BOSTON -- The community of Chico, Calif. and surrounding area has had seven alcohol-related deaths since fall of 2012. Two of the deceased were California State University at Chico students. But when it comes to risk reduction, the institution has realized there is strength in numbers -- and from diverse angles.
Editor's note: The above paragraph has been updated to correct the number of deaths at Chico State.
That's consistently been the case for more than a dozen state universities in California that have reduced rates of alcohol-related incidents in large part by partnering student health staff with scores of seemingly unrelated but immensely helpful groups, both on campus and off.
And those relationships are key to another part of those universities' efforts: letting students know you care early, letting them know often -- and not letting them forget it.
"The more enforcement and visibility," said Richard P. McGaffigan, program director for the Prevention Research Center, "the greater effect you would have."
At Chico State, alcohol violations fell from 827 in 2005-6 to 341 four years later.
Presenting here at the American College Health Association's annual meeting  to a packed room of college officials eager to learn from their success, representatives from Chico State and some of those other 13 universities acknowledged that, sure, they did have the help of a 10-year grant worth up to $45,000 each. But they said a lack of such funds shouldn't stop those in the audience from doing what they can.
The grant project, called Safer California Universities, is a longitudinal study that set out to identify where and how students get into trouble with alcohol, then test environmental prevention strategies  that have been effective in general settings, on campuses.
Each university codified its approach in a risk management plan. While each was tailored to the individual institution based on its own student survey results -- with variations depending on housing, proximity to bars, commuter population, etc. -- officials on the campuses have learned from one another, adopting practices that work and abandoning those that don't.
The project, funded by the National Institute of Alcohol Abuse and Alcoholism, has found statistically significant reductions in intoxication and incidents at areas where high-risk drinking is frequent. Over all, the study found the following after five years: At each campus, 900 fewer students reported drinking to intoxication at off-campus parties and 600 fewer getting drunk at bars or restaurants during the fall semester. The study projects those figures are equivalent to 6,000 fewer intoxication-related incidents at off-campus parties and 4,000 fewer incidents at bars and restaurants during fall semester.
The campuses that tightened enforcement the most saw the greatest reductions, but no reduction in one area (for example, bars and restaurants) caused an increase in another (say, fraternities and sororities) because of a shift in emphasis. Incidents are tracked through annual student surveys.
"What really holds this whole process together is the glue of the student visibility campaign," McGaffigan said. If students know that more police are out conducting DUI checkpoints and testing bars' ID checks, they might think twice about drinking -- or at least be aware of the consequences when they do. "We never really wanted to arrest a lot of students, but we wanted to promote safety through accountability."
That campaign involves websites, door hangers, newspaper ads, personal dorm walk-throughs from university presidents and police (friendly visits, not sting operations), and various forms of literature -- all with the goal of making sure students know how much is too much, what happens when you get caught, and where and how to find help when you need it.
To do that well involves collaboration with top-level administrators, university housing, campus and city police, local establishments, athletics departments, judicial affairs and anyone else who might be able to help. Rather than being a problem of staff members responsible for alcohol and drug issues, high-risk drinking becomes everyone's problem.
"It allowed us to get people at the table who hadn't been there before," said Meg Kobe, director of Student Health Outreach and Promotion at the University of California at Santa Cruz. "It really legitimized the work in a way that we hadn't known before."
For study participants, one thing proved key: starting early, in the first days and weeks of the new year.
"If you're on college campuses, we see that as usually when the tone is set around drinking," McGaffigan said. "So if we could have a strong intervention during that time, maybe we could change the drinking throughout the year."
Running with this idea, Chico State conducts three to five "party dispersal operations" during fall term.
"In [students'] minds, they're thinking, 'That could happen to me,' and that might diminish some of that behavior later in the semester," said Theresa Fagouri, coordinator of Chico State's Campus Alcohol and Drug Education Center. "It's not arresting everyone. It's a safety measure" -- one that means fewer hospital visits and less alcohol distributed to minors.
Chico State also sets up "Walking Under the Influence" tables late at night when students are stumbling home from parties. Officials hand out bottled water with safety tips. Another way officials have reduced drinking is by convincing local bars to delay opening until 10 a.m. on St. Patrick's Day, when students traditionally start lining up to drink at 6 a.m. The university and the city coordinate a "Shamrock Shuffle" run with a pancake breakfast to keep students busy. In March, the lines still built up outside the bars, but they were shorter than in years past.
The University of California at Davis runs weekly prevention ads in the campus newspaper and sends letters to students when the year begins (both of which are common steps), but its SafeParty@UCDavis  website is the program's centerpiece.
A collaborative effort by the city and the university, the website translates easily and in visually appealing fashion to students' smartphones or tablets (for instance, the site's background is dark so it's not too overwhelming when students pull it up on the street at night).
Along with safety tips (drink water, use the buddy system, etc.) and signs of alcohol poisoning, the site uses technology to help students help themselves. With one touch of an icon students can call a cab, or the university's designated driver service. Another icon automatically Google-maps the students' way to the emergency room.
"Prevention is a hard topic to sell.... People don't come calling until they need you," said Mandy Li, coordinator of alcohol, tobacco and other drug risk reduction at UC-Davis. Li solicited (very helpful) advice from students before creating the site. "Make sure that the websites you design are relevant."
After the action plans and implementation comes assessment and corrections. Signs you know it's working? A university encounters new challenges, such as figuring out who "owns" the program, who pays for increased enforcement, and how to keep the message fresh.
"Part of this work -- at least on our campus -- "was educating our senior leadership about why it's O.K. to talk about this stuff," Kobe said. "Most campuses don't like alcohol data out there, do they?"