BOYD AND FADEN 5

Introduction
MARK S. GOLDMAN, PH.D.
Department of Psychology, University of South Florida, BEH 339, 4202 Fowler Avenue, Tampa, Florida 33620-8200

A WARENESS 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
and Consequences of College Drinking, and Panel 2 fo­
cused on Prevention and Treatment of College Alcohol
Problems. Additional information about the structure and
at least 50 years. Available research indicates that approxi­ composition of the Task Force and its two panels is avail­
mately 80% of college students drink and that half of col­ able in their individual reports, which are on the NIAAA
lege student drinkers engage in heavy episodic drinking. web page (www.niaaa.nih.gov). Each of the two panels com­
Excessive alcohol intake among college students is associ­ missioned review papers to inform discussions and to lead
ated with a variety of adverse consequences: fatal and non­ to construction of the overall Task Force Report (which is
fatal injuries; alcohol poisoning; blackouts; academic failure; to be released in tandem with this supplement). The 18
violence, including rape and assault; unintended pregnancy; articles appearing in this supplement are adapted from the
sexually transmitted diseases, including HIV/AIDS; prop­ review papers. Each panel’s research recommendations fol­
erty damage; and vocational and criminal consequences that low that panel’s introduction.
could jeopardize future job prospects. Students who engage It must be noted that the extent and quality of the re­
in excessive drinking impact not just themselves. Fellow search base in each of the areas reviewed varied consider­
students experience secondhand consequences ranging from ably. In fact, this very variation was a primary impetus for
disrupted study and sleep to physical and sexual assault. the initiation of the Task Force on College Drinking. Al­
Furthermore, the institutions they attend expend valuable though college drinking has been a concern for some time,
resources to deal with institutional and personal conse­ amelioration of the problem has been hampered by incon­
quences of their behavior. sistent attention from both college administrators and re­
To address these serious consequences of alcohol con­ searchers. And, when attention is given, it is too often short
sumption by college students, the National Advisory Coun­ lived and based on current fads, rather than on solid em­
cil to the National Institute on Alcohol Abuse and pirical evidence. The fundamental rationale for the Task
Alcoholism (NIAAA) established the Task Force on Col­ Force on College Drinking is to organize and integrate ex­
lege Drinking in 1998. The composition of the Task Force isting information but, most importantly, to have the prod­
was novel. College presidents and research scientists were uct of these efforts serve as a foundation for future research
put together to ensure that the product would at the same that will advance our ability to impact the problems in ques­
time contribute to the scientific basis for addressing col­ tion. To this end, the articles in this supplement are offered
lege drinking and would be relevant to the practical chal­ as a foundation for the next generation of inquiry into this
lenges faced by college administrators. The Task Force was serious societal problem. Drinking on college campuses may
charged with integrating available scientific research with seem to be entrenched and impervious to intervention; how­
experiences reported by administrators, service providers ever, it is potentially modifiable with carefully targeted
and students. approaches endorsed by all stakeholders—including stu­
Because of the breadth of information to be considered, dents—who truly value the institution.
two panels were formed: Panel 1 reviewed the Contexts

6 JOURNAL OF STUDIES ON ALCOHOL / SUPPLEMENT NO. 14, 2002

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 evaluate college drinking, whereas others had a broader
two panels of the National Advisory Council on Alcohol focus. Despite different strengths and weaknesses, all ob­
Abuse and Alcoholism Task Force on College Drinking tain strikingly similar findings: About 80% of college stu­
(see Introduction, this supplement). They are organized and dents drink, about 70% have had a drink in the past 30
discussed below according to panel. days and about 40% engage in heavy episodic drinking.
Racial/ethnic and gender effects are also consistent across
Panel 1: The Contexts and Consequences studies; male students drink more than female students, and
of College Drinking white students drink more than black or Hispanic students.
Many biological, social and psychological factors have
The ten Panel 1 articles on college drinking fall into been studied to explain the wide variation in drinking among
three major categories: (1) the statistics of drinking in col­ individual college students. Baer (“Student Factors: Under­
lege; (2) the factors involved in college drinking—indi­ standing Individual Variation in College Drinking”) reviews
vidual, developmental and institutional; and (3) the this literature, which is of varying quality, is largely depen­
consequences of drinking, including theoretical ideas ap­ dent on questionnaire responses from cross-sectional con­
plied to the connection between alcohol consumption and venience samples and has tended to focus on student
three particularly serious consequences (risky sexual be­ personality characteristics. Nonetheless, a number of themes
havior, sexual assault and aggression.) Dowdall and emerge. Drinking among college students is often associ­
Wechsler (“Studying College Alcohol Use: Widening the ated with impulsivity/sensation seeking or the regulation of
Lens, Sharpening the Focus”) outline how to select the types negative emotional states including depression and anxiety.
of institutions to be included, specify the population to be Many students are heavily influenced by social factors, how­
studied, choose the sample and decide on the methods of ever. Studies have also indicated that religiosity is inversely
data collection and analysis when designing a study of drink­ related to drinking and sociability positively related to drink­
ing among college students. The authors indicate that ad­ ing and that members of Greek organizations and students
vancing this field will require complex study designs, new involved in athletics drink more that other students. Studies
variables and the incorporation of new data accrual and on expectancies and individual perceived norms have indi­
analytic methodology. They argue for future studies to in­ cated a relationship with drinking, although more work is
vestigate college drinking as a phenomenon that takes place needed. Also needed are more longitudinal studies, more
in a larger social, economic and political context than just investigations representative of the broader college popula­
the college itself. tion, additional work on the genetics of alcohol-related prob­
O’Malley and Johnston (“Epidemiology of Alcohol and lems in this population and studies that use multivariate
Other Drug Use among American College Students”) ex­ approaches.
amine the results of several large national studies on col­ Schulenberg and Maggs (“A Developmental Perspective
lege student drinking: (1) the Harvard School of Public on Alcohol Use and Heavy Drinking during Adolescence
Health College Alcohol Study, (2) the Core Institute, (3) and the Transition to Young Adulthood”) examine alcohol
Monitoring the Future, (4) the National College Health Risk use during adolescence and young adulthood in a develop­
Behavior Survey and (5) the National Household Survey mental framework, which considers the tasks and challenges
on Drug Abuse. Some studies were designed specifically to of adolescence. These fall within the broad domains of bi­
ology, cognition, identity, affiliation and achievement. The
authors indicate a number of differing alcohol use trajecto­
†
Vivian Faden is with the Epidemiology Branch, Division of Biometry ries at this time of life, some of which are more trouble­
and Epidemiology, National Institute on Alcohol Abuse and Alcoholism, some than others. They also examine risk and protective
Bethesda, MD. factors from a developmental perspective and within a so­

 BOYD AND FADEN 7

ciocultural context. Five conceptual models that relate clusion, these authors emphasize the importance of a co­
developmental transitions to substance use are offered: Over­ gent model of student drinking that incorporates the envi­
load, Developmental Mismatch, Increased Heterogeneity, ronment, student campus culture and individual factors.
Transition Catalyst and Heightened Vulnerability to Chance The consequences of college drinking were addressed in
Events. Like other researchers represented in this supple­ four papers commissioned by Panel 1. The first article pre­
ment, Schulenberg and Maggs recognize the complexity of sents an overview; those that follow offer more detailed
the influences on drinking among college students and rec­ analyses of three specific consequences: risky sexual be­
ommend multiwave, contextually sensitive, longitudinal re­ havior, alcohol-related sexual assault and alcohol-related
search. Finally, they suggest that a developmental aggression. Panel 1 decided that these three consequences
perspective can inform and enhance intervention. warranted additional attention because of their potential to
College students typically begin their collegiate careers cause serious and long lasting problems.
in late adolescence, a time of continued development of the Perkins (“Surveying the Damage: A Review of Research
brain. Two important questions arise, therefore. First, is on Consequences of Alcohol Misuse in College Popula­
there something about the adolescent brain that affects sen­ tions”) reviews the literature on the nature, extent and pat­
sitivity to alcohol’s effects, or that intensifies the adoles­ terns of negative consequences that result from alcohol
cent’s inclination to drink? Second, does drinking during consumption by college students. These consequences im­
this period of brain development have enduring effects on pact the individuals who drink, their fellow students and
the brain? Spear (“The Adolescent Brain and the College the institutions they attend. They range widely in severity
Drinker: Biological Basis of Propensity to Use and Misuse and may have short, longer term or even lifetime sequelae.
Alcohol”) examines animal and human studies relevant to The consequences of student alcohol consumption include
these critical questions. Although more work is needed, re­ fatal and nonfatal injuries; hangover and vomiting; alcohol
cent evidence indicates that adolescents may show reduced poisoning; blackouts; academic impairment or failure; vio­
sensitivity to alcohol’s effects and increased sensitivity to lence, including rape and assault; unintended sexual activ­
stressors, both of which may influence drinking behavior. ity; unintended pregnancy; sexually transmitted diseases,
In addition, alcohol exposure during adolescence may including HIV/AIDS; litter and property damage; and vo­
disrupt brain development and functioning. For example, cational and criminal consequences that could jeopardize
hippocampal volume has been associated with alcohol con­ future job prospects. One caveat is that the literature in this
sumption in human adolescents (De Bellis et al., 2000), area is of mixed quality and has significant gaps such as a
and neuropsychological studies of adolescents have indi­ paucity of information on patterns of consequences among
cated a connection between drinking and memory deficits different racial/ethnic groups or on individual and global
(Brown et al., 2000; Tapert and Brown, 1999). If supported time trends. Nonetheless, this body of work indicates sub­
by further research, such information might be dissemi­ stantial adverse consequences, with patterns of damage that
nated to adolescents as part of an integrated intervention appear to follow patterns of drinking. Generally, more con­
strategy. sequences are found among men than women and among
Presley, Meilman and Leichliter (“College Factors That whites and Native Americans than Hispanics and blacks.
Influence Drinking”) consider the relationship of collegiate Research in this area also has shown that most students do
environments to student drinking. The authors note, how­ not believe that they have a drinking problem, regardless
ever, that the existing literature in this area is sparse and of the alcohol-related consequences they experience.
typically has examined institutional variables one at a time, Cooper (“Alcohol Use and Risky Sexual Behavior among
rather than in multivariate models. In general, studies indi­ College Students and Youth: Evaluating the Evidence”) ex­
cate that the following institutional variables are related to plores alcohol consumption and risky sex among college
student alcohol consumption: affiliations (e.g., historically students and youth. The existing literature indicates a strong
black institutions, women’s institutions), presence of a Greek association between alcohol consumption and having mul­
system, role of athletics on campus, 2- or 4-year designa­ tiple or casual sexual partners as well as alcohol use and
tion, type of residence hall, institution size, location, overall the decision to have sex in the first place. There was an
quantity of drinking on campus, the pricing and availability inconsistent relationship between alcohol consumption and
of alcohol and outlet density. The authors conclude that, at the use of condoms and birth control. Available data indi­
this time, research is insufficient to indicate which factors cate that a large percentage of college students drink, many
most affect student drinking. Additional as yet unstudied are sexually experienced, and a substantial minority have
and/or unrecognized aspects of collegiate environments also experienced one or more adverse consequences of sexual
may be important predictors of student drinking on particu­ risk taking. The author explores the effect of alcohol on the
lar campuses. Colleges and universities are themselves em­ instigatory and inhibitory cues controlling sexual behavior,
bedded in larger environments at the same time that they the role of alcohol expectancies in sexual risk taking and
comprise smaller social and cultural environments. In con­ the extent to which an individual’s life situation may ex­
8 JOURNAL OF STUDIES ON ALCOHOL / SUPPLEMENT NO. 14, 2002

plain both drinking and risky sexual behavior. She con­ ies (often, but not exclusively, conducted with college stu­
cludes that each of these models may explain some aspects dents) also link alcohol and aggression. Despite some limi­
of the association between alcohol and sexual risk taking. tations, this body of work indicates that the consumption of
Drinking alcohol in sexual situations may increase the like­ alcohol significantly increases the likelihood of aggressive
lihood of intercourse depending on what drinking means to behavior. Giancola reviews general theories of aggression
the individual. Alcohol consumption also increases the like­ and the theoretical formulations that have been advanced
lihood of indiscriminate sexual behaviors, but this may be to explain the alcohol-aggression relationship. These con­
moderated by the individual’s stage in a relationship. The ceptual models include disinhibition and expectancy mod­
author concludes that historical context, developmental stage els and a number of cognitive models that focus on
and chronological age confound the link between alcohol processing of cues, self-awareness and executive function­
consumption and the use of protective measures in a sexual ing. Not all people become aggressive when they drink,
situation. In sum, a range of models plausibly relates alco­ however, nor do people become aggressive in all situa­
hol to risky sex; consequently, research should be directed tions. Studies have suggested that individual differences in
to understanding under what circumstances and for what dispositional aggressivity; expectancies about the effects of
individuals or subgroups of individuals different causal pro­ alcohol on aggression; drinking history; executive function­
cesses operate. ing; hostile attributional biases; individual biochemistry and
Abbey (“Alcohol-Related Sexual Assault: A Common gender; and contextual variables such as blood alcohol con­
Problem among College Students”) focuses on sexual as­ centration limb effects, alcohol type and dose, social pres­
sault involving female victims and male perpetrators. She sure and provocation affect the relationship of alcohol
defines sexual assault to include the full range of forced consumption and aggression. Giancola concludes that alco­
sexual acts, including rape. Cross-sectional studies have used hol consumption is not a factor in behavior for which there
varying definitions and time periods, but consistently indi­ is no predisposition in the sober state.
cate 25-50% of women report such an experience. Fewer
college men report committing sexual assault than women Recommendations
report experiencing it; according to Abbey, this discrep­
ancy is likely related to gender differences in understand­
After reviewing and discussing the material in this vol­
ing of a woman’s nonconsent. Of the sexual assaults on
ume, the panel made recommendations to college adminis­
campus, at least half are associated with alcohol use by the
trators, funding agencies and the research community. The
perpetrator or the victim, but most often by both. In most
research recommendations were based on the panel’s con­
cases, the victim knows the perpetrator, and about half of
clusion that sound, thoughtfully designed research studies
the time the assault occurs on a date. The strong associa­
are likely to have an impact on excessive and underage
tion between alcohol and sexual assault does not demon­
alcohol use among college students. The key research rec­
strate causality, however, and a number of causal pathways
ommendations of the Panel on Contexts and Consequences
may explain some sexual assaults. Abbey presents a con­
follow:
ceptual model of alcohol-related acquaintance sexual as­
sault and reviews the studies that examine the factors that
• Characterize better the extent of clinical level problems
may interact with alcohol to make sexual assault more likely.
(alcohol abuse and dependence) and alcohol-related
These factors include expectations about the effects of al­ comorbidity in the college population.
cohol; stereotypes about drinking women; alcohol’s effects • Understand the relationship between clinical levels of drinking
on cognition, behavior and motor skills; perceptions of con­ and student consumption indicators (e.g., heavy episodic
trol and responsibility; and peer environments that encour­ drinking).
age heavy drinking and sexual activity. The author suggests • Examine the predictive value of college drinking for later
that future studies include students of varying racial, cul­ alcohol-related problems.
tural and ethnic backgrounds; ascertain the amount of alco­ • Identify the economic consequences of college drinking,
hol consumed (and not just whether it was consumed); and including the cost to colleges of damage to the physical plant.
follow students longitudinally. The review concludes that, • Assess the impact of community pricing policies on drinking
among college students.
because of the strong association of alcohol use and sexual
• Understand more completely the academic consequences of
assault, programming and intervention on campuses in these
college drinking, including the mechanism(s) through which
two areas should be coordinated. alcohol may influence academic outcomes.
Giancola (“Alcohol-Related Aggression during the Col­ • Refine understanding of the heterogeneity of heavy drinking
lege Years: Theories, Risk Factors and Policy Implications”) trajectories in adolescence and early adulthood, through
examines research on prevalence and patterns of alcohol- longitudinal studies, with a particular focus on what factors
related aggression and indicates there is a serious problem determine moving from a heavy drinking or high episodic
on college campuses. A large number of experimental stud­ drinking pattern to a lower one, and vice versa.
 BOYD AND FADEN 9

• Focus on how developmental transitions to college, to work To reflect this position, DeJong and Langford adopt a
afterward, to a new intimate partner or to a new friendship can social ecological framework that recognizes that health be­
serve as windows of opportunity for effecting change in haviors, including drinking, are affected through multiple
behavior, including drinking. levels of influence. A simple typology for describing inter­
• Examine the relationship between the prior drinking histories
vention approaches is presented that crosses the levels of
of incoming students and their use of alcohol in college and
influence in the social ecological model (individual, group,
consider what other variables moderate this relationship.
• Assess whether alcohol use by college students interferes with institution, community and public policy) with intervention
their social and emotional development (both short- and long­ targets and methods (knowledge, attitudes and intentions;
term). environmental change; health protection; and intervention/
• Assess how institutional consequences (e.g., dismissal or other treatment). This sort of typology is useful in making com­
sanctions) impact drinking behavior. parisons among researched interventions, and it informed
• Identify those problem-related, individual-level variables (e.g., the final recommendations made by the panel. When such
drinking motivations) that are potentially modifiable; use this a typology is applied to ongoing prevention efforts, it be­
information to point to opportunities for intervention. comes clear that the majority of work has been directed
• Discern how individual-level variables interact with the larger toward individual and group programs that target knowl­
environment to identify possible environmental interventions
edge, attitudes and behavioral intentions; environmental
that might reduce the risk of hazardous drinking for especially
change has been relatively neglected. In fact, a 1998 ran­
vulnerable individuals.
• Improve understanding of the association between alcohol dom sample survey of 2- and 4-year colleges in the United
consumption and both acute and chronic problems, recogniz­ States indicates the existence of barriers to the institution
ing the complexities of the relationships, the influence of other of comprehensive programs. Many campuses do not have
variables at the individual and situational levels and bi­ in place basic infrastructures and resources needed to imple­
directional causation; high priority research areas include the ment and evaluate prevention strategies with an environ­
effects of alcohol consumption on sexual behavior, sexual mental management focus. Clearly, both research and
assault and other aggression, academic performance and dissemination efforts are needed in this regard.
compliance with academic norms. Not all prevention and intervention strategies are directed
• Assess more carefully the validity of self-report measures of toward the general college population, however. Popula­
student alcohol use and explore the use of alternative data
tion subgroups, based on risk for alcohol-related problems,
collection methods including observational, archival and
were also considered by the panel in assessing the potential
biomedical methods.
impact of specific intervention approaches, how they should
be implemented, to whom delivered and the appropriate
Panel 2: Prevention and Treatment of College
level of resources that should be allocated. The campus
Alcohol Problems
population includes approximately 19% abstainers, 37% “so­
cial” drinkers who do not engage in heavy episodic drink­
The Panel on the Prevention and Treatment of College ing, 21% higher risk drinkers who occasionally consume
Alcohol Problems commissioned the eight articles appear­ five or more (four or more for women) drinks on a single
ing in this section. To place subsequent reviews in context, occasion and 23% who frequently consume five or more
an overall review of practices currently in place to reduce drinks. Approximately 47% of drinkers do so “to get drunk”
alcohol-related problems on college campuses was com­ (Wechsler et al., 2000). Drinkers who fall near the extreme
pleted by DeJong and Langford (“A Typology for Campus- end of this continuum are likely to need more intensive
Based Alcohol Prevention: Moving toward Environmental intervention, and such services should be available to this
Management Strategies”). College administrations are un­ subset of the population. Lighter drinkers may be respon­
der pressure, due both to public opinion and potential legal sive to less costly approaches. It is critical that students
liability, to take action to prevent problems. Historically, who have chosen not to drink at all are also acknowledged
these prevention efforts have focused on educational strate­ and supported. Any successful comprehensive approach will
gies, but accumulating research has indicated these strate­ ensure that these students are helped to resist pressures to
gies do not appear to be effective in isolation (Larimer and drink if they so choose and will provide the means for
Cronce, this supplement). More likely to have significant minimizing the untoward effects of other students’ drink­
impact are comprehensive interventions that include promi­ ing (e.g., on their ability to study).
nent environmental components. This position is entirely The following seven articles review and evaluate the
consistent with the recommendations of other authors in research literature underlying intervention approaches for
this supplement (see especially Toomey and Wagenaar; specific groups, make recommendations regarding future
Hingson and Howland), the Panel Report on Prevention research and discuss effective implementation of the inter­
and Treatment of College Alcohol Problems and the full ventions studied. Each provided valuable information for
Report of the Task Force on College Drinking. the panel’s deliberations.
10 JOURNAL OF STUDIES ON ALCOHOL / SUPPLEMENT NO. 14, 2002

Larimer and Cronce (“Identification, Prevention and on an intervention approach that spans the individual ver­
Treatment: A Review of Individual-Focused Strategies to sus environmental distinction. Campus norms for alcohol
Reduce Problematic Alcohol Consumption by College Stu­ use, perceived or real, are a strong predictor of individual
dents”) review research on interventions directed toward student drinking. He distinguishes attitudinal norms, which
individuals published between 1984 and 2000. Such inter­ describe attitudes about acceptable or expected behavior,
ventions have long dominated campus efforts to reduce al­ from behavioral norms, which describe what members of
cohol-related problems, but surprisingly few have been the group actually do. Perkins argues that, for college stu­
rigorously evaluated; fewer yet have been tested using ran­ dents, peer group and campus norms exert a stronger influ­
domized control designs. Hence, only 32 prevention stud­ ence on behavior than do family expectations. It should be
ies were identified that met minimal methodological criteria noted, however, that some recent research suggests parents
for inclusion in the review. may not be completely without influence if they make a
The initial response to campus alcohol-related problems concerted effort to moderate drinking by their older teens
is generally educational. If only students understood the (Turrisi et al., 2001). Nevertheless, social norms are pow­
risks involved, they would certainly modify their alcohol erful. To potentially influence these norms, Perkins goes
use behavior. But in accord with earlier reviews, Larimer on to argue that faculty expectations about alcohol and aca­
and Cronce report little evidence for the effectiveness of demic standards be emphasized to incoming freshmen and
informational programs that do not also include other ap­ that faculty become involved in outreach activities to direct
proaches. Much stronger support exists, however, for the problem drinkers into campus services. Resident advisers
effectiveness of skills-based and motivational enhancement are identified as another potential reference group that could
programs. These approaches also provide alcohol informa­ and should convey clear normative standards to students.
tion, but presented within a context that emphasizes its rel­ The strongest and most immediate normative influence re­
evance to specific alcohol-related situations and decisions. mains other students, however. Students appear to overesti­
For example, factual information about alcohol effects may mate other students’ actual drinking and approval for heavy
be used to challenge erroneous alcohol expectancies held by drinking and to underestimate fellow students’ support for
many college students that are known to predict their drinking. drinking restrictions. The correction of these misperceived
Multicomponent programs typically include some com­ norms underlies normative feedback components in indi­
bination of expectancy challenge, self-monitoring, drink re­ vidual-focused interventions and is the goal of some cam­
fusal skills, moderate drinking techniques, lifestyle skills/ pus-wide programs, including most social marketing
balance, normative feedback and motivational enhancement. campaigns (see DeJong, this supplement). Although this
Good evidence is reported for the effectiveness of multi­ approach has become widespread, and some limited evalu­
component skills-based programs, as well as for some of ation has been supportive, no rigorous research trials utiliz­
their components that have been tested in isolation. These ing randomized control designs are yet available. Research
programs involve multiple sessions with trained leaders. of this nature is needed to justify allocation of limited cam­
Even when delivered in groups, however, they are resource pus resources to the approach and to explore more fully
intense, making them less attractive for large-scale imple­ intervention characteristics and campus conditions that af­
mentation. Brief motivational interventions are a practical fect success.
alternative that may be equally effective for many at-risk In a related vein, a link between advertising and alcohol
students, and current research suggests they may not al­ consumption is intuitively compelling, but has not been con­
ways require one-on-one interaction with a provider. In con­ sistently supported by research. Saffer (“Alcohol Advertis­
trast, little research has been carried out on treatment ing and Youth”) reviews the research and varying
approaches for college students. methodologies used to study the relationships among ad­
Emerging across all the prevention and treatment litera­ vertising, brand capital (name recognition and perceived
ture is the issue of identifying, recruiting and retaining stu­ value), market share and total market size (consumption).
dents who are in need of alcohol programs. This issue The concept of diminishing marginal return is key to un­
remains a major challenge for both campus service provid­ derstanding these relationships. It describes the response
ers and researchers. Larimer and Cronce emphasize the need function of changes in a product’s consumption in response
for campus level coordination among multiple campus ser­ to increases (or decreases) in its advertising. At low levels
vice systems (e.g., student health centers, emergency rooms, of advertising, an increase is followed by a measurable in­
police) and for research on alcohol services delivery. This crease in consumption. At higher levels of advertising, how­
integration will require organizational changes. To date, no ever, this function flattens, and consumption is no longer
research exists on how such changes can be promoted and responsive to increases in advertising. A similar but in­
supported. verted function describes the relationship between
Perkins (“Social Norms and the Prevention of Alcohol counteradvertising and consumption. That is, at low levels
Misuse in Collegiate Contexts”) reviews theory and research of background counteradvertising, increases should result
 BOYD AND FADEN 11

in a marked decrease in consumption. At higher levels of the first, enforcement of the minimum legal drinking age
counteradvertising, increases or decreases may not result in (MLDA) law, is addressed in depth in the article by
changes in consumption. Hence, because alcohol advertis­ Wagenaar and Toomey (this supplement). Because many
ing is pervasive, econometric studies may not be sensitive undergraduate students are under age 21, this strategy is
to change or assess in a range where change actually makes especially relevant for campuses. Two sources of alcohol
a difference. In dealing with advertising, partial bans are for underage drinkers must be addressed: social providers
not likely to be effective, and total bans are not practical. and commercial providers. The former includes parents,
Advertising bans in one medium also are weakened by sub­ other adults, older siblings, friends and social environments
stitution of increased advertising in alternative media and/ where alcohol is provided freely without regard to age of
or other promotions. No data are available on campus-spe­ the consumer; the latter refers to licensed alcohol establish­
cific advertising and its potential role in conveying exag­ ments. Strategies to reduce social access for college stu­
gerated campus drinking norms or in reinforcing positive dents include decreasing the number of large drinking
drinking expectancies, however. Research in this area is parties, preventing underage access to alcohol at parties,
clearly needed. Evidence for the effectiveness of increasing awareness of laws and enforcing laws against
counteradvertising with regard to tobacco use indicates a social provision. Commercial availability can be minimized
potentially effective strategy; additional research is needed through reduction of false identification, training of alcohol
on effective message content and placement. establishment management and staff, restriction of certain
Many college campuses have indeed employed counter- kinds of sales and vigorous enforcement of laws banning
advertising to reduce college drinking. DeJong (“The Role sales to minors.
of Mass Media Campaigns in Reducing High-Risk Drink­ A second group of environmental strategies is directed
ing among College Students”) reviews these campus media toward reducing overall consumption and risky alcohol use
campaigns. Many have been informational and may be con­ in the college population, regardless of drinker age. These
sidered a form of counteradvertising. Some have been de­ efforts include restrictions on where, when and how alco­
signed to correct misperceived social norms (social norms hol is sold (e.g., outlet density, hours of operation), de­
marketing campaigns). Others have sought support for par­ creasing alcohol flow at parties (e.g., eliminating
ticular policies or policy change (advocacy campaigns). Un­ self-service), increasing the price of alcohol and restricting
fortunately, empirical evaluation of these campaigns has where alcohol can be sold. A third group of strategies has
been limited. Most media messages on college drinking addressed specific alcohol-related problems, such as drunk
also have focused on negative consequences of drinking, driving. The final group of strategies de-emphasizes the
an approach previously found to be ineffective and some­ importance of alcohol on campus. Examples include estab­
times counterproductive. Instead, guidelines are presented lishing alcohol-free residence halls, scheduling core courses
for the development of media campaigns based on estab­ on Fridays and establishing alcohol-free social venues. The
lished practices in commercial marketing and public health authors provide some logical guidelines for how college
campaigns, as well as experience with college populations. administrators and other leaders might select policy goals
Most campus alcohol prevention efforts have not drawn on for their particular campus. They caution, however, that
this material. A planning approach is described in which most of these strategies have not been evaluated for col­
message design does not take place until broader questions lege populations, and some are not well evaluated in the
regarding campaign strategy have been addressed. These general population. The need for research is clear.
campaigns should also expand their focus to the broader Wagenaar and Toomey (“Effects of Minimum Drinking
social and policy environment. The importance of forma­ Age Laws: Review and Analyses of the Literature from
tive, process and outcome evaluation is emphasized. 1960 to 2000”) review the extensive research literature on
Toomey and Wagenaar (“Environmental Policies to Re­ the relationship between MLDA, alcohol consumption by
duce College Drinking: Options and Research Findings”) young persons and highway traffic fatalities. Although the
review environmental policies used or recommended to re­ federal government passed the Uniform Drinking Age Act
duce college alcohol-related problems. Many of these poli­ in 1984, which prompted all states and the District of Co­
cies have proven effective in the general population; their lumbia to establish age 21 as the MLDA, there are periodic
extension to college environments, including surrounding calls to reconsider this policy, especially in light of campus
communities, is a logical next step. The authors acknowl­ drinking problems. Wagenaar and Toomey persuasively ar­
edge the importance of the social environment in individual gue for the effectiveness of the current law, based on evi­
drinking behavior, but suggest that the social environment dence from more than 100 studies utilizing a variety of
is substantially shaped by public and institutional policies. outcome measures and study designs.
They identify four general types of environmental strat­ Fluctuations in the MLDA by state during the 1970s
egies used at the community level that are theoretically and the subsequent uniform shifts to age 21 in the late
appropriate for the college population. The importance of 1980s provided the opportunity for a variety of “natural
12 JOURNAL OF STUDIES ON ALCOHOL / SUPPLEMENT NO. 14, 2002

experiments.” Longitudinal studies of increases and de­ munity interventions have been well evaluated in the gen­
creases in MLDA were possible, as well as cross-sectional eral population. Although all programs evaluated were con­
comparisons of states with different MLDAs. These studies sidered to be “comprehensive community interventions,”
are summarized by design, methodology, outcome measures they varied considerably in approaches actually used, popu­
and findings in a series of tables that will be an excellent lations targeted, type of community and intended outcome.
reference for others doing research in this field. Although Some were primarily policy oriented (Communities Mobi­
findings are not always consistent, the preponderance of lizing for Change), whereas others relied most heavily on
the data indicate inverse relationships between the MLDA educational approaches (Midwestern Prevention Project). For
and alcohol-related outcomes in the age group affected by some intervention targets, such as blood pressure or exer­
the policy (i.e., ages 16-20). Outcomes include alcohol sales, cise, there were no obvious policy options. The community
self-reported consumption, fatal traffic crashes, alcohol-re­ interventions reviewed had varying degrees of success, and
lated crashes and injuries, drunk driving offenses, emer­ in this review the authors seek common characteristics that
gency hospital admissions, juvenile crime, nontraffic injuries predict effectiveness and can inform future efforts to re­
and fatalities and self-reported alcohol-related problems. duce underage drinking, excessive drinking and related prob­
The authors also review evidence regarding mediating lems among college students.
factors that may influence whether an MLDA effect is ob­
served. Most prominent is that the law has not been rigor­ Recommendations
ously enforced. It is, in fact, striking that effects have been
observed at all because implementation of the law in most Based on discussions of the material presented in this
locales has been minimal. Because few of the studies were supplement and on other sources, the panel made recom­
specific to college populations, research directed toward mendations to college administrators, funding agencies and
this area would be useful to policy-makers. Such research the research community. Key research questions from the
is especially important because the MLDA law is frequently Panel on Prevention and Treatment follow:
criticized. Doubts remain about its effectiveness, and some
critics hypothesize that drinking by persons ages 18-20 could Promoting health behaviors through individual- and
be better controlled if it were legal, especially in the col­ group-focused approaches
lege environment. In response, the authors list the most
• What are the campus-wide effects of providing individual-
frequently raised criticisms and provide research-based re­ and group-focused interventions?
sponses. This section should be useful for policy-makers at • How well do these interventions work with different campus
all levels, as well as those that advocate for responsible populations, including students in Greek-affiliated organiza­
alcohol-control policies. tions; incoming students; mandated students; adult children of
These types of large-scale environmental interventions, alcoholics; athletes; students at various risk levels based on
particularly those involving policy change, require involve­ current alcohol practices; students living on- and off-campus;
ment of both community and campus leaders and their con­ and members of different ethnic, religious and cultural
stituencies as well as interaction between the two. For groups?
example, regulation and limitation of alcohol availability • How effective are student-to-student interventions?
• What are the most effective uses of computer-based technolo­
cannot be accomplished by either campuses or communi­
gies in college alcohol initiatives?
ties in isolation. Similarly, enforcement of campus alcohol
• Should approaches be tailored to the needs and situations of
regulations and community ordinances will be more effec­ underage students versus those age 21 and over?
tive with formal communication and coordination between • What are the most effective and cost-effective ways to
the two. Hence, colleges and communities must work to­ conduct outreach for alcohol services?
gether through “town-gown” coalitions to tackle the com­ • What criteria are appropriate for diagnosing college student
plex alcohol-related problems that plague them both. alcohol problems? Do they differ from the general population
Hingson and Howland (“Comprehensive Community In­ criteria used in currently available instruments?
terventions to Promote Health: Implications for College- • How well do pilot programs work when taken to scale on
Age Drinking Problems”) review the research literature on different campuses?
just this sort of community-based approach. Comprehen­
Creating a healthy environment
sive community interventions already have been promoted
to address a variety of health risks, including high blood • What is the effect of banning or stringently regulating alcohol
pressure and cholesterol levels, lack of exercise, smoking, on campus? Do problems simply move off campus? How are
drug use, unsafe sex practices and alcohol-related prob­ on-campus and off-campus cultures affected?
lems. No rigorous evaluations have been undertaken of cam­ • Are parental notification policies effective? If so, what are the
pus-community coalitions, however, and campus populations characteristics of effective parental notification programs? At
have not been included in the existing studies. Twenty com­ what point should parents be notified for optimal results?
 BOYD AND FADEN 13

• What is the most effective type of campus disciplinary system disseminated to community audiences, such as chiefs of

for alcohol offenses? Should campus alcohol disciplinary police, parents and legislators?

systems and standards be extended to students who live off • How effective are state-level coalitions that support individual
campus and in what circumstances? Should infractions be campus-community collaborations.
handled differently for those under age 21? • What planning structure or process is most effective in
• How does the academic environment affect student drinking developing campus alcohol policies and programs?
patterns? For example, would high-risk drinking be reduced if • What is the relative effectiveness of different accountability
more classes were scheduled on Fridays or academic expecta­ structures for managing college alcohol programs?
tions were increased (e.g., reducing grade inflation, increasing • What are the costs and effects of alcohol prevention interven­
difficulty of classes and requirements)? tions, including campus-based and comprehensive campus-
• What is the impact of substance-free housing on alcohol- community efforts? How can programs be made more cost
related problems? effective?
• What approaches effectively reduce alcohol-related problems • Which alcohol policies and programs most benefit the college
within the Greek system? Does the presence of a live-in and university in terms of student recruitment, student quality
resident adviser reduce drinking? Does delaying rush reduce and academic performance, student diversity, student
alcohol-related problems? Do risk management efforts make a retention, faculty behaviors, fund-raising and alumni relations?
positive difference? • What are the most effective strategies for involving presidents,
• What are the key environmental characteristics that influence administrators, faculty, students, other staff and boards of
drinking? How should environmental characteristics and directors in alcohol-related problem prevention programs?
environmental change be measured? • Is it effective to make prospective students aware of alcohol
• Do alcohol-free activities and venues reduce college alcohol- policies during the marketing or admissions process?
related problems? What factors (e.g., frequency, timing, type, • What are the most effective ways of engaging, optimizing and
planning) influence effectiveness? maintaining the involvement of different student subgroups,
• How are social norms campaigns most effectively used (e.g., including ethnic and racial minorities?
in combination with other activities, to set the stage for more • How can higher education and secondary education work
comprehensive initiatives)? together on alcohol issues, including the transition from high
school to college?
Creating comprehensive college-community interventions
References
• Are comprehensive college-community interventions to BROWN, S.A., TAPERT, S.F., GRANHOLM, E. AND DELIS, D.C. Neurocognitive
reduce high-risk college drinking effective? What is the most functioning of adolescents: Effects of protracted alcohol use. Alcsm
effective mix of policy and program elements? What are the Clin. Exp. Res. 24: 164-171, 2000.
assets and liabilities for colleges and communities? DE BELLIS, M.D., CLARK, D.B., BEERS, S.R., SOLOFF, P.H., BORING, A.M.,
• Is it more effective to focus such efforts on drinking practices HALL, J., KERSH, A. AND KESHAVAN, M.S. Hippocampal volume in ado-
or on the health and social problems high-risk drinkers cause lescent-onset alcohol use disorders. Amer. J. Psychiat. 157: 737-744,
for themselves and others? 2000.
• Where should decision-making responsibility be focused: in TAPERT, S.F. AND BROWN, S.A. Neuropsychological correlates of adoles­
city government, the college and university, another group or cent substance abuse: Four-year outcomes. J. Int. Neuropsychol. Soc.
5: 481-493, 1999.
institution or a combination of players?
TURRISI, R., JACCARD, J., TAKI, R., DUNNAM, H. AND GRIMES, J. Examina­
• What are the best strategies for mobilizing and optimizing the
tion of the short-term efficacy of a parent intervention to reduce col­
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• Do effects of college-focused programs extend to others in the 2001.
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ordinances? Public Health 1999 College Alcohol Study. J. Amer. Coll. Hlth 48:
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