It Takes a Village

Ever since states in the 1980s raised the drinking age to 21, a huge focus of college health experts has been to prevent illegal drinking by freshmen and sophomores, most of whom, at residential colleges, are under the legal drinking age. But increasingly, health experts say this emphasis -- however understandable -- has ignored an important reality: the individuals who drink the most, and are therefore more susceptible to risky behavior, are legal drinkers 21 and over.

According to the national College Alcohol Study, juniors and seniors binge drink more than freshmen and sophomores, and legal-age students drink more overall than underage students. Those findings may not be terribly surprising; when students turn 21, alcohol is almost always within reach.

To the experts, those data illustrate the growing importance of "campus-community" alliances, which at a handful of colleges are reducing risky drinking levels across the board. In this context, community means local bars and restaurants as well as hospitals and law enforcement -- anyone who might provide alcohol or deal with the effects of student boozing, including by those who are of age. While the colleges using this strategy are not necessarily doing so exclusively to target legal-age drinkers, they are finding ways to reach those older students who are probably less likely to respond to the posters, lectures and mailings of traditional education campaigns, many of which focus on those younger than 21.

Yet, the vast majority of institutions still rely on the latter method, and the reasons for resistance vary. Environmental prevention, in which colleges analyze data and work closely with community leaders to reduce high-risk drinking off-campus, is more expensive and time-consuming than traditional education campaigns. It is also a less-established strategy, and is foreign to many administrators. After all, a college can make whatever rules it wants for the student union, and order the creation of countless posters, websites and seminars, but it can't order an off-campus bar to do much of anything.

"I think that previously, people were still really hoping that they could come up with some kind of effective messaging that would be successful," said Robert Saltz, senior research scientist at the Pacific Institute for Research and Evaluation. "But in the last 10 years I think everybody has become less satisfied.... They want to see that you're doing something that's actually going to work. Professionals on the campuses really want evidence-based strategies." But no matter how many colleges are having this conversation, the fact remains that not as many are taking action.

"I think everybody is -- at least, they desire to have evidence-based interventions," Saltz said. "Now it's more a matter of resources."

According to a study Saltz published last year, California colleges that employed community intervention techniques saw "significant reductions" in harmful college drinking (defined as drinking to intoxication) at off-campus bars and house parties: 15 percent and 9 percent reductions, respectively, in the likelihood that the student drank to intoxication the last time he or she drank. The study illustrates that even though environmental prevention may not necessarily be targeted at a particularly high-risk group, it can have an impact on all age groups.

But to reach legal-age students, collaboration with local bars and restaurants is essential. It’s been nearly 10 years since the National Institute on Alcohol Abuse and Alcoholism emphasized the importance of innovative tactics in preventing alcohol abuse among students. But according to a follow-up survey, only about half of responding institutions said they had tried one of four community prevention efforts, such as lobbying for mandated training for alcohol servers or enforced age compliance checks at establishments. (In contrast, 98 percent reported engaging in purely educational efforts like sending mailings and giving lectures.) Only 2 percent of colleges addressed increasing the price of alcohol (perhaps by lobbying for more taxes or, as Nebraska did, working to stop bars from giving out free birthday drinks) -- an effort that the study and Nelson say could make a big difference. “Binge drinking is cheaper than a first-run movie,” he said. “The cost of a movie has gone up dramatically; the cost of binge drinking has remained stable. From that perspective, it’s a better deal. It’s no wonder some college students are likely to choose that as a form of entertainment.”

The risk levels of student subgroups inevitably vary by campus. For instance, at the University of Nebraska at Lincoln, although underage students don’t drink as much, their behavior is generally more risky when they do. High-risk drinkers are the ones who are more likely to run into law enforcement, or show up in the hospital. They’re more likely to go over the edge. While legal-age students are more likely to drink in bars or other licensed establishments that have some monitoring system in place, underage students are more likely to drink at house parties where nobody’s paying attention to consumption.

Those aren’t just assumptions; they’re facts that Linda Major and her colleagues at Nebraska have deduced through careful data analysis – in partnership with local stakeholders such as police, hospitals and bars. Nebraska joined Harvard University’s A Matter of Degree program, “a demonstration initiative to reduce binge drinking and related harms among college students by changing campus and community environments.” They formed a campus-community coalition led by the vice chancellor for student affairs and the Lincoln chief of police, and used data from AMOD, student surveys, police citations and hospital records to map the neighborhoods and bars where the highest-risk student drinking takes place.

Their work over the past five years has resulted in a startling reduction of disruptive drinking at Nebraska, which has all the makings of a party school. With 100 bars within a 1-mile radius of the campus and five colleges in one town, students never want for a good time. But a variety of efforts, including increased police patrols and traffic checkpoints, have resulted in a 77-percent citywide decline in repeat offenders, and a 44-percent decline in wild party citations.

Nebraska’s efforts – and considerable success – illustrate why environmental prevention is becoming the strategy of choice at some colleges. With this approach, drinking is framed as a problem that affects not just campus residents, but everyone in the community, said Toben F. Nelson, an assistant professor at the University of Minnesota School of Public Health. “I suspect a shift in attention to those who are of legal age has more to do with reframing the issue, taking it on more as a public health issue,” he said, while noting that this was the major contribution of the CAS, which he helped create.

That study tracked data from 1993 to 2001, and found that despite prevention efforts consistently targeting underage students, legal-age students are more exposed to potential risk because they drink more. “Previously – and maybe even in the earlier 2000s – the prevention focus was really on underage. [Colleges thought,] ‘Those other students can drink and we’re not going to worry too much about them. In fact, there’s nothing we can do,’ ” Nelson said. “I think there has been this shift toward recognizing that heavy drinking is a problem that pervades all college students, and it’s particularly a problem for those who can access alcohol because they tend to drink more.”

While Nelson believes this notion is spreading to more administrators – in thoughts if not actions – others aren’t so optimistic. “I think it has not caught their attention at all,” said Andrew Wall, assistant professor of education leadership at the University of Rochester. One reason is because student health offices don’t have the sophisticated data and analysis that researchers do. Wall’s data evaluation indicates that there is still some heavy drinking among 18- to 20-year-olds, but consumption peaks at 21 and remains high through 24. “That’s a pretty big shift. It sort of suggests that the effect of college is being magnified as opposed to diminishing as students mature,” he said. “Because there’s no developmental reason that their consumption would increase, it suggests that there are environmental causes.”

At the University of California at Berkeley, where underage drinkers slightly edge out legal-age ones for the group with the most "alcohol problems," such causes are addressed through collaboration between campus stakeholders. "If we all do a little bit, it's greater than the sum of the parts," said Karen Hughes, coordinator for PartySafe@Cal, a health services program at Berkeley that promotes environmental prevention efforts and educates students about alcohol risk management.

Yet Hughes has encountered much resistance to new methods, which require throwing out old ones. She still gets requests from campus groups for lectures and other outdated tactics. "It takes a real commitment to say, 'You know what? I know you think that's what you want, [but] we're putting our energies into strategies that are going to make a bigger difference.'"

Officials at the University of Iowa are also taking up such strategies, but retaining the focus on underage drinkers because "that's where it's illegal," said Susan Assouline, chair of the planning committee for Iowa's Alcohol Harm Reduction Plan. Also, at Iowa, where the binge drinking rate is nearly double the national average, underage students are actually more likely than their legal-age peers to binge. Still, Assouline said, "Anybody who's 21 or older will benefit from the change in the culture that will happen."

But it’s also crucial to remember that not every campus is the same, Major noted. “Obviously there’s no magic bullet; there’s no quick fix,” she said. “While I think that it’s important for everybody to use science-based education strategies, it’s important for everyone to use environmental strategies…. The ways you develop and use them are specific to your environment…. You need to pay attention to your own culture.”