A Call to Action: Changing the Culture of Drinking at U.S. Colleges


1 A Call to Action: Changing the Culture of Drinking at U.S. Colleges Task Force of the National Advisory Council on Alcohol Abuse and Alcoholism National Institutes of Health U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES www.collegedrinkingprevention.gov

2 A Call to Action: Changing the Culture of Drinking at U.S. Colleges April 2002 National Institute on Alcohol Abuse and Alcoholism

3 Contents Special Thanks to Enoch Gordis, M.D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .v . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii Comment from the Institute Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix Task Force Co-Chairs Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 College Drinking Is a Culture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 The Answer: Change the Culture. The Question: How? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 A Snapshot of Annual High-Risk College Drinking Consequences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Heavy Episodic Consumption of Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Alcohol and Adolescent Brain Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Factors Affecting Student Drinking Living Arrangements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 College Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 First-Year Students . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Other Factors Affecting Drinking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Comparison with Noncollege Peers Secondhand Consequences of Drinking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Post-College Consequences Issues Involved in A Call to Action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 The Challenge for Colleges and Communities Impact of Inadequate Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Problems with Program Design 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Impact on Implementation 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Results of Prolonged Ineffectiveness 12 Integrating Research Into College Alcohol Program Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Involving Colleges and Universities 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Establishing Administrative Norms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Obtaining External Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 A Call to Action: Recommendations for Addressing Excessive College Drinking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Recommendations for Colleges and Universities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Overarching Framework 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Recommended Strategies 15 Tier 1: Evidence of Effectiveness Among College Students . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Tier 2: Evidence of Success With General Populations That Could Be Applied to College Environments . . . . . . . . . . . . . . . . . . 17 . . . . . . . . . . . . . . . . . . . . . . Tier 3: Evidence of Logical and Theoretical Promise, But Require More Comprehensive Evaluation 20 23 Tier 4: Evidence of Ineffectiveness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A Special Role for College Presidents 26 The Need for Student Participation in Prevention Policymaking and Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Recommendations for the Research Community 28 Recommendations for NIAAA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 32 A F inal Word . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ce Members and Participants Task For . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 College and University Presidents 45 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Special Thanks to Other Participating College Presidents 45 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Researchers . 46 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Task Force Panel Members 46 47 Students . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . National Institute on Alcohol Abuse and Alcoholism 47 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Contributors . 47 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Resour ces . 48 49 Commissioned Papers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Panel 1—Contexts and Consequences 49 Panel 2—Prevention and Treatment 50 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Joint Panel Papers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51 III

4 Special Thanks to Enoch Gordis, M.D. The Task Force wishes to extend a special thank you to Dr. Enoch Gordis for his leadership and dedication. Dr. Gordis stepped down as Director of NIAAA on December 30, 2001, after 15 years of outstanding leadership. He was the inspiration for this project, citing the lack of research on this important public health problem. “For decades, there has been meeting after meeting that offered plausible, intelligent recommendations, all with no evaluations. Then, when these programs fail to work, meetings are again convened to ponder the same questions. Only through a commitment to research can we truly begin to understand what can and cannot be done, so that in five or ten years we don’t find ourselves asking the same questions yet again.” In light of his vision, we offer this report as a beginning. V

5 Comment from the Institute Every year as spring break approaches or when another promising young student dies in an alcohol-related tragedy, college drinking becomes a national issue. Although excessive drinking by college students is accepted as a rite of passage by many, alcohol-related tragedies never fail to shock us and to prompt calls for immediate action. When schools respond with well-intentioned programs, but the problem persists, it is natural to wonder how much we really understand about excessive, college student drinking. Is it inevitable? Can we take steps to prevent it or reduce its consequences? Why have efforts to date proven ineffective? The fact is that since 1976, when the newly created National Institute on Alcohol Abuse and Alcoholism (NIAAA) issued its only report on abusiv e drinking b y college students, research advances have transformed our understanding of alcohol abuse and related problems. For example, we now know that a broad array of factors affect college student drinking behavior. These include an individual’s susceptibility to alcohol, campus norms related to drinking, and conditions within the larger community that make alcohol readily accessible and fail to penalize inappropriate use. Together these influences contribute to a culture of drinking that is more damaging and deadly than previously recognized. This report, developed by the NIAAA-supported Task Force on College Drinking after 3 years of intensive discussions, describes our new understanding of dangerous drinking behavior b y college students and its consequences w many drink how much, the Task Force focused on the for both drinkers and nondrinkers. Rather than debate ho consequences. What it found challenges many common assumptions about the size and nature of the problem. Not only do some 1,400 college students between the ages of 18 and 24 die every year as a result of hazardous drinking, but a half million suffer unintentional injuries under the influence of alcohol. Another 600,000 are assaulted by fellow drinking students and more than 70,000 are sexually assaulted. The data on academic achievement, damage to facilities, and health problems are equally alarming. The nature of existing data leads to the inference that some college students meet the diagnostic criteria for alcohol dependence as currently specified by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), but are not receiving treatment. Although most students who exhibit dangerous drinking behavior during their college career mature out of heavy drinking, this behavior and its consequences are nonetheless cause for concern. In its report, the Task Force outlines a series of recommendations for colleges and universities, researchers, and eliance on scientific evidence and its call for NIAAA. What distinguishes this guidance from others is its firm r collaboration betw een academic institutions and researchers. In response to the information and recommendations in this report, NIAAA is committing an additional $8 million over the next two fiscal years to the issue of college drinking. It also is collaborating with several college presidents to determine the effectiveness of policies aimed at reducing the problem. The chancellor of a university that recently suffered the alcohol-related death of one of its students said, “Our children’ s liv es are at real risk, and universities need to make every effort to prevent any more lives from being wasted.” This report underscores the wisdom of that advice and urges us to join forces in changing the culture of drinking on our Nation’s campuses from one that fosters destructive behavior to one that discourages it. Raynard Kington, M.D., Ph.D., M.B.A. Acting Director National Institute on Alcohol Abuse and Alcoholism VII

6 Preface scientific papers intended to synthesize what we know Task Force Co-Chairs and identify r e esearch gaps. Most of these papers ar The Task Force on College Drinking, a group of ournal of J being published in a special supplement to the distinguished educators, alcohol researchers, and Studies on Alcohol . The extent of drinking consequences students, has been meeting for 3 years to respond to the among college students is described in a paper by Ralph persistent and pervasive problem of excessive drinking by Hingson et al., being published in the March issue of students on U.S. college campuses. The Task Force was the Journal. (Please visit our Web site: established by the National Advisory Council on www.collegedrinkingprevention.gov for additional Alcohol Abuse and Alcoholism. Although NIAAA has information.) maintained a modest portfolio of grants on college drinking for many years, the Task Force represents an During the course of our deliberations, it became clear effort to address the issue in the most coordinated and that three primary constituencies must be addressed to comprehensive way possible. change the cultur e of drinking on campus. They are: (1) individuals, including at-risk or alcohol-dependent The goals of the Task Force are threefold: drinkers, (2) the student population as a whole, and 1. Provide research-based information about the (3) the college and the surrounding community. To be nature and extent of dangerous drinking to high ention pr e, pr ev ograms must target all three. The effectiv school and college administrators, students, Task Force devised a simple, but comprehensive, 3-in-1 parents, community leaders, policymakers, to help colleges and universities with this Framework resear chers, and members of the retail beverage process. industry; 2. Offer recommendations to college and university Another theme that emerged r epeatedly in our work presidents on the potential effectiveness of current was the need for schools to base their alcohol policies erse the culture of drinking on strategies to r ev n and prevention programs on scientific evidence. I campus; and evention strategies that appear in this selecting the pr 3. Offer recommendations to the research community, report, we considered feasibility, theoretical rationale, including NIAAA, for future research on and outcomes in noncollege settings as well as prev enting hazardous college student drinking. demonstrated effectiveness on college campuses. However, we also found that a number of potentially To this end, the Task Force conducted a effective strategies have little evidence to support them comprehensive revie w of r esearch on drinking by college because they have not been thoroughly evaluated. This students and on strategies to prevent it. We established raises a key point. Additional research is needed to two panels that addressed: (1) the contexts in which determine the value of these promising strategies. We college drinking occurs and its consequences, and strongly encourage colleges and universities to (2) prevention and treatment. In addition to extensive collaborate with researchers in testing their value on deliberations, the panels commissioned 24 original campus. IX

7 Changing the Culture of Drinking at U.S. Colleges A Call to Action: these problems and unable to move ahead and make Because the results of the Task Force’s work are appreciable differences. important to a broad audience, we have summarized our information and recommendations in a variety of We urge college and univ ersity presidents to apply the formats. In addition to this report, our products include: recommendations in this report. M oreover, we challenge  An alcohol prevention program handbook— society to no longer ignore the consequences of drinking Reducing Alcohol Problems on Campus: A Guide to on our Nation’s campuses. Parents, prevention Planning and Evaluation; organizations, the alcohol beverage and hospitality Brochures for college and university presidents,  industries, and the Federal government must together student peer educators, and parents (future apply all necessary financial and intellectual resources to brochures include community leaders, high school address this pervasive and persistent problem. guidance counselors, and students); The final reports of the Task Force’s two  Edward A. Malloy, C.S.C. panels— High-Risk Drinking in College: What We Task Force Co-Chair How To Know and What We Need To Learn and P resident Reduce High-Risk College Drinking: Use Proven University of Notre Dame Strategies, Fill Research Gaps —that describe each panel’s findings in detail; and Mark Goldman, Ph.D. The scientific papers commissioned by the panels  Task Force Co-Chair to supplement the current research literature. D istinguished Research Professor of Psychology (Please see the Resources section of this report for University of South Florida information on ordering or downloading these products.) The consequences of drinking on campus are too damaging to ignore. Although research alone is insufficient to r everse the problem, it will point the way to solutions. We are simultaneously confronted with statistics that show college drinking worsening and other data that suggest the reverse. This underscores the conundrum that college drinking-related problems are persistent but may change in nature and intensity over time. As a result, this report should not be considered the final solution. It is the beginning, a call to action, involving college presidents, researchers, and students. Unless we improve the collection of data and rigorously evaluate prevention programs, using the most innovative methods available, we will continue to be perplexed by X

8 Introduction “Underage drinking and excessive drinking have negative effects on everything we’re trying to do as a university. They compromise the educational environment, the safety of our students, the quality of life on campus, town/gown relationships, and our reputation.” —Dr. Judith Ramaley, Former President, University of Vermont Other than the damage and injuries that occur during College Drinking Is a Culture spring break each year, the only consequences of college The tradition of drinking has developed into a kind of drinking that usually come to the public’s attention are culture—beliefs and customs—entrenched in every level occasional student deaths from alcohol overuse (e.g., of college students’ environments. Customs handed alcohol poisoning) or other alcohol-related tragedies. down through generations of college drinkers reinforce They prompt a brief flurry of media attention; then, the students’ expectation that alcohol is a necessary topic disappears until the next incident. In fact, the ingredient for social success. These beliefs and the consequences of college drinking are much more than expectations they engender exert a powerful influence occasional; at least 1,400 college student deaths a year are over students’ behavior toward alcohol. linked to alcohol, as new research described in this report reveals. High-risk drinking also results in serious injuries, Customs that promote college drinking also are assaults, and other health and academic problems, and is embedded in numerous levels of students’ environments. a major factor in damage to institutional property. The ts arenas carry advertisements The walls of college spor relative scarcity of headlines about college drinking belies from alcohol industry sponsors. Alumni carry on the an important fact: that the consequences of excessive alcohol tradition, perhaps less flamboyantly than during college drinking are more widespread and destructive their college years, at sports events and alumni social than most people realize. While only isolated incidents functions. Communities permit establishments that tend to make news, many school presidents conclude that serve or sell alcohol to locate near campus, and these these pervasive, albeit less obvious, problems are occurring on their campuses at the same time. It is a establishments depend on the college clientele for their persistent and costly problem that affects virtually all financial success. residential colleges, college communities, and college students, whether they drink or not. Students derive their expectations of alcohol from their environment and from each other, as they face the The call to action on campus has to do not so much w social insecurity of establishing themselves in a ne with drinking per se, but with the consequences of milieu. Environmental and peer influences combine to excessive drinking by college students. S tudents who create a culture of drinking. This culture actively drink ex cessively have higher rates of injuries, assaults, promotes drinking, or passively promotes it, through academic problems, arrests, vandalism, and other health tolerance, or even tacit approval, of college drinking as a and social problems, compared with their nondrinking rite of passage. counterparts. They disrupt the studies and threaten the health and safety of their peers. 1

9 A Call to Action: Changing the Culture of Drinking at U.S. Colleges have assessed what both schools and researchers need to The Answer: Change the Culture. ograms. On the do to establish effective prev ention pr The Question: How? basis of their findings, they have made the When a student dies from intoxication or another recommendations contained in this report. Their alcohol-related incident makes headlines, college recommendations focus not on how to effect some type drinking captures the public’s attention, for a while. On of blanket prohibition of drinking, but on changing the the campus itself, administrators deal with the culture of drinking on campuses and involving the immediate problem, and campus life soon returns to surrounding communities. normal. Generally, the incident doesn’t result in effective, long-term changes that reduce the consequences of Foremost among their recommendations is that to college drinking. ene at achieve a change in culture, schools must inter v three levels: at the individual-student level, at the level of Among the reasons for this seeming inattention to the entire student body, and at the community level. long-term solutions is that administrators see college Research conducted to date strongly supports this three- have drinking as an unsolvable problem. When schools level approach. Within this overarching structure, made efforts to reduce drinking among their students— schools need to tailor programs to address their specific and many have made considerable effort—they haven’t alcohol-related problems. Underlying each had significant, campus-wide success. With each failed recommendation is the Task Force’s understanding that effort, the image of college drinking as an intractable no two schools are alike, that environmental influences problem is reinforced, administrators are demoralized, as well as individual student characteristics impact and the likelihood that schools will devote resources to alcohol consumption, and that effective strategies extend prevention programs decreases. beyond the campus itself to encompass the surrounding community. One reason for the lack of success of prevention efforts is that, for the most part, schools have not based their The Task Force’s focus is on how to change the culture prev ention efforts on strategies identified and tested for that underlies alcohol misuse and its consequences on effectiveness by research. Research on college drinking is campus, rather than on simply determining the number a relatively young field, and the data are incomplete. . of negative alcohol-related incidents that occur each y ear Until the recent formation of the Task Force on College But because data on the consequences of college drinking Drinking, administrators and researchers did not underscore the need for effective prevention strategies, typically collaborate on this topic. Without the expertise these data are included in the section that follows. The of the research community, administrators were at a report offers (1) a general approach to incorporating disadvantage in trying to identify and implement prevention programs on campus, (2) specific interventions strategies or combinations of strategies to address alcohol that schools can combine to meet the needs of their problems specific to their schools. campuses, and (3) recommendations for future research on college drinking. Now, the Task Force on College Drinking has brought together experienced administrators and scientists, who 2

10 What Can Research Bring to Prevention Programs? The research community can provide schools with techniques that will enable them to:  realistically assess their alcohol-related problems;  develop research-based programs designed to prevent/ameliorate these problems;  adjust programs to meet individual schools’ needs; and  define measurable outcomes that can be used periodically to reflect a program’s success or the need for its further adjustment. In conducting their work, members of the Task Force on College Drinking relied on the results of well-designed empirical studies to formulate their recommendations. They downplayed results of methodologically weak studies and assertions that exceeded what the data supported. Studies accept­ able to the Task Force followed the principles of the scientific method and met rigorous design and execution criteria. New techniques have enabled researchers to compare alcohol-related problems in large groups of col­ lege students and their noncollege peers and to map the extent of these problems, nationally and regionally. Armed with this information, researchers can determine how new laws and policies, alco­ hol-prevention programs, and trends in the general population affect drinking patterns among col­ lege students and their noncollege peers. Research shows that a number of personal factors, from family background to alcohol use during high school, influence college students’ drinking patterns. In the college environment, additional fac­ tors contribute to drinking patterns; for example, membership in fraternities or sororities, sports teams, or other social groups and college organizational factors such as size, location, and number of commuter students. Recent techniques enable researchers to test models for prevention that encom­ pass a multiplicity of factors. 3

11 A Call to Action: Changing the Culture of Drinking at U.S. Colleges e than M Health Problems/Suicide Attempts: or A Snapshot of Annual High-Risk 150,000 students dev elop an alcohol-related health College Drinking Consequences problem (Hingson et al., 2002) and between 1.2 and 1.5 The consequences of excessive and underage drinking percent of students indicate that they tried to commit affect virtually all college campuses, college suicide within the past year due to drinking or drug use communities, and college students, whether they choose (Presley et al., 1998). to drink or not. Drunk Driving: 2.1 million students between the 1,400 college students between the ages of 18 Death: ages of 18 and 24 dr o ve under the influence of alcohol and 24 die each y ear fr om alcohol-related unintentional last year (Hingson et al., 2002). injuries, including motor vehicle crashes (Hingson et al., 2002). Vandalism: About 11 per cent of college student drinkers r eport that they have damaged property while 500,000 students between the ages of 18 and Injury: under the influence of alcohol (Wechsler et al., 2002). e unintentionally injur 24 ar ed under the influence of alcohol (Hingson et al., 2002). Mor e than 25 per Property Damage: cent of administrators from schools with relatively low drinking More than 600,000 students between the ages Assault: levels and over 50 percent from schools with high y another student who has e assaulted b of 18 and 24 ar drinking levels say their campuses have a “moderate” or been drinking (Hingson et al., 2002). “major” problem with alcohol-related property damage (Wechsler et al., 1995). een Sexual Abuse: Mor e than 70,000 students betw the ages of 18 and 24 are victims of alcohol-related About 5 per cent of 4 Police Involvement: -year college sexual assault or date rape (Hingson et al., 2002). students are involved with the police or campus security as a result of their drinking (Wechsler et al., 2002) and Unsafe Sex: 400,000 students between the ages of 18 an estimated 110,000 students between the ages of 18 and 24 had unprotected sex and mor e than 100,000 and 24 are arrested for an alcohol-related violation such een the ages of 18 and 24 report having students betw as public drunkenness or driving under the influence been too intoxicated to know if they consented to (Hingson et al., 2002). having sex (Hingson et al., 2002). cent of Alcohol Abuse and Dependence: 31 per Academic Problems: cent of college About 25 per college students met criteria for a diagnosis of alcohol students r eport academic consequences of their drinking abuse and 6 per cent for a diagnosis of alcohol including missing class, falling behind, doing poorly on ding to dependence in the past 12 months, accor exams or papers, and receiving lower grades overall (Engs questionnaire-based self-reports about their drinking et al., 1996; Presley et al., 1996a, 1996b; Wechsler et al., (Knight et al., 2002). 2002). 4

12 Heavy Episodic Consumption of Alcohol There is evidence that more extreme forms of drinking Data from several national surveys indicate that about , frequent by college students are escalating. In one study four in five college students drink and that about half of binge drinkers (defined as three times or more in the college student drinkers engage in heavy episodic past 2 weeks) grew from 20 percent to 23 percent consumption. Recent concerns have, therefore, often between 1993 and 1999. The number of students who focused on the practice of binge drinking, typically reported three or more incidents of intoxication in the defined as consuming five or more drinks in a row for past month also increased (Wechsler et al., 2000b). It men, and four or more drinks in a row for women. A should be noted, however, that the number of college shorthand description of this type of heavy episodic students who do not drink is also growing. In the same drinking is the “5/4 definition.” Approximately two of study, the percentage of abstainers increased from 15 to five college students—more than 40 percent—have 19 percent. engaged in binge drinking at least once during the past 2 weeks, according to this definition. It should be noted, however, that colleges vary widely in their binge drinking rates—from 1 percent to more than 70 percent—and a study on one campus may not apply to others (Wechsler et al., 1994, 1998, 2000b). The U.S. Surgeon General and the U.S. Department of Health and Human Ser vices (USDHHS) have identified binge drinking among college students as a major public health problem. In “Healthy People 2010,” which sets U.S. public health goals through the year 2010, the Federal government has singled out binge drinking among college students for a specific, targeted r eduction (e.g., from 39 percent to 20 percent) by the year 2010. “Healthy People 2010” notes that: “Binge drinking is a national problem, especially among males and young adults.” The report also observes that: “The perception that alcohol use is socially acceptable correlates with the fact that more than 80 percent of American youth consume alcohol before their 21st birthday, whereas the lack of social acceptance of other drugs correlates with comparatively lower rates of use. Similarly, widespread societal expectations that young persons will engage in binge drinking may encourage this highly dangerous form of alcohol consumption” (USDHHS, 2000). 5

13 A Call to Action: Changing the Culture of Drinking at U.S. Colleges Understanding Alcohol Consumption Historically, binge drinking has referred to an extended The term alcohol consumption encompasses two ideas period of heavy drinking (for example, a “bender” that lasts important in characterizing an individual’s drinking behav­ 3 days or more) that is seen in some alcoholic patients. ior: frequency (how often a person drinks) and quantity Some clinicians believe that using the term binge to refer (how much a person drinks). Frequency of consumption to a less severe phenomenon blurs this important distinc­ refers to the number of days or, sometimes, occasions that tion. However, Dr. Wechsler has observed that the term an individual has consumed alcoholic beverages during a binge is now commonly associated with eating and shop­ specified interval (e.g., week, month, and year). Quantity ping and that its application to alcohol use is consistent of consumption refers to the amount ingested on a given with the term’s generally accepted meaning. drinking occasion. Other researchers have voiced concern because the specific Most typically, consumption is assessed using “standard time period over which the five or four drinks are con­ drinks”—in the United States, these are 5 ounces of wine, sumed is not specified nor is the body mass of an individ­ 12 ounces of beer, or 1.25 ounces of distilled spirits. ual drinker. For example, after 5 drinks consumed over a Because individuals do not drink the same amount at every fixed time span, a man of 240 pounds would have a lower drinking occasion, some surveys attempt to assess the fre­ blood alcohol level than a man of 140 pounds. Nor would quency with which a person drinks various amounts of a male or female of the same body weight achieve the same alcohol (e.g., one to two drinks, three to four drinks, five blood alcohol level following equal consumption because to six drinks) over a specified period of time. Although of gender-related differences in physiology. Dr. Wechsler cumbersome, this approach probably provides a fairly accu­ believes that the phrase “in a row” implies a relatively short rate assessment of total volume consumed and of variability time frame. He also shows that individuals who consume in drinking pattern. alcohol at these levels increase their likelihood of experienc­ ing a range of negative consequences. For many purposes, however, identifying “light” or “mod­ erate” consumption is not the issue, “heavy” consumption Whether terms such as heavy drinking, binge drinking, or is. For that reason, it is common to assess heavy consump­ drinking to intoxication are used to describe students’ tion on the basis of the frequency of consuming a number behavior, it is clear that consumption of large quantities of of drinks meeting or exceeding a certain threshold. When alcohol on a single drinking occasion is important in describing college drinking, heavy drinking occasions are assessing alcohol involvement. Also key in evaluating alco­ often referred to as “binges.” Based on the influential work hol consumption are the consequences of that consump­ of Henry Wechsler and colleagues—who define binge as tion which can include academic, personal, social, legal, five or more drinks in a row for men and four or more and medical problems as well as dependent symptoms such drinks for women—the prevalence of binge drinking has as tolerance, withdrawal, and loss of control. become a key measure in estimating the extent of alcohol problems on college campuses. 6

14 A A LCOHOL AND DOLESCENT B D EVELOPMENT RAIN In humans, adolescent-onset alcohol abuse has been Adolescence is a time of transition, physically, socially, associated with a reduction in the size of the and emotionally. The adolescent brain is in transition as eBellis et al., 2000). hippocampus (D well. Although important structural and functional changes take place in the brain from childhood to Research also suggests that adolescents are less sensitive adulthood (Giedd et al., 1999), during adolescence such than adults to some of alcohol’s effects. F or example, changes are widespread. During adolescence, the brain adolescent rats, on their first exposure to alcohol, are less undergoes a major remodeling involving the formation of susceptible than adult rats to alcohol’s sedative effects, as new connections between nerve cells, as well as the well as its effects on balance and motor coordination pruning of existing synaptic connections. These changes (Little et al., 1996; White et al., 2001). It is not known affect the processes involved in planning and decision- whether these differences occur in humans. However, the making, impulse control, voluntary movement, memory, findings suggest that adolescents might be able to stay and speech production, among others (Rubia et al., awake and mobile at higher blood alcohol levels than 2000). Similar changes occur in those parts of the brain adults with an equivalent history of alcohol exposure that seem to affect how a person responds to alcohol and while, at the same time, experiencing greater alcohol- other drugs (Spear, 2000; Teicher et al., 1995). As a induced cognitive impairments and, possibly, more injury result, alcohol appears to have different effects on to the brain following high alcohol exposure levels. adolescents than adults (Spear, 2000). Animal studies suggest that alcohol may have a greater impact on adolescent than adult memory (Mar kweise et al., 1998; Pyapali et al., 1999) and that these effects may be long lasting. Preliminary studies suggest that rats exposed to high levels of alcohol during adolescence may be more sensitive to alcohol-induced memory impairments later in life (White et al., 2000). Human studies have detected cognitive impairments in adolescent alcohol abusers weeks after they stopped drinking (Brown et al., 2000). Although the causes of these long-lasting changes are unclear, they may in some cases involv e alcohol-induced injury to the nervous system. In rats, exposure to high amounts of alcohol produces more extensive brain damage in adolescents than adults (Crews et al., 2000). 7

15 A Call to Action: Changing the Culture of Drinking at U.S. Colleges Factors Affecting Student Drinking “Decisions about alcohol consumption are not just individual, they can affect the common life of the university.” Edward A. Malloy, President University of Notre Dame peers, and this rapid increase in heavy drinking over a Living Arrangements relatively short period of time can contribute to The proportion of college students who drink varies difficulties with alcohol and with the college transition in depending on where they live. Drinking rates are highest general (Schulenberg et al., 2001). Anecdotal evidence in fraternities and sororities followed by on-campus suggests that the first 6 weeks of enrollment are critical to housing (e.g., dormitories, residence halls) (Presley et al., first-year student success. Because many students initiate 1996a, 1996b; Wechsler et al., 1998, 2000b). Students heavy drinking during these early days of college, the who live independently off-site (e.g., in apartments) potential exists for excessive alcohol consumption to drink less, while commuting students who live with their interfere with successful adaptation to campus life. The families drink the least (O’Hare, 1990; Presley et al., transition to college is often so difficult to negotiate that 1996a, 1996b). about one-third of first-year students fail to enroll for their second year (Upcraft, 2000). College Characteristics Although the existing literature on the influence of A Rite of Passage for All, or a collegiate environmental factors on student drinking is Habit for Some That Impacts All? limited, a number of environmental influences working in concert with other factors may affect students’ alcohol Although the consequences of campus drinking are a major problem, contrary to popular misconceptions, the majority of consumption (Presley et al., 2002). Colleges and college students drink moderately or abstain (Wechsler et al., universities where excessive alcohol use is more likely to 2000b). For many students, alcohol use is not a tradition. occur include schools where Greek systems dominate Students who drink the least attend: (i.e., fraternities, sororities), schools where athletic teams Two-year institutions  are prominent, and schools located in the Northeast  Religious schools  Commuter schools (Presley et al., 1996a, 1996b; Wechsler et al., 1996, Historically Black colleges and universities  1997, 1998, 2000b; Werner and Greene, 1992). (Meilman et al., 1994, 1995, 1999; Presley et al., 1996a, 1996b). Students who drink the most include: First-Year Students First-year students (within the first weeks of arrival)  Males  Some first-year students who live on campus may be at Whites  particular risk for alcohol misuse. During their high  Members of fraternities and sororities school years, those who go on to college tend to drink Athletes  less than their noncollege-bound peers. But during the (Johnston et al., 2001b; Wechsler et al., 1996, 1997, 1998, 2000b). first few years following high school, the heavy drinking rates of college students surpass those of their noncollege 8

16 peers drink more often, college students tend to drink Other Factors Affecting Drinking alley and more heavily when they do drink (O’M Numerous other factors affect drinking behavior among ohnston, 2002). J college students. These include biological and genetic predisposition to use, belief system and personality, and Secondhand Consequences of Drinking expectations about the effects of alcohol (Sher et al., 1999; Zucker et al., 1995). In addition to individual student Students who do not drink or do not abuse alcohol characteristics, the size of a student body, geographical experience secondhand consequences from others’ location, and importance of athletics on campus are also excessive use. In addition to physical and sexual assault associated with consumption patterns as are external and damaged property, these consequences include environmental variables including the pricing and unwanted sexual advances and disrupted sleep and study availability of alcohol in the area surrounding a campus (Hingson et al., 2002; Wechsler et al., 1995, 2000b). The (Chaloupka and Wechsler, 1996; Chaloupka et al., 1998; problems produced by high-risk drinking are neither Leichliter et al., 1998; Nelson and Wechsler, 2001; Presley victimless nor cost-free. All students—whether they et al., 1996a, 1996b; Wechsler et al., 1994, 1997, 1998, misuse alcohol or not—and their parents, faculty, and 2000a, 2000b). members of the surrounding community experience the negative consequences wrought by the culture of drinking Although some drinking problems begin during the on U.S. campuses. college years, many students entering college bring established drinking practices with them. Thir ty percent of Post-College Consequences 12th-graders, for example, report binge drinking in high The consequences of alcohol abuse during the college school, slightly more report having “been drunk,” and years do not end with graduation. Frequent, excessive almost three-quarters report drinking in the past year drinking during college increases the prospects for (Johnston et al., 2001a). Colleges and universities “inherit” continuing problems with alcohol and participation in a substantial number of drinking problems that developed other “health-compromising or illegal behaviors” earlier in adolescence. (Schulenberg et al., 1996). On the other hand, in a prospective study of college students, researchers found Comparison with Noncollege Peers that although fraternity/sorority membership is College drinking occurs at a stage in life when drinking associated with high levels of alcohol consumption in levels are generally elevated. Compared to all other age college, Greek status did not predict post-college heavy groups, the prevalence of periodic heavy or high-risk drinking levels (Sher et al., 2001). drinking is greatest among young adults aged 19 to 24; and among young adults, college students have the Overall, these data indicate that high-risk drinking highest prevalence of high-risk drinking (Johnston et al., exposes students, either directly or indirectly , to 2001b; Substance Abuse and Mental Health Services unacceptable risks. Administration, 2001). Although their noncollegiate “I’ve lived in college dormitories for much of my adult life, so I know firsthand the impact irresponsible drinking has on the quality of residential life...reducing alcohol-related harm is clearly central to our mission.” Edward A. Malloy, President University of Notre Dame 9

17 A Call to Action: Changing the Culture of Drinking at U.S. Colleges Issues Involved in A Call to Action During the course of the Task Force on College Barriers to Implementing Drinking’s deliberations, college presidents, students, Research-Based Programs and researchers candidly discussed the dilemmas colleges confront when attempting to respond to the persistent  Data collection requirements and pervasive problems related to drinking on campus.  Lack of information An understanding of these realities is crucial to  Problems with implementation (unrealistic objectives, developing and implementing effective alcohol abuse inadequate resources) prevention programs. Students’ rights and liability concerns  A number of other factors related to students’ rights The Challenge for and liability concerns also discourage schools from Colleges and Communities exploring the issue further and implementing prevention programs. At what point, for example, is a student’s right The consequences of excessive student drinking have of privacy violated because of the institution’s concerns historically placed college presidents and administrators about alcohol abuse? Does a college face legal liability if in untenable positions. When student deaths, injuries, or it designates a residence hall substance-free when the brawls occur on campus, the response tends to be majority of its students are underage? How does an immediate and focused largely on the individual institution respond to the residential requirements of students and families involved. Once the crisis recedes, students in recovery whose needs are protected by the there is little incentive to consider either the root causes Americans with Disabilities Act? If stepped-up of such events or their broader implications, especially enforcement efforts limit the availability of alcohol on when other priorities compete for a president’s time and campus, will students endanger themselves and others by attention. In addition, there is little incentive for driving to off-campus bars? How will alumni react to partnerships between the university or college and the changes in school “traditions” with respect to alcohol? surrounding community, leaving the university or Although colleges can resolve each of these concerns, the college with the entire problem. process takes time and requires a substantial commitment of leadership and resources. “Universities are often afraid to reveal that they have a problem with alcohol, although everyone knows it anyway. But we’ve seen important benefits from focusing on the problem and taking a tough stand. Applications are up, student quality is up, more students are participating in activities like drama and music, and alumni giving has increased. I know that support for the University has grown with our reputation for taking strong ethical positions and sticking with them.” Robert L. Carothers, President University of Rhode Island 10

18 On the basis of experience, many schools also tend to Steps in Integrating Research be justifiably concerned about prevention efforts where into College Alcohol Programs data collection is a key activity. Data collection efforts can be difficult to implement on campus. Legal and Involve college and university presidents using prevalence and  ethical considerations, such as the necessity of obtaining cost data, evidence of research effectiveness, and aspirations consent from parents and the obligation to protect the for a lasting legacy. confidentiality of student responses, impede and Establish administrative norms acknowledging the need for  frequently stop the process completely. Colleges and research and mandating evaluation. universities that persist despite these barriers sometimes  Obtain external support from the surrounding community, find that the resulting data are subjectively interpreted alcohol beverage and hospitality industries, foundations, and and may be used to tarnish a school’s reputation. other organizations concerned about the consequences of student drinking. The widespread perception that student-drinking rates iven are immutable is another deterrent to action. G Impact on Implementation these obstacles, it is not surprising that some colleges are Implementation is another area where insufficient reluctant to undertake and sustain rigorous efforts to research shortchanges schools. Without a strong research address underage and excessive drinking on campuses. base to guide their formulation, program objectives tend to be nonspecific or unrealistic. Lack of information also Impact of Inadequate Information affects a college’s capacity to develop a meaningful Both college presidents and researchers on the Task staffing plan and budget, deficiencies that limit program Force agreed that the perception that underage and success at the outset. When vital information is not excessive college drinking is intractable reflects the need included in program design, used to guide for more credible research and evaluation to be brought implementation, and monitored through careful to this issue. In general, colleges and universities have evaluation, results are likely to be disappointing. not applied the methods, techniques, and findings from cutting-edge alcohol prevention research to the problem Results of Prolonged Ineffectiveness of college student drinking. In addition to poor outcomes, prevention efforts that fail to achieve their goals: Problems with Program Design  Demoralize the many college administrators who are In some cases, campus initiatives have been designed charged with addressing this problem, without considering the important role of research in  Leave fewer resources available for investment in productive programs, and planning and evaluating a school’s alcohol program. As a result, principles useful in selecting effective programs  Lead to a growing sense of fatalism about the issue. have been overlooked. Without this knowledge, colleges find it difficult to identify and combine strategies that With resources committed to ineffective programs, the address the particular drinking problems on their problems associated with underage and ex cessiv e college campuses. The role of science should be emphasized more drinking—violence, injuries, sexual assaults, vandalism, for planning (selecting evidence-based strategies) and poor academic performance—persist and, in the process, evaluation (determining effects of any current strategies). derail and sometimes destroy the lives of many of the 11

19 A Call to Action: Changing the Culture of Drinking at U.S. Colleges Nation’s most promising young adults. Reversing this Creating a Research-Based situation is crucial and, from the Task Force’s perspective, will happen only if every college and university president Campus Alcohol Program works in conjunction with the alcohol research Why Do It? community to implement evidence-based prevention strategies. Task Force members also understand that for Excessive drinking affects all students, increases  some administrators this step represents a mindset institutional costs, and hurts town-gown change—one that looks to validated research for genuine relationships. answers rather than quick fixes, which may seem  Research-based strategies are more effective than appealing when confronted with a crisis. quick fixes and produce quantifiable results. Effective programs improve student health and  safety and contribute to a meaningful legacy. Integrating Research Into College Alcohol Program Planning Where To Begin? Integrating research into college alcohol program  Commit to a long-term, research-based approach. planning requires the active participation of college and Persuade the larger campus community of the  university presidents; cooperation from the larger wisdom of this approach. campus community—including faculty, staff, and the surrounding community (e.g., local police, local How Do I Take Action? businesses, community leaders), as well as students,  Collect basic information about the nature and extent of student drinking as a first step. parents, and alumni; and support from alcohol Design a comprehensive program using the  researchers and policymakers. “3-in-1” framework recommended by the Task Force. Incorporate strategies that address the Involving Colleges and Universities particular problems on your campus.  Secure outside support for your program. The first step in integrating research into the planning and execution of campus alcohol programs is to How Can I Sustain Interest in the Program? convince college and university presidents of the wisdom Create administrative norms that help institutionalize  of supporting long-term research agendas that may not the program. produce results during their tenure. Compelling  Monitor program results and publicize them. arguments for this position can be made on the basis of:  Continue the conversation on this issue with all Data describing the dimensions of the college  members of the campus community, local drinking epidemic and its effects on students, community leaders, and your peers; use this institutional costs and good will, and the surrounding dialogue to improve and update the program to community; respond to changing conditions on campus. 12

20  Findings indicating that research-based strategies are Improves the effectiveness of prevention programs  effective in reducing underage and excessive student aimed at adolescents and young adults, and drinking; and  Provides much-needed accountability for resources  College presidents’ desires to ensure a legacy that expended. includes improved student health and safety as major achievements. In the Task Force’s view, the prospects for genuine progress in addr essing underage and excessive student Establishing Administrative Norms drinking are enhanced substantially when colleges and Once college and university presidents are committed to universities can: using a research-based approach, the next step is to  Assess their problems realistically, establish administrative norms that:  Adopt research-based strategies to confront them,  Recognize the importance of research, and  Adjust program activities to meet institution-specific  Require inclusion of review and evaluation needs, and components before institutional resources are  Define outcomes for drinking programs that reflect allocated for program implementation. desired changes and can be measured. Obtaining External Support External resources can help presidents ensure that Support is also needed on a more global level. Schools ’s these important activities are integrated within a school cannot be expected to mount campaigns for or program for addressing hazardous student drinking. implement research-based approaches on their own. Commitments are needed from the community Defining Credible Research surrounding the campus, as well as from funding Task Force members relied on to understand the credible research sources such as foundations, national organizations, impact of high-risk drinking on campus and formulate recommen­ and the hospitality and alcohol beverage industries to dations for addressing it. In contrast to research that is methodologi­ support only comprehensive, research-based strategies cally weak or where more has been inferred than the data allow, for addressing underage and excessive college drinking. credible research increases understanding. Concerted efforts by State and Federal policymakers Sound research follows the principles of the scientific method and and leaders from the broad-based alcohol abuse uses as many rigorous methodological techniques as possible when prevention and treatment fields are also essential to designing studies. Among those techniques are randomized assign­ ment of study subjects to control and experimental groups, use of achieving this goal. pre- and post-observations or multiple observations when feasible, and use of probability sampling. Credible research provides the foundation for making Whereas findings from inadequately designed, implemented, or ana­ The sophisticated methods solid programming decisions. lyzed research can lead to erroneous conclusions, credible research yed in contemporary research are producing emplo advances the practice of alcohol problem prevention and treatment information that: by generating, methodically applying, and testing new ideas. 13

21 A Call to Action: Changing the Culture of Drinking at U.S. Colleges A Call to Action: Recommendations for Addressing Excessive College Drinking To provide practical assistance to colleges and 3-in-1 The Task Force members agreed that the universities, the Task Force on College Drinking is a useful introduction to encourage amework Fr developed a series of recommendations on integrating presidents, administrators, college prevention specialists, research-based principles and practices in alcohol students, and community members to think in a broad program planning. The Task Force also prepared and comprehensive fashion about college drinking. It is recommendations specifically for researchers and NIAAA designed to encourage consideration simultaneously of on the direction of future research and areas for potential multiple audiences on and off campus. The Task Force collaboration with colleges and universities. All offers the 3-in-1 Framework as a starting point to recommendations are based on scientific evidence, reflect develop effective and science-based prevention efforts. a consensus among Task Force members, and represent the most objective guidance currently available on The brief descriptions that follow provide the rationale preventing risky drinking by college students. As such, ee targets in pr for emphasizing these thr evention the Task Force believes that these recommendations programs aimed at high-risk student drinking and should serve as the basis for all interventions supported identify alternative prevention strategies that address by national, state, and local organizations and each group. implemented by colleges and communities. (1) Individuals, Including At-Risk or Alcohol- Recommendations for Dependent D The risk for alcohol problems rinkers: exists along a continuum. Targeting only those with Colleges and Universities identified problems misses students who drink heavily or To change the culture of drinking on campus, the Task misuse alcohol occasionally (e.g., drink and drive from Force recommends that all colleges and universities time to time). In fact, nondependent, high-risk drinkers adopt the following overarching approach to program development and then select appropriate strategies from What does a multivariate among those presented on the following pages to tailor programs to the special needs of their schools. perspective mean? Alcohol research clearly indicates that multiple factors interact Overarching Framework to produce various drinking patterns. Factors include students’ The research strongly supports the use of comprehensive, genetic/biological characteristics, family and cultural back­ integrated programs with multiple complementary grounds and environments, previous drinking experiences in components that target: (1) individuals, including high school, and the particular environment of the college in at-risk or alcohol-dependent drinkers, (2) the student which they are enrolled. Even within one college, patterns may population as a whole, and (3) the college and the be influenced by students’ participation in fraternities/sorori­ surrounding community (Hingson and Howland, 2002; ties, sports teams, or other social groups. Research now has the capacity to bring this enlarged perspective to the problem of DeJong et al., 1998; Institute of Medicine, 1989). The college drinking and to test models that take into account presented here focuses simultaneously 3-in-1 Framework many of these factors. on each of the three primary audiences. 14

22 account for the majority of alcohol-related deaths, Specific strategies useful in addressing these problem ary by school. Examples of some of the areas tend to v disability, and damage (Lemmons, 1995; Kreitman, most promising strategies appear in the section 1986). “Recommended Strategies” (please see below). It is crucial to support strategies that assist individual (3) College and the Surrounding Community: students identified as pr oblem, at-risk, or alcohol- einforcing interventions between the college Mutually r trategies are clearly needed to dependent drinkers. S and surrounding community can change the broader engage these students as early as possible in appropriate environment and help reduce alcohol abuse and alcohol- screening and intervention services—whether provided related problems over the long term. When college on campus or through referral to specialized drinking is reframed as a community as well as a college community-based services. One important effort to problem, campus and community leaders are more likely increase on-campus screening is National Alcohol to come together to address it comprehensively. The Screening Day, an event that takes place in April each joint activities that typically result help produce policy year. This program, supported by NIAAA and the and enforcement reforms that, in turn, affect the total Substance Abuse and Mental Health Services drinking environment. Campus and community Administration, provides free, anonymous testing and alliances also improve relationships overall and enable health information at a growing number of colleges and key groups such as student affairs offices, residence life universities. directors, local police, retail alcohol outlets, and the court system to work cooperatively in resolving issues (2) Student Body as a Whole: The key to affecting involving students (Hingson and Howland, 2002; the behavior of the general student population is to Holder et al., 1997a, 2000; Perry and Kelder, 1992; addr ess the factors that encourage high-risk drinking Saltz and Stangetta, 1997). (D eJong and Langenbahn, 1996; DeJong and Linkenbach, 1999; DeJong and Langford, 2002; Following are specific strategies that can be used Edwards et al., 1994; Perkins, 2002; Toomey and ramework to create programs within the 3-in-1 F Wagenaar, 2002; Toomey et al., 1993). addressing all three levels. They include the:  Widespread availability of alcoholic beverages to Recommended Strategies underage and intoxicated students, The evidence supporting the substance abuse  Aggressive social and commercial promotion of prevention strategies in the literature varies widely. alcohol, These differences do not always mean that one strategy Large amounts of unstructured student time,  is intrinsically better than another. They may reflect the  Inconsistent publicity and enforcement of laws and fact that some strategies have not been as thoroughly campus policies, and studied as others or have not been evaluated for Student perceptions of heavy alcohol use as the norm.  application to college drinkers. To provide a useful list 15

23 A Call to Action: Changing the Culture of Drinking at U.S. Colleges that accounts for the lack of research as well as negative Influence of Implicit findings, Task Force members placed prevention Expectations and Thoughts strategies in descending tiers on the basis of the evidence available to support or refute them. Thoughts and motives of which individuals are unaware or bare­ ly aware often influence behavioral choices. Research in cogni­ Tier 1: Evidence of Effectiveness Among tive psychology and neuroscience has vastly improved capacity to College Students assess “implicit” decision making. Recently, this understanding Strong research evidence (two or more favorable studies has been applied to the problem of college drinking. As a result, program planners are developing prevention programs that do available) supports the strategies that follow. All not assume that every choice college students make has been strategies target individual problem, at-risk, or alcohol- carefully considered before they act on it. dependent drinkers. Their efficacy as part of a campus- wide strategy has not been tested. behavior on campus and uses data to refute beliefs about the tolerance for this behavior as well as beliefs about the e-behavioral skills with Strategy: Combining cognitiv number of students who drink excessively and the norms clar ational enhancement ification and motiv amounts of alcohol they consume. strives Cognitive-behavioral skills training interventions. to change an individual’s dysfunctional beliefs and As its name implies, is motivational enhancement thinking about the use of alcohol through activities such designed to stimulate students’ intrinsic desire or as altering expectancies about alcohol’s effects, motivation to change their behavior. Motivational documenting daily alcohol consumption, and learning to enhancement strategies are based on the theory that manage stress. individuals alone are responsible for changing their drinking behavior and complying with that decision Norms or values clarification examines students’ (Miller et al., 1992). In motivational enhancement e drinking per ceptions about the acceptability of abusiv interventions, interviewers assess student alcohol consumption using a formal screening instrument. Results are scored and students receive nonjudgmental Assessment of Alcohol Problems feedback on their personal drinking behavior in Within the last generation, researchers have developed semi­ comparison with that of others and its negative structured interviews that provide reliable, standardized assess­ consequences. Students also receive suggestions to ments of alcohol consumption, alcohol problems, and the symp­ support their decisions to change. toms of alcohol abuse and dependence. Research indicates that combining the three strategies w researchers to evaluate the extent of These new techniques allo is effective in r educing consumption (Larimer and various alcohol-related problems among college and noncollege samples and to assess their magnitude nationally and regionally. C ronce, 2002). One example of such an approach is a They also enable researchers to determine how alcohol-related program using motivational enhancement, developed by problems change in response to general population trends, new laws and policies, and alcohol prevention and programs. 16

24 alcohol consumption rates, compared to control group Marlatt. The program, the Alcohol Skills Training ticipants, at both the 2-y par ear follow-up (Marlatt et al., Program (ASTP), is a cognitive-behavioral alcohol 1998) and 4-year outcome assessment periods (Baer et prevention program that teaches students basic al., 2001). BASICS has also been found to be clinially principles of moderate drinking and how to cope with significant in an analysis of individual student drinking high-risk situations for excessive alcohol consumption changes over time (Roberts et al., 2000). (Fromme et al., 1994). The ASTP is designed for group administration and includes an alcohol expectancy challenge component. Controlled outcome studies show This Strategy: Challenging alcohol expectancies. that the ASTP significantly reduces drinking rates and strategy wor ks b y using a combination of information associated problems for both 1-year (Kivlahan et al., and experiential learning to alter students’ expectations 1990) and 2-year follow-up periods (Baer et al., 1992). about the effects of alcohol so they understand that drinking does not necessarily produce many of the effects they anticipate such as sociability and sexual Offering brief motivational enhancement Strategy: attractiveness (Darkes and Goldman, 1993, 1998; Jones ventions. Students who receive brief (usually 45­ inter et al., 1995). The research conducted to date indicates minute), personalized motivational enhancement that the positive effects of this strategy last for up to 6 sessions, whether delivered individually or in small weeks in men, but additional research is under way to groups, reduce alcohol consumption. This strategy can verify and extend this approach to women and for also reduce negative consequences such as excessive longer time periods. drinking, driving after drinking, riding with an intoxicated driver, citations for traffic violations, and injuries (Aubrey, 1998; D’Amico and Fromme, in press; Tier 2: Evidence of Success With General Larimer and Cronce, 2002; Marlatt et al., 1998; Monti Populations That Could Be Applied to et al., 1999). This approach has been used successfully in College Environments medical settings (Dimeff, 1999; Monti et al., 1999). An The Task Force recommends that college presidents, effective brief intervention has been developed at the campus alcohol program planners, and student and University of Washington. This brief intervention for community leaders explore the strategies listed below high-risk drinkers is based on the ASTP program and is because they have been successful with similar known as the BASICS program: Brief Alcohol Screening populations, although they have not yet been and Intervention for College Students (Dimeff et al., comprehensively evaluated with college students 1999). BASICS is administered in the form of two (Hingson et al., 1996; Holder et al., 2000; Saltz and individual sessions in which students are provided Stangetta, 1997; Voas et al., 1997). These environmental feedback about their drinking behavior and given the strategies are not guaranteed to alter the behavior of opportunity to negotiate a plan for change based on the every college student, but they can help change those principles of motivational interviewing. High-risk aspects of the campus and community culture that drinkers who participated in the BASICS program support excessive and underage alcohol use. significantly reduced both drinking problems and 17

25 A Call to Action: Changing the Culture of Drinking at U.S. Colleges “Student safety is of paramount importance, we simply have to make certain that our [alcohol prevention] program is working.” William Jenkins, President Louisiana State University System driving and related injuries and deaths can be reduced by Strategy: Increased enforcement of minimum lowering legal blood alcohol limits to .08 percent for drinking age laws (Toomey and Wagenaar, 2002). The adult drivers (Dee, 2001; Hingson et al., 1996a, 2000; minimum legal drinking age (MLDA) law is the most Schultz et al., 2001; Voas et al., 2000); setting legal well-studied alcohol control policy. Compared to other blood alcohol content (BAC) for drivers under age 21 at programs aimed at youth in general, increasing the legal .02 percent or lower (Hingson et al., 1994; Wagenaar et age for purchase and consumption of alcohol has been al., 2001); use of sobriety check points (Castle et al., the most successful effort to date in reducing underage 1995; Lacey et al., 1999; Schultz et al., 2001); server drinking and alcohol-related problems. Most studies training intervention (Gliksman et al., 1993; Lang et al., suggest that higher legal drinking ages reduce alcohol 1998; Russ and Geller, 1987; Saltz, 1989; Schultz et al., consumption, and over half found that a higher legal 2001); and administrative license revocation laws (Dee, drinking age is associated with decreased rates of traffic 2001; Klein, 1989; Voas et al., 2000; Zador et al., crashes. Studies also indicate that policies are less 1989). Safety belt laws, particularly primary enforcement effective if they are not consistently enforced. Moreover, belt laws, have been shown in numerous studies to the certainty of consequences is more important than reduce traffic deaths and injuries (Dinh-Zaar et al., severity in deterring undesirable behavior. 2001). When California changed from a secondary to a primary enforcement belt law that permits police to stop The benefits of the MLDA have occurred with vehicles and give a citation simply because an occupant et studies of the effects of minimal enforcement, y was not belted, safety belt use rates increased 39 percent eased enforcement show that it is highly effective in incr among drivers with BAC of .10 percent or higher reducing alcohol sales to minors (Wagenaar and Toomey, compared to 23 percent overall (Lange and Voas, 1998). 2002). Increased enforcement—specifically compliance This indicates that primary enforcement belt laws can checks on retail alcohol outlets—typically cuts rates of prevent many alcohol-related traffic fatalities. sales to minors by at least half (Preusser et al., 1994; Comprehensive community interventions have also Lewis et al., 1996; Grube, 1997). Efforts to reduce the shown that increased enforcement and publicity of laws use of false age identification and tighter restrictions on to reduce alcohol-impaired driving have produced “home delivery” of alcohol may also help enhance the significant reductions in the types of motor vehicle effectiveness of this law. crashes most likely to involve alcohol (Holder et al., 2000) and alcohol-related traffic deaths (Hingson et al., Strategy: Implementation, increased publicity, and 1996b). educe alcohol-impaired cement of other laws to r enfor Injury and deaths caused by alcohol-impaired driving. 18

26 the hospitality industry would welcome written policies Strategy: Restrictions on alcohol retail outlet about r esponsible service of alcohol and training in how (Scribner et al., 1995; Gruenewald et al., 1993). density to implement them appropriately. Policies could include Studies of the number of alcohol licenses or outlets per serving alcohol in standard sizes, limiting sales of population size have found a relationship between the pitchers, cutting off service of alcohol to intoxicated density of alcohol outlets, consumption, and related patrons, promoting alcohol-free drinks and food, and problems such as violence, other crime, and health eliminating last-call announcements. Servers and other problems (Toomey and Wagenaar, 2002). One study, staff could receive training in skills such as slowing targeting college students specifically, found higher levels alcohol service, refusing service to intoxicated patrons, of drinking and binge drinking among underage and checking age identification, and detecting false older college students when a larger number of identification. To prevent sales to underage patrons, it is businesses sold alcohol within one mile of campus important to back identification policies with penalties (Chaloupka and Wechsler, 1996). Numbers of outlets for noncompliance. may be restricted directly or indirectly through policies that make licenses more difficult to obtain such as mation of a campus and The for Strategy: increasing the cost of a license. community coalition involving all major stakeholders may be critical to implement these strategies ncreased price and excise taxes on Strategy: I A number of comprehensive community effectively. (Godfrey, 1997; Chaloupka and alcoholic beverages efforts have been designed to reduce alcohol and other Wechsler, 1996; Sutton and Godfrey, 1995; Kenkel, substance use and related negative consequences among 1993). The effect of price on consumption has been underaged youth, including college students, and among studied extensively. All types of drinkers appear to be adults (Chou et al., 1998; Hingson et al., 1996b; affected by price. Studies show that when the price of Holder and Treno, 1997; Holder et al., 1997b; Pentz et alcohol increases, many alcohol-related problems, al., 1989; Perry et al., 1996; Saltz and Stangletta, 1997; including motor vehicle fatalities, robberies, rapes, and Wagenaar et al., 2000); and their outcomes demonstrate liver cirrhosis mortality, decrease (Cook and Moore, the potential effectiveness of this approach in college 1993). Although older heavy drinkers seem to be less communities. For example, the Community Trials affected by variations in price than other consumers, Program (Grube, 1997; Holder and Treno, 1997; price still appears to have a substantial impact on young, Holder et al., 1997a, b; Holder and Reynolds, 1997; heavy drinkers. For this reason, efforts to increase price Holder et al., 2000; Treno and Holder, 1997; Reynolds or to prevent reductions in price likely would affect the et al., 1997; Saltz and Stangletta, 1997; Voas et al., behavior of the full spectrum of drinkers on campus. 1997), which focused on alcohol trauma in the general population, resulted in a significant decline in esponsible beverage service policies in R Strategy: emergency room admissions for alcohol-related assault. social and commercial settings (Saltz and Stangetta, Both this program and Communities Mobilizing for 1997; Holder et al., 1997b; Treno and Holder, 1997). Change (CMCA) (Wagenaar et al., 1999, 2000), which Studies suggest that bartenders, waiters, and others in was designed specifically to reduce drinking among 19

27 A Call to Action: Changing the Culture of Drinking at U.S. Colleges young people, resulted in reduced alcohol sales to Tier 3: Evidence of Logical and Theoretical minors. In the CMCA project young people ages 18 to Promise, But Require More Comprehensive 20 reduced their propensity to provide alcohol to other Evaluation teens and were less likely to try to buy alcohol, drink in The Task Force recognizes that a number of popular a bar, or consume alcohol. The Massachusetts Saving strategies and policy suggestions make sense intuitively Lives Program (Hingson et al., 1996b), designed to or have strong theoretical support. Many also raise reduce drunk driving and speeding in the general researchable questions that may be crucial in reducing population, produced relative declines in alcohol-related the consequences of college student drinking. Although traffic deaths among persons 16 to 25 years of age. the Task Force is eager to see these strategies implemented and evaluated, it cautions interested This approach reframes the issue as a community schools to assemble a team of experienced researchers to problem, not simply a college pr oblem, brings together assist them in the process. ers needed to address it, and sets the the range of play stage for cooperative action. In addition to college The Task Force recommends that schools considering presidents and campus administrators, stakeholders in aluation any of these strategies incorporate a strong ev campus-community coalitions include student groups, component to test their viability in actual practice. faculty, staff, community leaders, law enforcement, and very strategy that appears below targets the student E representatives from hospitality and alcohol beverage population as a whole. industries (Hingson and Howland, 2002). Research shows that promoting community ownership of Adopting the following campus-based Strategy: programs enhances success (Holder et al., 1997a; Perry et policies and practices that appear to be capable of al., 1996). On that basis, active campus and community reducing high-risk alcohol use. These activities ar e coalitions can be expected to build support for addressing particularly appealing because straightforward and underage and excessive college drinking; help assure that relatively brief evaluations should indicate whether they strategies used respond to genuine community needs; would be successful in reducing high-risk drinking on a maintain and, ultimately, institutionalize effective particular campus. strategies; and evaluate and disseminate the results of the  Reinstating Friday classes and exams to reduce coalition’s activities to other college communities Thursday night partying; possibly scheduling (Hingson and Howland, 2002). Saturday morning classes; “Excessive student drinking contributes to failed academic performance ranging from missed classes to attrition. At the same time, many colleges and universities unwittingly help create a culture of student drinking by scheduling no classes on Friday, thereby creating three-day weekends, and by grade inflation which tolerates and even rewards minimal student performance.” Susan Resneck Pierce, President University of Puget Sound 20

28  Implementing alcohol-free, expanded late-night student activities;  Eliminating keg parties on campus where underage drinking is prevalent; Establishing alcohol-free dormitories;   Employing older, salaried resident assistants or hiring adults to fulfill that role;  Further controlling or eliminating alcohol at sports events and prohibiting tailgating parties that model heavy alcohol use;  Refusing sponsorship gifts from the alcohol industry to avoid any perception that underage drinking is acceptable; and  Banning alcohol on campus, including at faculty and alumni events. Strategy: Increasing enforcement at campus-based events that pr omote excessive drinking (DeJong, 1998; DeJong and Langenbahn, 1996; Gomberg, 1999; Gulland, 1994; Pittayathikhun et al., 1997). Campus police can conduct random spot checks at events and parties on campus to ensure that alcohol service is monitored and that age identification is checked. It may be important for non-students to enforce these campus policies. Resident assistants and others charged with developing close supportive relationships with students might find it difficult to enforce alcohol-related rules and regulations consistently and uniformly. Strategy: Increasing publicity about and enforcement of underage drinking laws on campus and eliminating “ mixed messages.” As indicated previously, active enforcement of minimum legal age drinking laws results in declines in sales to minors (Grube, 1997; Lewis et al., 1996; Preusser et al., 1994; Wagenaar et al., 2000). Lax enforcement of State laws 21

29 A Call to Action: Changing the Culture of Drinking at U.S. Colleges “We dare not let alcohol blemish your bright promise.” Thomas K. Hearn, Jr., President Wake Forest University in a letter to incoming first-year students destinations. Safe rides are usually restricted to students, and local regulations on campus may send a “mixed guests.” Safe faculty, staff , and a limited number of “ message” to students about compliance with legally rides sponsors often include student government, Greek imposed drinking restrictions. Creative approaches are Councils, student health centers, campus police, needed to test the feasibility of this strategy (DeJong and Mothers Against Drunk Driving chapters, and other Langford, 2002). local community organizations, agencies, and businesses. They have been criticized as potentially encouraging y Consistently enforcing disciplinar Strategy: high-risk drinking, and this possibly should be eJong and (D actions associated with policy violations considered in design, promotion, and monitoring. Langford, 2002). Inconsistent enforcement of alcohol- related rules may suggest to students that “rules are made to be broken.” To test the effectiveness of this approach Strategy: Regulation of happy hours and sales would likely require staff and faculty training, frequent and W (Chaloupka echsler, 1996; Toomey and Wagenaar, communication with students, and the implementation 2002). Happy hours and price promotions—such as two of a research component. drinks for the price of one or women drink for free—are associated with higher consumption among both light and heavy drinkers. Research shows that as the price of Conducting marketing campaigns to Strategy: alcohol goes up, consumption rates go down, especially ceptions about alcohol use ect student misper corr among younger drinkers. Because many bars (Berkowitz, 1997; Clapp and McDonnell, 2000; DeJong surrounding campuses attract students by promoting and Linkenbach, 1999; Johannessen et al., 1999; Page et drink specials, restrictions on happy hours have the al., 1999; Perkins, 1997, 2002; Perkins and Wechsler, potential to reduce excessive consumption off campus. 1996). On the basis of the premise that students If colleges and universities have a licensed establishment overestimate the amount of drinking that occurs among on campus, drink specials could be prohibited or their peers and then fashion their own behavior to meet promotion of alcohol-free drinks and food specials could this perceived norm, many schools are now actively be encouraged. In nonlicensed settings on campus that conducting “social norming” campaigns to correct many serve alcohol, event planners could opt to limit the of these misperceptions. amount of free alcohol that is available and eliminate all self-service. Schools could also limit alcohol use to Provision of “safe rides” programs Strategy: weekends or after regular class hours in an effort to ong, 1995). Safe rides attempt to prevent drinking (D eJ separate drinking from activities more closely aligned and driving by providing either free or low-cost with the core academic mission. transportation such as taxis or van shuttles from popular student venues or events to residence halls and other safe 22

30 known as OCTAA—when not used with other strategies Strategy: Informing new students and their parents (Larimer and Cr once, 2002; Maddock, 1999; Sammon about alcohol policies and penalties before arrival and et al., 1991). However, there is no scientific evidence during orientation periods (DeJong and Langford, 2002). that these programs actually work well if used in There is some anecdotal evidence that experiences during conjunction with other complementary strategies. the first 6 weeks of enrollment affect subsequent success during the freshman year. Because many students begin Strategy: Informational, knowledge-based, or drinking heavily during this time, they are unable to adapt alues clarification interventions about alcohol and v appropriately to campus life. Alerting parents and students the problems related to its excessive use, when used to this possibility early on (e.g., through preadmission alone (Larimer and Cronce, 2002; Maddock, 1999). letters to parents and inclusion of information in This strategy is based on the assumption that college orientation sessions and in presidents’ and student leaders’ students excessively use alcohol because they lack welcoming speeches) may help prevent the development knowledge or awareness of health risks and that an of problems during this critical, high-risk period. increase in knowledge would lead to a decrease in use. Tier 4: Evidence of Ineffectiveness Although educational components are integral to some The Task Force recognizes that it is difficult or successful interventions, they do not appear to be impossible to “prove” that a specific intervention effective in isolation. Despite this evidence, approach is universally ineffective. Nevertheless, when informational/educational strategies are the most there are consistent findings across a wide variety of well- commonly utilized techniques for individually focused designed studies, it is possible to conclude that an prevention on college campuses (DeJong and Langford, approach is not likely to be effective and that limited 2002; Larimer and Cronce, 2002; Ziemelis, 1998). resources should be used in other ways. Additionally, if there is strong evidence that an intervention approach is Providing blood alcohol content feedback Strategy: eath analysis tests to actually harmful or counterproductive, recommendations to students. This strategy uses br provide students accurate information on their BAC. It not to use it can be made based on fewer studies. could be used as part of a research evaluation or to dissuade students from driving while under the influence The Task Force also notes that some interventions may or continuing to drink past intoxication. Providing this be ineffective when used in isolation, but might make an tant contribution as part of a multicomponent information to students who are drinking must be impor integrated set of programs and activities. However, until approached with caution. Some researchers have found there is evidence of a complementary or synergistic effect that the presence of immediate breath analysis feedback resulting from inclusion with other strategies, college can actually encourage excessive drinking when students administrators are cautioned against making make a contest of achieving high BACs (personal assumptions of effectiveness without scientific evidence. communications from Scott Geller, 2002 and Robert For instance, two strategies sometimes are labeled as Voas, 2002). If BAC feedback is to be provided in ineffective—the TIPS server training program and Prime naturalistic settings, the procedure should be carefully for Life! On Campus (Talking About Alcohol), formerly monitored for adverse effects and adjusted as necessary. 23

31 A Call to Action: Changing the Culture of Drinking at U.S. Colleges 3-in-1 Framework Level of Operation Community Individuals, including Student At-Risk and Population as Strategy Tier Dependent Drinkers Whole Combining cognitive-behavioral skills with norms 1: Effective Ye s No No clarification & motivational enhancement intervention among college Offering brief motivational enhancement interventions Ye s No No students in student health centers and emergency rooms Challenging alcohol expectancies No Ye s No Increased enforcement of minimum drinking age laws Yes No Yes 2: Effective Implementation, increased publicity, and enforcement No Yes Yes with general of other laws to reduce alcohol-impaired driving populations Restrictions on alcohol retail density No Yes No Increased price and excise taxes on alcoholic beverages No No Yes Responsible beverage service policies in social & No Yes Yes commercial settings The formation of a campus/community coalition No Yes Yes Adopting campus-based policies to reduce high-risk 3: Promising No Yes No use (e.g., reinstating Friday classes, eliminating keg parties, establishing alcohol-free activities & dorms) Increasing enforcement at campus-based events that No Yes No promote excessive drinking Increasing publicity about enforcement of underage No Yes Yes drinking laws/eliminating “mixed” messages Consistently enforcing disciplinary actions associated No Yes No with policy violations Conducting marketing campaigns to correct student No No Yes misperceptions about alcohol use on campus Provision of “safe rides” programs No Yes Yes Regulation of happy hours and sales No Yes Yes Enhancing awareness of personal liability Ye s Ye s No Informing new students and parents about alcohol Ye s Ye s No policies and penalties Informational, knowledge-based or values clarification N/A N/A N/A 4: Ineffective interventions when used alone 24

32 A Special Role for College Presidents “It has been my experience, both on campus and in the community, that invitations on presidential letterhead result in greater participation in our efforts than otherwise have been the case.” Susan Resneck Pierce, President University of Puget Sound drinking, presidential leadership is crucial to set plans in In the Task Force’s view, presidential leadership is motion and support the actions needed to reverse the essential to ensure that recommendations relevant to culture of drinking on campus. each college and university are incorporated into its alcohol abuse prevention program planning process. As a school’s chief executive officer, educational leader, and public spokesperson, a president is expected to set priorities, serve as a catalyst for new programs, and communicate concern about issues compromising the educational environment (DeJong, 1998). By virtue of their authority, presidents can pull together all the disparate pieces of institutional policy on alcohol from student life, athletics, administrative affairs, and residence life. Once new or refined policies and practices are in place, their position helps ensure that every sector of the college implements the new procedures (Mara, 2000; DeJong, 1998). Presidential visibility and influence also lend increased importance to prevention efforts on campus and in the community and promote student as well as faculty investment in and ownership of programs. According to the project director of Louisiana State University’s Community Coalition for Change, students deem it an “honor” to participate on the college prevention task force when the school president calls for their involvement and conveys personal commitment to the issue. The Task Force recognizes that although research can provide useful guidance to colleges and universities in addressing the consequences of high-risk student 25

33 A Call to Action: Changing the Culture of Drinking at U.S. Colleges The Need for Student Participation in Prevention Policymaking and Programs  Joint campus and community coalitions, Both college presidents and student members of the Task Force reiterated the importance of involving students in  Reviews of proposed policies before they are finalized, rethinking a school’s approach to high-risk student  Judicial reviews by dormitory councils that hear cases drinking. Students are not only the primary targets and of first alcohol infractions, and beneficiaries of prevention programs, but also key Training of student residence hall staff to eliminate  contributors to their successful implementation (Mara, communication of mixed messages about alcohol use 2000; Presidents Leadership Group, 1997). on campus and improve consistent enforcement of alcohol policies. In their discussions about the practical issues involved in developing and sustaining workable policies, Task From the Task Force’s perspective, inviting students to Force members described several areas where student share in the development and implementation of the participation not only improved a school’s policy, but r ecommendations outlined above will help ensure that also increased campus-wide “ownership” of the the strategies selected meet an institution’s specific needs prevention efforts emanating from it (Mara, 2000). and receive the continued attention required for success. These include participation in (Mara, 2000):  Campus-based task forces to direct prevention program efforts and develop specific strategies for promoting change in student organizations, 26

34 Steps That Signal Imminent Change in the Culture of Drinking identify strategies appropriate for a given school and College and university presidents will need time to carefully community. Strategic plans also include ongoing program consider the implications of the Task Force’s recommendations. evaluation and campus monitoring components to ensure that As they do, the Task Force suggests that they take the following, both needs and progress are assessed at timed intervals. immediate steps to signal their interest in changing the culture of drinking on campus: Communicate the institution’s position on underage and  Review current alcohol prevention programs, assess  Students, parents, alumni, community excessive drinking. whether they are working, and consider what could be leaders, and college faculty and staff are more likely to support changed. Research-based methods are available to assist a school’s efforts to reduce underage and excessive drinking if college presidents with this task. Without an informed they understand why action is necessary and how student assessment, colleges and universities cannot fully identify health and safety can benefit from the university’s position. needs or structure programs to respond to the particular types Orientation and other appropriate gatherings of the university of drinking problems on their campuses. community may offer appropriate opportunities to convey those messages. Involve students, the community, and other stakeholders  Strategies Commit to addressing the issue over time.  in the review and assessment process and in the planning effective in reducing underage and excessive drinking require and implementation of interventions. Stakeholders can help substantial time to produce results. Planning efforts ensure that planned interventions represent and reconcile the recognizing this need can help ensure that programs are diversity of perspectives on campus, include appropriate and implemented effectively and achieve intended outcomes. acceptable strategies, and achieve wider buy-in for proposed changes. A mix of students and more “permanent” Collaborate with NIAAA to develop an evaluation plan.  stakeholders will help guarantee continuity over time. Practical strategies for beginning and supporting institutional initiatives include: Focus on strategies most likely to make a difference at   Using data collection and data extrapolation methods to individual institutions and document them in a strategic assemble information needed in problem assessment, plan. Effective alcohol policies and programs are tailored to  Evaluating campus-based approaches and longer-term the specific situation on each campus. Just as there are campus- and community-based environmental approaches, multiple contributing factors to high-risk drinking, there are and multiple strategies that can be applied to improve identified Participating in research dissemination initiatives offered  problems. A strategic planning process conducted in by NIAAA. collaboration with campus and community stakeholders can 27

35 A Call to Action: Changing the Culture of Drinking at U.S. Colleges Recommendations for the Research Community As the Task Force explored the role of the research  Improve existing data systems such as the Department community in supporting college drinking prevention of Transportation’s Fatality Analysis Reporting System (FARS) and the Centers for Disease Control and programs, the need for both new and expanded research­ Prevention’s Vital Statistics Mortality files to more oriented activities became clear. Researchers, no matter their subject specialty or interest, are members of their accurately specify, count, and monitor college student college or university community and, as such, have a deaths over time. unique knowledge and concern about alcohol-related Collaborate with universities to capitalize on the  “natural” research opportunities that emerge when problems. Specifically, researchers need improved methods for understanding the dimensions of the schools, communities, or States institute a major alcohol problem on campus, developing timely answers policy change that affects multiple aspects of the academic community—for example, restricting sales to immediate policy questions, and evaluating the of alcohol at school-sponsored events. impact of prevention programs on student drinking. In the Task Force’s view, enhancing both the methods and Partner with individual institutions to implement  opportunities for conducting evaluations is a priority. short-term studies to assess the impact of popular, Well-designed evaluations increase the likelihood of commonsense strategies for changing campus-based environmental policies and practices that have not yet program effectiveness, maximize the use of resources, been comprehensively evaluated. The strategies in Tier and validate program credibility. Evaluation results also help researchers develop the knowledge needed to 3 could be effectively studied through short and inform future policies and programs (Saltz and DeJong, relatively simple campus-based research efforts. 2002).  Offer assistance to colleges and universities in using research-based evidence to develop and improve To amass the research-based information needed to current alcohol policies. improve campus-based prevention policies and programs, the Task Force recommends that the research community:  Expand its focus on extracting information from existing research databases and studies and produce findings that are immediately useful in understanding college drinking.  Develop specific standards and guidelines for assessing campus alcohol problems, monitoring trends, and evaluating interventions. This should include developing more effective screening tools for use by clinicians and researchers to facilitate the identification of at-risk, problem, and dependent drinkers among college students. 28

36 Recommendations for NIAAA One of the Task Force’s most important tasks is to situation in comparison to others. To support this orce recommends that NIAAA: activity, the T ask F recommend activities and research that NIAAA could Design and implement one national surveillance and  sponsor to support colleges and universities in their data system for all colleges and universities to efforts to change the culture of drinking on campus. establish reliable estimates of the magnitude of the Backed by the NIH reputation for rigorous scientific problem, provide mechanisms to track nationwide research, NIAAA is in a unique position to foster careful changes, assist colleges in monitoring their own studies of underage and excessive college drinking. campuses, and facilitate intercampus research. Results from such efforts would enable campus and  Take the leadership role in working with other community policymakers to speak with greater relevant agencies and organizations, researchers, and confidence about the causes and consequences of the college administrators to support development of a problem and its possible solutions. The Task Force urges range of state-of-the-art screening and assessment NIAAA and the Congress to expand funding to support measures for use by colleges as well as researchers. these vital research endeavors on as many campuses as possible. (2) Facilitating Lengthy and Complex Research ce recommends that NIAAA assist colleges or The Task F From the Task Force’s perspective, NIAAA should and universities by providing guidance and consultation assume primary responsibility for: Supporting the research community’s efforts to  The Need for Longitudinal Studies address existing knowledge gaps and alter the culture of drinking on campus; The overwhelming majority of studies on college student  Facilitating long-term, campus-community research drinking assess students at a single point in time. Although these aimed at preventing hazardous student drinking; and "cross-sectional" snapshots provide useful information  Imparting what is known about the patterns of concerning the extent that two factors—such as heavy drinking college drinking and the quality of current and fraternity membership—are correlated, they cannot specify interventions to encourage college presidents, the nature of the causal relationship between the two. For example, if heavy drinking is associated with fraternity administrators, and other campus and community memberships, it could be because: leaders to adopt policies and implement strategies  Greek residence life facilitates drinking (i.e., socialization), based on research.  Heavier drinkers differentially affiliate with Greek organizations because of the drinking opportunities they may The Task Force grouped its recommendations for afford (i.e., selection), or NIAAA by these three functional areas. Other factors such as personality traits promote both  affiliation and drinking. upporting Development of Improved Research (1) S Only by prospectively following individual students and Methods assessing them on multiple occasions can researchers begin to Impro ved data collection and extrapolation methods will uncover the likely direction of influence, if any, between help equip college administrators to assess the dimensions drinking behavior and its correlates. of the problem on their campuses and understand their 29

37 A Call to Action: Changing the Culture of Drinking at U.S. Colleges on the implementation of longitudinal studies and joint Partner with other Federal and State agencies and  campus and community-based initiatives designed to national organizations to support campuses interested alter the larger environment as it affects student in implementing joint campus- and community-based drinking. Such studies are complicated to implement initiatives. and require a greater commitment of resources than  Organize multisite campus trials of individual those highlighted above. However, they also have the campus- and community-based projects that have potential to change the landscape permanently by been evaluated favorably. providing conclusive evidence of the long-term consequences of hazardous student drinking and (3) Disseminating Research-Based Information and reducing tolerance for it at all levels of the campus- Pr omoting Its Application on Campus community environment. Outreach efforts are essential to disseminate information about existing research-based initiatives to stakeholders and persuade colleges and universities to rely on The Task Force recommends that NIAAA: research-based strategies in developing campus policies  Pursue longitudinal studies of youth—beginning early and programs. in adolescence (7th grade) and continuing into young adulthood—to obtain information about such The Task Force recommends that NIAAA: important issues as the development of alcohol  Share the results of the Task Force’s comprehensive problems over time and their longer-term consequences. review of the current state-of-the-research on college drinking with a variety of audiences, including local, Support research on the effectiveness of joint campus-  State, and national organizations interested in the and community-based coalitions in reducing issue, to expedite and reinforce the process of underage and excessive drinking. Coalitions could information exchange. include alcohol wholesalers and retailers as well as college presidents, campus and community leaders, Develop a series of regional workshops across the  and policymakers. Coalition activities could also span United States to share the Task Force’s the continuum of program possibilities from strategies recommendations with college presidents and designed to address those social norms and promote campus participation in surveillance characteristics of the campus-community activities and research trials. environment that influence student drinking to the  Expand the dialogue among college presidents and provision of alcohol prevention and treatment services. administrators, community leaders, and researchers “It is not realistic to expect that colleges can eradicate alcohol problems among students, given the complexity of the issues and the role of alcohol in the broader social culture. But we can work to prevent alcohol-induced behavior that violates our sense of peace and security and that makes us passive contributors to the degradation of student lives.” Edward A. Malloy, President University of Notre Dame 30

38 through annual updates and other mechanisms Continually update informational materials based on  designed to: research for key stakeholders that include brochures  for college presidents, parents, high school guidance Disseminate research findings to the campus and counselors, student activists, and community leaders. surrounding community and promote two-way communication between campus/community Assist campus planners and their counterparts in the  leaders and researchers, community in incorporating research into the  planning, implementation, and evaluation of campus- Support continued campus and community based and joint campus- and community-based participation in research-based activities,  alcohol programs and policies. Alert researchers to emerging alcohol-related issues on campus and within the community,  Foster collaborations between campus administrators  and community leaders to facilitate the process of Offer practical feedback to researchers on policy information exchange and ongoing communication. changes and other intervention efforts that affect college drinking, and  Coordinate and cooperate with other Federal agencies  in providing training on alcohol and drug abuse to Provide campuses and collaborating communities college student health center personnel. with technical assistance to help them implement effective data collection and intervention efforts. 31

39 A Call to Action: Changing the Culture of Drinking at U.S. Colleges A Final Word using research-based strategies in developing their The concerns expressed by the members of the Task pr e evaluation as an important ograms and emphasiz Force on College Drinking reflect the concerns of priority. college presidents, students, parents, and college communities nationwide about the consequences of high-risk student drinking. The culture of drinking on Despite the advances that have been made, there is little evidence of effectiv eness av contemporary college campuses is antithetical to the ailable for many of the culture of learning, which is the core of higher most appealing prevention strategies identified in this education. report. Because ideas and data fuel the intellectual life on campus, the Task Force encourages colleges and universities to work collaboratively with NIAAA and the As the information in this report clearly demonstrates, research community in planning and assessing those cessive consumption does not om ex the fallout fr strategies. School presidents who served on the Task discriminate. It threatens the health and safety of all Force observed that it is difficult to mobilize staff and students, disrupts the academic process, frustrates direct their energy to implementing programs of faculty, and disturbs the lives of those in adjacent uncertain efficacy. Results from carefully conducted communities. Yet the experience of a growing number of evaluations will enable presidents to allay those concerns colleges and universities offers new hope for changing and ensure administrators, faculty, and students that the culture of drinking and reducing its negative they are investing in strategies with proven value. consequences. We believe the combination of vigorous leadership, institutional resolve, and campus-community partnerships can make a difference. Although there are no easy answers to high-risk college eason for optimism. More educators e is r drinking, ther at the college/university and, as important, secondary Improvements in research methodology also enhance school levels are acknowledging the existence of a evention strategies, so that understanding of effectiv e pr problem. Researchers are discovering new approaches for schools can begin to design programs that suit their responding, and communities are becoming aware of needs. At the same time, there is increasing recognition their vital role in prevention. Through committed that high-risk drinking is not a neatly bounded collaborative efforts grounded in research and supported phenomenon that can be addressed solely within the by institutional leadership, the Task Force is convinced borders of the college or university. It frequently begins that the culture of drinking at U.S. colleges and in high school, is sustained by a combination of campus universities can be changed. and community conditions, and follows a course affected by an array of personal, behavioral, biological, and genetic as well as social and environmental factors. For this reason, the Task Force recommends a multidimensional approach to college student drinking that acknowledges these diverse but intersecting influences. It also recommends that schools commit to 32

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51 A Call to Action: Changing the Culture of Drinking at U.S. Colleges Wechsler H, Lee JE, Kuo M, Seibring M, Nelson TF, Lee HP. Trends in college binge drinking during a period of increased prevention efforts: Findings from four Harvard School of Public Health study surveys, 1993–2001. Journal of American College Health 50(5):203–217, 2002. Wechsler H, Moeykens B, Davenport A, Castillo S, Hansen J. The adverse impact of heavy episodic drinkers on 56(6):628–634, 1995. nal of Studies on Alcohol our J other college students. Werner MJ, Greene JW. Problem drinking among college freshmen. Journal of A dolescent Health 13(6):487–492, 1992. White AM, Ghia AJ, Levin ED, Swartzwelder HS. Binge-pattern ethanol exposure in adolescent and adult rats: ential effects on subsequent ethanol exposur Differ e. Alcohol Clinical and Experimental Research 24(8):1251–1256, 2000. White AM, Montoya D, Wilson WA, Swartzwelder HS. Differences in EtOH-induced motor impairments and lcohol Clinical and Experimental Research 25(Supplement): A EtOH metabolism in adolescent and adult rats. 109A, 2001. Jour nal Zador P, Lund A, Fields M, Weinberg K. Fatal crash involvement and laws against alcohol impaired driving. ublic Health Policy 10:467–485, 1989. of P Ziemelis A. Efforts, evidence, and promising directions. Paper presented at the Higher Education Center for Alcohol and Other Dr ug Prevention, Center Associates Annual Meeting, 1998. Zucker RA, Fitzgerald HE, Moses HD. Emergence of alcohol problems and the several alcoholisms: A developmental perspective on etiologic theor y and life course trajectory. In: Cicchetti D (ed), Developmental Psychopathology, Vol. 2: Risk, Disorder, and Adaptation. New York: John Wiley & Sons, 677–711, 1995. 44

52 Task Force Members and Participants Reverend Edward A. Malloy, C.S.C. College and University Presidents (Task Force Co-Chair) Tomas A. Arciniega, Ph.D. President President University of Notre Dame California State University at Bakersfield Susan Resneck Pierce, Ph.D. Robert L. Carothers, Ph.D. President President University of Puget Sound University of Rhode Island Judith Ramaley, Ph.D. (Co-Chair: Panel on Prevention John T. Casteen III, Ph.D. (Co-Chair: Panel on and Treatment) Contexts and Consequences) Former President President University of Vermont University of Virginia Special thanks to other Edward T. Foote II, LL.B. participating College Presidents: President Emeritus and Chancellor Marilou E ldred, Ph.D. and Former President President University of Miami Saint Mary’s College Michael Hooker, Ph.D. (deceased) Thomas K. Hearn, Jr., Ph.D. Chancellor President University of North Carolina at Chapel Hill Wake Forest University William L. Jenkins, D.V.M., Ph.D. Shirley H. Showalter, Ph.D. President President Louisiana State University System Goshen College William E. Kirwan, Ph.D. James J. Stukel, Ph.D. President President Ohio State University University of Illinois James E. Lyons, Sr., Ph.D. President California State University, Dominguez Hills 45

53 A Call to Action: Changing the Culture of Drinking at U.S. Colleges Kenneth J. Sher, Ph.D. Researchers rofessor Curators ’ P Marilyn Aguirre-Molina, Ed.D. Department of Psychological Sciences The Joseph L. Mailman School of Public Health University of Missouri–Columbia Columbia University Henry Wechsler, Ph.D. Michael Fleming, M.D. ector of College ir Lecturer and D tment of F Depar amily Medicine Alcohol Studies University of Wisconsin–Madison ealth and Social Behavior tment of H Depar Harvard School of Public Health Mark S. Goldman, Ph.D. (Task Force Co-Chair) esear Distinguished R ch Professor Sharon C. Wilsnack, Ph.D. (Co-Chair: Panel on Department of Psychology Contexts and Consequences) University of South Florida istinguished P Chester Fritz D rofessor Department of Neuroscience Ralph Hingson, Sc.D. (Co-Chair: Panel on Prevention University of North Dakota School of eatment) and Tr Medicine and Health Sciences rofessor and Associate Dean for Research P Boston University School of Public Health Robert A. Zucker, Ph.D. Pr ofessor of P sychology Harold D. Holder, Ph.D. Director, Division of Substance Abuse, Department enior Scientist ector and S Dir of Psychiatry Prevention Research Center , Alcohol Research Center ector Dir Pacific Institute for Research and Evaluation University of Michigan Donald S. Kenkel, Ph.D. Task Force Panel Members anagement olicy Analysis and M Office of P David Anderson, Ph.D. Cornell University Director Center for the Advancement of Public Health G. Alan Marlatt, Ph.D. George Mason University Pr ofessor and D irector Addictive Behaviors Research Center William DeJong, Ph.D. University of Washington ector Dir igher Education Center for Alcohol and The H Marcus A. Rothschild, M.D. Other Drug Prevention Consultant elopment Center, Inc. Education D ev edical Center Veterans A dministration M 46

54 Ellen R. Gold, Ph.D. Joan Wehner Masters Director University of Missouri–Columbia University Health Services Eastern Michigan University National Institute on Alcohol Abuse and Alcoholism Gayle Boyd, Ph.D. (Coordinator: Panel on Prevention Patrick Johnson, Ph.D. and Treatment) Fellow Fred J. Donodeo, M.P.A. (Task Force Coordinator) Division of Health and Treatment and Analysis Vivian B. Faden, Ph.D. (Coordinator: Panel on The National Center on Addiction and Contexts and Consequences) Substance Abuse at Columbia University Stephen W. Long (Task Force Director) Robert F. Saltz, Ph.D. Prevention Research Center Contributors Pacific Institute for Research and Evaluation Elaine Arkin (Health Consultant) Amy Bielski (ORC Macro) Students Gayle Boyd (NIAAA) Brant Woodrow Grimes Susan Cahill (NIAAA) University of North Dakota Mary Lou Dogoloff (Logicon/ROW Sciences) Fred Donodeo (NIAAA) Michaela Keegan Peggy Eastman (Author and Journalist) University of Rhode Island Vivian B. Faden (NIAAA) Mark Goldman (University of South Florida) Stacie Lambert Ralph Hingson (Boston University) Louisiana State University Harold Holder (PIRE) Stephen Long (NIAAA) Chris Linder Joy Mara (Joy R. Mara Communications) University of Nebraska Alan Marlatt (University of Washington) Lisa Patton (Logicon/ROW Sciences) Kenneth J. Sher (University of Missouri) Lindsey Bronwyn Mercer Linda Spear (Binghamton University) University of California at Berkeley Aaron White (Duke University) Sharon Wilsnack (University of North Dakota School of David Odell Medicine and Health Sciences) University of Puget Sound Robert A. Zucker (University of Michigan) Patrick Henry Sweet III University of Virginia 47

55 A Call to Action: Changing the Culture of Drinking at U.S. Colleges Resources The following materials related to college drinking will Future Brochures be available from NIAAA by mail or through the What High School Guidance Counselors Need to Know NIAAA Web site: About College Drinking National Institute on Alcohol Abuse and Alcoholism What Community Leaders Need to Know About College 6000 E x ecutive Boulevard, Willco Building Drinking Bethesda, Maryland 20892-7003 www.collegedrinkingprevention.gov What Students Need to Know About College Drinking Task Force Report Planning and Evaluation Handbook A Call to Action: Changing the Culture of Drinking at Reducing Alcohol Problems on Campus: A Guide to U.S. Colleges Planning and Evaluation Final Report of the Task Force on College Drinking Panel Reports High-Risk Drinking in College: What We Know and What We Need To Learn Final Report of the Task Force on College Drinking’s Panel on Contexts and Consequences ow To Reduce High-Risk College Drinking: Use Proven H Str ategies, Fill Research Gaps Final Report of the Task Force on College Drinking’s revention and Treatment Panel on P Brochures What Presidents Need to Know About College Drinking What Parents Need to Know About College Drinking What Peer Educators and Resident Advisors (RAs) Need to w A bout College Drinking Kno 48

56 Commissioned Papers The Adolescent Brain and the College Drinker: Panel 1—CONTEXTS AND CONSEQUENCES B asis of P ropensity to Use and Misuse iological B Studying College Alcohol Use: Widening the Lens, Alcohol Sharpening the Focus Linda P. Spear, Ph.D., Distinguished Professor and W. Dowdall, Ph.D., Professor, Department of George sychology, Center for tment of P Chairperson, Depar t. Joseph’s University, and Sociology , S Developmental Psychobiology, Binghamton University Henry Wechsler, Ph.D., Lecturer and Director of College Alcohol Studies, Department of Health College Factors That Influence Drinking and Social Behavior, Harvard School of Public Health Cheryl A. Presley, Ph.D., Director, Student Health P Vice Chancellor for rograms and Assistant to the Epidemiology of Alcohol and Other Drug Use Student Affairs for Research, Executive Director, Core among American College Students Institute, Southern Illinois University; Philip W. alley, Ph.D., Senior Research Scientist, Patrick M. O’M Meilman, Ph.D., Director, Counseling and esearch, University of Michigan, ocial R Institute for S Psychological Services, Courtesy Professor of Human and Lloyd D. Johnston, Ph.D., Distinguished Development, Associate Professor of Psychology in Research Scientist, Institute for Social Research, Clinical Psychiatry, Cornell University; and Jami S. University of Michigan Leichliter, Ph.D., Behavioral Scientist, Division of STD Prevention, Centers for Disease Control and Student Factors: Understanding Individual Variation Prevention in College Drinking aer, Ph.D., Research Associate Professor, John S. B Surveying the Damage: A Review of Research on sychology, University of Washington, Depar tment of P Consequences of Alcohol Misuse in College and Coordinator of Education, Center of Excellence Populations in Substance Abuse Treatment and Education, VA esley Perkins, Ph.D., Professor of Sociology, H. W Puget Sound Health Care System opology and Sociology, Hobart Depar tment of Anthr and William Smith Colleges A Developmental Perspective on Alcohol Use and dolescence and the rinking during A Heavy D Alcohol Use and Risky Sexual Behavior among Transition to Young Adulthood Y College Students and outh: Evaluating the Evidence John E. Schulenberg, Ph.D., Senior Research Scientist, M. Lynne Cooper, Ph.D., Professor of Psychology, esearch, Professor, Department of ocial R Institute for S sychology, University of Missouri at tment of P Depar Psychology, and Research Scientist, Center for Human Columbia Growth and Development, University of Michigan, and Jennifer L. Maggs, Ph.D., Associate Professor, Family Studies and Human Development, University of Arizona 49

57 A Call to Action: Changing the Culture of Drinking at U.S. Colleges Identification, Prevention, and Treatment: Alcohol-Related Sexual Assault: A Common Problem A Review of I ndividual-F ocused Strategies to among College Students Reduce Problematic Alcohol Consumption by Antonia Abbey, Ph.D., Associate Professor, College Students edicine, Wayne State Depar tment of Community M University Mary Larimer, Ph.D., Assistant Professor of Psychiatry and Behavioral Sciences, A djunct Assistant P rofessor of Psychology, Associate Director, Addictive Behaviors Alcohol-Related Aggression during the College Years: Research Center, University of Washington, and Jessica Theories, Risk Factors, and P olicy I mplications M. Cronce, B.S., Research Coordinator, Addictive Peter R. Giancola, Ph.D., Assistant Professor of esear Behaviors R ch Center, Department of Psychology, , University of Kentucky chology Psy University of Washington Today’s First-Year Students and Alcohol M. Lee Upcraft, Ph.D., Senior Scientist, Center for Social Norms and the Prevention of Alcohol Misuse the Study of H igher E ducation, Professor Emeritus of in Collegiate Contexts Higher Education and Assistant Vice-President esley Perkins, Ph.D., Professor of Sociology, W H. Emeritus for Student Affairs, The Pennsylvania State Depar tment of Anthr opology and Sociology, Hobart University and William Smith Colleges So What Is an Administrator to Do? Alcohol Advertising and Youth Susan Murphy, Ph.D., Vice President, Student and affer, Ph.D., Professor of Economics, Kean y S Henr er Academic S vices, Cornell University University, and Research Associate, National Bureau of Economic Research Panel 2—PREVENTION AND TREATMENT A Typology for Campus-Based Alcohol The Role of Mass Media Campaigns in Reducing Prevention: Moving toward Environmental rinking among College Students High-Risk D Management Strategies W illiam DeJong, Ph.D., Professor, Boston University William D eJong, Ph.D., Professor, Boston University ealth, and D School of Public H irector, U.S. irector, U.S. School of Public H ealth, and D Department of Education’s Higher Education Center Department of Education's Higher Education Center for Alcohol and Other Drug Prevention for Alcohol and Other Drug Prevention, and Linda Langford, Sc.D., Associate Director of Evaluation and Assessment, U.S. Department of Education’s Higher Education Center for Alcohol and Other Drug Prevention 50

58 Environmental Policies to Reduce College Drinking: The Role of Evaluation in Prevention of College Options and Research Findings Student D rinking P roblems Traci L. Toomey, Ph.D., Assistant Professor, School of Robert F. Saltz, Ph.D., Associate Director and Senior Public H ealth, D ivision of Epidemiology, University ch Scientist, P Resear revention Research Center, of Minnesota, and Alexander C. Wagenaar, Ph.D., Berkeley, CA Professor and Director, Alcohol Epidemiology View from the President’s Office: The Leadership of Program, School of Public Health, Division of Change Epidemiology, University of Minnesota Joy R. Mara, M.A., Mara Communications Effects of Minimum Drinking Age Laws: Review and JOINT PANEL PAPERS Analyses of the Literature fr om 1960 to 2000 Wagenaar, Ph.D., Professor and The Student Perspective on Alcohol Abuse Alexander C. Dir ector Peggy Eastman, A uthor and Journalist , Alcohol Epidemiology Program, School of Public Health, Division of Epidemiology, University Magnitude of Alcohol-Related Mortality and of Minnesota, and Traci L. Toomey, Ph.D., Assistant ges 18–24 Morbidity among U.S. College Students A Professor, School of Public Health, Division of Ralph Hingson, Sc.D., Professor and Chair, Social and Epidemiology, University of Minnesota epar Behavioral Sciences D tment, Boston University Comprehensive Community Interventions to School of Public Health; Timothy Heeren, Ph.D., ealth: Implications for College-Age Pr omote H Assistant Professor, Biostatistics Department, Boston Drinking Problems University School of Public Health; Ronda Zakocs, Ralph Hingson, Sc.D., Professor and Chair, Social and Ph.D., Assistant Professor, Department of Social and Behavioral Sciences D epar tment, Boston University Behavioral Sciences, Boston University School of School of Public Health, and Jonathan Howland, Public Health; Andrea Kopstein, Ph.D., Chief, Ph.D., M.P.H., Professor and Chair, Social and Program Evaluation Branch, Center for Substance Behavioral Sciences Department, Boston University Abuse Treatment, Substance Abuse and Mental Health School of Public Health Services Administration; and Henry Wechsler, Ph.D., Lecturer and Director of College Alcohol Studies, Department of Health and Social Behavior, Harvard School of Public Health 51

59 National Institute on Alcohol Abuse and Alcoholism NIH Publication No. 02-5010 Printed April 2002 National Institute on Alcohol Abuse and Alcoholism • National Institutes of Health U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

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