIAAA staff and one liaison organization representative.

Call to Order and Opening Remarks

Dr. Kenneth R. Warren, Acting Executive Secretary, opened the meeting by welcoming all attendees to the meeting of the National Advisory Council on Alcohol Abuse and Alcoholism to discuss the newly completed College Drinking Task Force Report.

Dr. Kington, Acting NIAAA Director, thanked the Advisory Committee members for participating in the review of the findings of the Task Force. He then asked Dr. Mary Dufour, Deputy Director, NIAAA, to chair the meeting.

Dr. Dufour briefly reviewed the background of the Task Force. The Task Force began their work three years ago and was co-chaired by Reverend Edward Malloy, President of Notre Dame, and Dr. Mark Goldman. She then turned the discussion over to Drs. Goldman and Hingson who gave additional history on the work of the Task Force.

In tracing this history, Dr. Goldman noted that the problem of underage drinking is not new. He recalled a letter he was given, which originally was sent by the president of the University of Iowa to a local restaurant. That letter told the restaurant owner that he should stop serving the undergraduates because it was causing too many problems, which the kids were bringing back to campus, and this was just going to have to stop. The local restaurateur replied, "You’re never going to be able to stop college drinking. This is a silly enterprise, and why are you taking it on?" That exchange of letters took place about 1934.

Dr. Goldman pointed out that, although underage drinking has posed a problem for decades, only recently has the subject of college drinking gained tremendous publicity, and the high rates of alcohol related deaths among college-age people have attracted congressional attention. The time was right for NIAAA to organize the Task Force on College Drinking.

The Task Force was made up of a diverse group—researchers and college presidents, as well as college and high school students—who came together to develop the most comprehensive approaches for dealing with drinking on college campuses.

The Task Force created two panels. The first one, Contexts and Consequences, concentrated on providing an overview of college drinking (for example, where drinking takes place and at which colleges and universities) and sought to better understand its consequences. Panel 2 focused on Prevention and Treatment.

Each panel was co-chaired by a researcher and a college president. Panel 1 was chaired by Drs. John Casteen from the University of Virginia and Sharon Wilsnack, University of North Dakota; Panel 2 was chaired by Drs. Judith Ramaley from the University of New Hampshire and Ralph Hingson, Boston University.

These Panels produced a number of important papers. The main product was the College Drinking Draft Report, which constitutes the final overall Task Force Report. This Report reviews the existing literature, identifies what we need to know, and makes recommendations based on what we already know. The Report is unique in that it is the first NIH report on college drinking. It includes suggestions for how to proceed based on those findings. Most importantly, it underscores the need for using rigorous research methods and solutions based on solid research findings. As noted by Dr. Goldman, such methods will ensure that research on the question of how best to prevent drinking on college campuses can move forward. Dr. Goldman said that this Report should not be viewed as an end product but actually as the beginning of a process.

Dr. Goldman noted that while the College Drinking Draft Report is the main product of the Task Force, each panel also produced individual papers focusing on the areas in which they were specifically involved. Panel 1 developed papers providing statistics on drinking and describing variables associated with college drinking. Panel 2 papers addressed intervention approaches and ongoing policies and practices.

The results of the 24 commissioned scientific papers were instrumental in informing the Task Force’s Draft Report. Most of those papers will be published in a special supplementary issue of the Journal of Studies on Alcohol, due out in March. Brochures on college-age drinking directed toward college presidents, parents, and peer educators also are planned.

Dr. Goldman pointed out that the papers on intervention underscored the fact that existing interventions do not address the different levels of intervention—including those directed at individual students, toward the university as a whole, and toward the communities in which the universities are located—all of which need to be addressed together to have an impact.

Dr. Goldman noted too that the Panel’s work led to a new way of thinking about intervention strategies—that is, classifying strategies into tiers. One tier includes strategies that already have empirical support within the college framework. Another tier includes interventions that have been shown to be effective in other venues, but which have not yet been tested in a college setting or which have not been supported by test results. Most of these strategies are large scale environmental prevention efforts that hold promise for preventing alcohol problems in college-age people.

According to Dr. Goldman, the Task Force plans to produce material that will challenge some of these existing notions or at least call for more research on practices such as these—which already are very well accepted but which lack empirical support.

At this point, Dr. Goldman turned the proceedings over to Dr. Hingson, who offered further comment on the key findings of the Task Force Panels.

Dr. Hingson said that as each Panel prepared their respective findings they exchanged reports to obtain the peer review of the other Panel. He noted that as he started to read the report he was struck by the magnitude of the college drinking problem.

Dr. Hingson also became concerned that the prime focus of the draft report at that time was on alcohol overdose deaths—more than 80 deaths among college students in a three year period. His concern was that there are many ways in which college students may lose their lives as a result of alcohol ingestion other than by overdosing. Dr. Hingson said that most of the survey work, though quite informative, gives only percentages on the proportion of college students who engage in certain risky behaviors or experience certain problems. Because the percentages have not been translated into absolute numbers it has been difficult to get a full sense of just how many college students are affected by alcohol related problems.

Recognizing this, the Panel further assessed the magnitude of alcohol related health problems among college students, including the number of students who drink heavily, drive after drinking, experience unintentional injuries and other health problems, as well as the number who die from alcohol related deaths.

The Panel obtained data from a number of sources, including the Fatality Analysis Reporting System of the U.S. Department of Transportation, mortality statistics from the Centers for Disease Control and Prevention (CDC), U.S. Census Bureau population data on numbers of individuals in the United States who are 18 to 24, and data from the U.S. Department of Education on the number of college students 18 to 24 in the United States. The meta-analysis of fatal non-traffic injury deaths developed by Gordon Smith also was included; it featured more than 300 medical examiner studies during a 20 year period. The Panel looked at national surveys that included college students: the 1995 CDC National College Youth Risk Behavior Survey; the Harvard School of Public Health College Alcohol Survey, conducted by Henry Wechsler; and the National Household Survey on Drug Abuse.

Dr. Hingson noted that the National Household Survey on Drug Abuse was quite helpful because it included more than 19,000 18 to 24 year olds, of which nearly 7,000 were enrolled either as full-time or part-time college students. Data from that survey enabled the Panel to make comparisons between 18 to 24 year olds in college and those who were not. They found that a greater proportion (42 percent) of college students reported heavy episodic drinking (i.e., five or more drinks on an occasion at least once in the last month), versus 38 percent of same age non-college drinkers. College drinkers also were more likely than non-college drinkers to report driving under the influence of alcohol in the previous year (27 percent versus 20 percent).

According to Dr. Hingson, the Panel estimated that approximately 1,400 18 to 24 year old college students die each year as a result of an alcohol related unintentional injury. About 1,100 of those injuries are from traffic crashes, the leading cause of death in the United States for people ages 1 through 24.

In another projection to determine the scope of drinking and drinking related problems in this age group, Dr. Hingson said the Panel used percentages of people who reported various risky behaviors and mapped them against college enrollment figures. For example, there are 8 million college students in the United States. The 27 percent of college students in the National Household Survey who said they drove under the influence of alcohol in the last year translates to approximately 2 million college students. Forty-two percent of those surveyed said they had five or more drinks on an occasion in the past month, which translates to 3.3 million students. The Panel also estimated that 3.3 million rode in a vehicle driven by another person who had been drinking.

Using this projection technique, the Panel also was able to estimate that, as a result of drinking:

• 500,000 college students aged 18 to 24 were hurt or injured in the previous year;
• 400,000 had unprotected sex;
• more than 100,000 had sexual intercourse when they were too intoxicated to consent;
• 70,000 were victims of a sexual assault or date rape; and,
• 600,000 in a given year were assaulted by other students who had been drinking.

According to Dr. Hingson, this is the first time estimates of the absolute numbers of college students affected by these problems have been made. He also noted that the finding that college drinkers were more likely than non-college drinkers to drink heavily and to engage in risky behaviors may be misleading. Although it was estimated that each year, 1,400 college students aged 18 to 24 die from unintentional alcohol related injuries, the Panel projected that 3,200 non-college, 18 to 24 year olds die each year from alcohol related unintentional injuries. The Panel also estimated that although 2 million college drinkers drive under the influence of alcohol, another 3.3 million non-college persons of that age also engage in this risky behavior.

Dr. Hingson summarized the Panel findings by saying that two strong conclusions can be reached. First, the magnitude of the problem of college-age drinking is enormous and should be of concern to everyone. He added that the Panel used the most conservative methods available to estimate the numbers of students involved and that the current reporting systems need to be improved. For example, the Fatality Analysis Reporting System and the CDC mortality data do not specifically identify whether people who die in traffic crashes are college students. He went on to say that it would be especially useful if the reports of all traffic deaths and all unintentional injury deaths included testing for the presence of alcohol and indicated whether the person involved was a college student or not.

Second, successful interventions do exist to reduce drinking problems among college students, including a number of individually oriented brief motivational intervention techniques, and a series of environmental interventions, such as enforcement of the legal drinking age, increasing price (through, for example, higher taxes), reducing outlet density, and so on.

In addition, said Dr. Hingson, colleges and communities must collaborate to develop comprehensive community/campus programs to reduce alcohol related problems. Campuses cannot address the problem without involving the community, as that will simply drive alcohol related college problems out into the community. Likewise, if the community addresses the problem but the campus does not, it will drive the problem back onto the campus. This problem effects everyone, college and non-college alike.

In further summarizing the Panel findings, Dr. Goldman noted that there is a larger issue to confront. He stressed that the Task Force Report should not be just another Government document, with a brief mention on the back pages of a newspaper. This Report needs to signal the beginning of an initiative that will alert the world to the enormity of the problem of college-age drinking and the fact that this problem is not being addressed.

According to Dr. Goldman, a key issue is that while many people may recognize that college drinking is a problem, it often is treated as "no big deal." The public perspective is that these are isolated instances, and that by and large most adults somehow got through it, so why is NIAAA making a big deal out of it?

Dr. Goldman pointed out that the title of the Report should focus on changing the culture of drinking within the community as a whole and not just within the campus environment.

The floor was then opened for discussion.

Dr. Caetano said he had no problems at all with the report. He agreed that it must be emphasized that this is not a problem that college campuses or college and university presidents or regents can solve by themselves. He noted that for years American society has seen this as a problem of college kids that should be left to the college campuses to handle. The general public has been reluctant to see college drinking as a consequence of the role of alcohol in the larger U.S. society and especially in the communities in which colleges are located. Dr. Caetano said that the Task Force needs to use all possible means to emphasize this broader context.

Dr. Kington thanked Drs. Caetano, Goldman and Hingson, and asked other participants if they wished to comment.

Dr. Holder began his comments by saying that he had been involved in the Task Force from the start. He re-emphasized that drinking among people who are underage (that is, under 21) and among 21 to 25 year olds is the highest of any age group in our society. These people also incur a much higher proportional risk for alcohol related problems. Dr. Holder said his concern was that the Panel has not systematically targeted the 21 to 25 year old age group. He said he was now convinced, after looking at statistics from the military, that perhaps the highest risk drinking environment in the United States is the college and university setting. He noted that the military has made significant strides in cutting down on substance abuse problems, not only drug use but also alcohol use.

Dr. Holder also agreed that people have not systematically looked at the college population or the college campus from a prevention point of view. Much of what has been done in prevention, he said, has focused on targeting specific populations, usually high-risk individuals who have been identified for individual interventions. According to Dr. Holder, this is only the "tip of the iceberg" in terms of drinking problems and the distribution of drinking.

Dr. Holder remarked that everyone understood the impatience of college presidents who want a quick solution to this problem. Unfortunately, he noted, ready made research based, evidence based prevention strategies specifically designed for college campuses do not yet exist.

Lastly, Dr. Holder, in agreement with Drs. Goldman and Hingson, emphasized that very few colleges are fortresses, isolated from the communities in which they exist. In fact, the college often dominates the community. College drinking is a problem that affects the college campus and the community in which it is situated. To design effective prevention measures researchers must undertake controlled studies that involve both the college and the community. The focus should not be only on the community or on the individual students, but should instead target the overall environment in which the college exists and in which these students live.

Dr. Aguirre-Molina agreed with the comments made by Dr. Holder. She added that this Report gives the Task Force an important opportunity to focus more than momentary attention to the issue of college-age drinking. She reiterated earlier comments that careful follow-up will be important.

Dr. Alpha Brown asked if the topic of alcohol marketing would be addressed in the Report. Although he noted a reference to the topic, he indicated that this is an important issue for youth. He cited the fact that media and music targeted to youth often are "very saturated with alcohol use messages."

Dr. Hingson responded that the Report included information from a paper on alcohol advertising by Dr. Henry Saffer. According to Dr. Saffer, the most cost effective way to address the issue of alcohol advertising is through counter-advertising about the harms associated with alcohol. He recommended that the Task Force promote the use of counter-advertising to accompany advertisements that promote alcohol use. He also urged that counter-advertisements employ a number of communication vehicles, such as electronic and print media, billboards, and so on.

Dr. Goldman added that in considering the issue of advertising, it is difficult to isolate marketing targeted to college students from marketing directed to the community at large. He noted the media may promote alcohol in ways other than through advertising. He cited as an example, the movie "E.T.," in which E.T. drinks beer and the little boy who is attached to him becomes wildly intoxicated and causes all kinds of mayhem that is very entertaining to kids. He said it is difficult to separate the effects of advertising from those of the larger media environment. Nevertheless, he agreed that counter-advertising is useful and suggested that, instead of concentrating only on alcohol’s harmful effects, the goal of the counter-advertising message might simply be to diminish the sense that alcohol does good things for you. As he noted, "It isn’t just that it makes you sick and causes accidents, which most people think is not going to happen to them, but that it doesn’t provide the level of good time that most people think it does either." Advertising must be approached in a broader way, though we do not yet have the specifics on how to do this.

Dr. Brown agreed that advertising is only one way that alcohol is marketed in our society. He related an experience in which he conducted a simple test with a seventh grade class, asking them if they knew the name of the Secretary of State and the deputy governor. Only 1 child out of 40 knew the answers. On the other hand, when he asked them if they knew what a "Bud" was or if they knew the color of Newports, it became clear that they have knowledge of specific brands of alcohol and tobacco products. Dr. Brown said the children were unaware of how strongly advertising can influence them. He said it is important to equip youth and young adults with an understanding of the techniques used in marketing—not just through counter-advertising but through counter-information.

Dr. Goldman thanked the Council for their feedback on the Report. He said that this meeting illustrated one of the main goals of the Report—to generate new ideas and new ways of testing those ideas. Testing, he said, is key. Dr. Goldman recalled that at the start of the project, NIAAA’s former director, Dr. Enoch Gordis, discussed the difficulty facing the Task Force: that the problem of underage drinking periodically becomes recognized, then re-recognized, but then the focus tends to fade away, despite many good intentions. He attributed this fluctuation in focus to the fact that, although the ideas have been generated and the programs are put into place based on those ideas, no one really tests them.

Dr. Goldman stated that it is vital that the Task Force’s recommendations have an empirical foundation, a research basis, wherein ideas are generated, implemented, tested, and then revised based on research findings. Dr. Goldman said he agreed with "virtually everything said" at the meeting, adding only that more needs to be done. The current version of the Report, he said, was restricted to spotlighting only those programs that to date have been tested. Dr. Goldman closed by expressing the Council members’ hope that this Report kicks off a new phase of research.

Dr. Kington added that NIAAA sees this Task Force as a beginning of a long process that will lead to effective evidence based interventions. He then called for a motion to accept the Council Task Force Report.

Dr. Caetano so moved and Dr. Aquirre-Molina seconded the motion.

All council members were in favor of accepting the report; there were no abstainers.

Dr. Warren thanked the Council members for participating in the meeting. He noted that the motion passed, and handed the floor back over to Dr. Kington.

Before closing the meeting, Dr. Kington reminded everyone that the Report would be embargoed until 7:00 a.m. on April 9, and that NIAAA would be distributing information about media events which would be of particular interest to Council members.

There were no further comments or questions and the meeting was adjourned at 2:55 p.m.

CERTIFICATION

I hereby certify that, to the best of my knowledge, the foregoing minutes are accurate and complete.

Posted: November 18, 2002