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How To Reduce High-Risk College Drinking: Use Proven Strategies, Fill Research Gaps
Comprehensive College-Community Interventions
Comprehensive college-community interventions are multicomponent programs that colleges and
communities conduct collaboratively in an effort to reduce high-risk drinking and its
consequences. College students are not usually the sole focus of these programs, but components
within the program target them specifically. Students also benefit from the broader,
community-wide aspects of the program designed to reduce such behaviors as drinking and driving
and sales to minors.
Summary of Relevant Research
A number of factors support the development of comprehensive college-community interventions to
address college drinking problems. First, this approach reframes the issue as a community problem,
not simply a college problem. It brings together the range of players needed to address the
problem and sets the stage for cooperative action. Second, such efforts appear to offer a
high-yield, low-cost approach for institutions. Some joint activities require few university
resources but result in policy and enforcement reforms that alter the drinking environment. Third,
such alliances can improve town-gown relationships overall, improving, for example, networking
between student affairs offices and local police or other agencies related to student concerns and
enhancing opportunities for faculty researchers to conduct needed studies.
Comprehensive community interventions to reduce health problems typically involve several
governmental agencies as well as private citizens and organizations. Most use multiple program
strategies such as education programs, media advocacy, community organization and mobilization,
and environmental policy changes or heightened enforcement of existing policies (Hingson and
Howland, 2002).
Although there is no research evidence to support collaborations among colleges and universities
and community groups aimed at college drinking (Hingson and Howland, 2002), community coalitions
have had positive effects on reducing alcohol problems in the general population. In fact, efforts
to date have had the greatest impact on youth, reinforcing the potential of campus-community
coalitions to reduce college-age drinking problems. In addition, the National Academy of Sciences
has recommended this approach for reducing alcohol-related health problems (IOM, 1989) based on
its success in addressing other health issues.
A number of comprehensive community efforts have been designed to reduce alcohol and other
substance use among underaged youth, including college students, and adults (Chou et al., 1998;
Hingson et al., 1996; Holder, 1997a,b; Holder and Treno, 1997; Pentz et al., 1989; Perry et al.,
1996; Saltz and Stangletta, 1997; Wagenaar et al., 2000a,b). These interventions have resulted in
reductions in underage alcohol use and alcohol-related problems, including drunk driving and
alcohol-related motor vehicle fatalities.
Community Trials Program
The Community Trials Program (Grube, 1997; Holder et al., 1997a,b; 2000; Holder and Reynolds,
1997; Holder and Treno, 1997; Reynolds et al., 1997; Saltz and Stangletta, 1997; Treno and Holder,
1997; Voas et al., 1997) was a 5-year initiative designed to reduce alcohol-involved injuries and
death in three communities. The theoretical basis of this program was to alter individual behavior
by changing the environmental, social, and structural contexts of alcohol use.
Program Components
The Community Trials Program had five mutually reinforcing components:
- Community mobilization addressed support for public policy interventions by
increasing general awareness, knowledge, and concern about alcohol-related trauma. Program
initiatives were jointly planned by project organizers and local residents and implemented by the
residents.
- The responsible beverage service (RBS) component sought to reduce sales to
intoxicated patrons and increase enforcement of local alcohol laws by working with restaurants,
bar and hotel associations, beverage wholesalers, the Alcohol Beverage Control Commission, and
local law enforcement.
- A component to decrease DWI offenses sought to increase the number of DWI
arrests by a combination of special officer training, deployment of passive alcohol sensors, and
the use of driving under the influence (DUI) checkpoints. News coverage publicized these
activities.
- A component directed toward underage drinking sought to reduce alcohol sales to
minors by enforcement of underage sales laws; training of sales clerks, owners, and managers to
prevent sales of alcohol to minors; and advocacy to bring media attention to the issue of underage
drinking.
- Local zoning and other municipal powers that determine alcohol outlet density
were used to reduce availability of alcohol.
Program Outcomes
This multicomponent approach was tested in a quasi-experimental design in three matched pairs of
communities and resulted in a 43 percent decline in alcohol-related assault admissions. Although
not all measures indicated effects in the predicted direction, there was strong support for the
efficacy of a coordinated, comprehensive community-based intervention to reduce high-risk alcohol
consumption and alcohol-related trauma.
Intermediate outcomes also indicated success, including decreases in alcohol outlet sales to
underage-appearing pseudopatrons without identification. Local regulations of alcohol outlets and
public sites for drinking were changed in all three experimental communities. Changes in the
Northern California intervention city were typical. The city council implemented a proposal to
eliminate special land use conditions for alcohol outlets, adopted restrictions on the
availability of alcohol in city parks, denied a new alcohol license, revoked a retailer’s
conditional use permit because of liquor sales violations, and instituted a citywide ordinance
requiring new owners of off- and onsite alcohol outlets to complete a responsible server course.
In addition, the Hispanic Chamber of Commerce voted to make its annual festival alcohol free.
The DWI reduction component resulted in an increase in news coverage of DWI, additional police
officer enforcement, greater use of Breathalyzer equipment, and increased public perceptions of
risk of arrest for DWI. Alcohol-related crash involvement as measured by single vehicle night
crashes declined 10 to 11 percent more among program than comparison communities.
Communities Mobilizing for Change on Alcohol
Communities Mobilizing for Change on Alcohol (CMCA) was a 6-year project designed
to test creative approaches to reduction of drinking by young people. The project
was implemented in seven small to midsized communities in Minnesota and Wisconsin
in 1993. Eight additional communities in the region served as a control group.
CMCA emphasized environmental factors that affect the supply of alcohol to youth
and used a community organization approach to achieve policy changes among local
institutions. Adults and young people in each community identified and promoted
a variety of issues designed to change the local environment in ways that made
alcohol more difficult to obtain and made underage drinking less acceptable
within the local culture (Wagenaar et al., 1999, 2000a,b).
Program Objectives
Specific objectives were to change community policies and procedures to reduce:
- Access to alcohol by underage youth whether through retail sales to youth or
purchase/provision by parents, other adults, or older youth;
- Number and proportion of alcohol outlets selling to underage individuals;
- Youth and adult support for or tolerance of underage purchase and consumption of alcohol;
- Prevalence, quantity, and frequency of alcohol consumption among youths 15 to 20 years of age;
and
- Incidence of alcohol-related health and social problems among youths 15 to 20 years of age (Wagenaar
and Perry, 1995).
Program Outcomes
Retailers in intervention communities increased age-identification checking
and reduced sales to minors, especially in on-sale establishments. Young people—ages
18 to 20—reduced their propensity to provide alcohol to other teens and
were less likely to try to buy alcohol, drink in a bar, or consume alcohol.
However, there were no effects on drinking by high school seniors (Wagenaar
et al., 1999, 2000a).
From the perspective of this report, it is encouraging that the intervention had its greatest
effects on college-age youth. Additional analyses of arrest and traffic crash data indicated that
DUI violations declined in the intervention communities. Again, this effect was most marked for
college-age youth and only approached significance for youth ages 15 to 17. There were no
differences in arrests for disorderly conduct or traffic crashes for either age group.
Collectively, findings from the CMCA project indicate that a community-organization approach to
limiting youth access to alcohol can be effective for college-age youth, 18 to 20 years old (Wagenaar
et al., 1999, 2000a,b).
Massachusetts Saving Lives Program
The Massachusetts Saving Lives Program (Hingson et al., 1996) also illustrates combinations of
approaches that communities have used successfully to combat risky drinking and enhance public
safety.
Program Components
To reduce drunk driving and speeding, communities introduced media campaigns, drunk driving
checkpoints, business information programs, speeding and drunk driving awareness days, speed watch
telephone hotlines, police training, high school peer-led education, Students Against Drunk
Driving chapters, college prevention programs, alcohol-free prom nights, beer keg registration,
and increased liquor outlet surveillance by police to reduce underage alcohol purchase. To
increase pedestrian safety and safety belt use, program communities conducted media campaigns and
police checkpoints, posted crosswalk signs warning motorists of fines for failure to yield to
pedestrians, added crosswalk guards, and offered preschool education programs and training for
hospital and prenatal staff. Coordinators engaged in numerous media advocacy activities designed
to help local news outlets move beyond reporting only the specifics of motor vehicle crash
injuries and deaths to explaining trends in local traffic safety problems and strategies
communities were implementing to reduce traffic injury and death (Hingson et al., 1996).
Program Outcomes
During the 5 years of the program, the proportion of drivers under age 20 who reported driving
after drinking in random-digit dial telephone surveys declined from 19 percent during the final
year of the program to 9 percent in subsequent years. The proportion of vehicles observed speeding
through use of radar from unmarked cars was cut in half, and safety belt use increased from 22
percent to 29 percent of motor vehicle occupants. Differences between intervention and comparison
communities were statistically significant. Alcohol-related traffic deaths declined 42 percent
more in Saving Lives cities relative to the rest of the State during the 5 years of the program as
compared to the previous 5 years. This decline was also seen among 16- to 25-year-olds, many of
whom may have been college students (Hingson et al., 1996).
Other Comprehensive Community Interventions
In addition to reducing underage alcohol consumption, drunk driving, and their consequences,
comprehensive community interventions have also reduced smoking and risky sexual behaviors among
adolescent and college-age populations (CDC, 1999; COMMIT Research Group, 1995; Forster et al.,
1998; Kegeles et al., 1998; Vincent, 1987). Research shows that combining environmental and
institutional change with health education theory-based programs designed to change behavior and
promote community ownership of programs enhances success (Hingson and Howland, 2002). Reviews of
comprehensive programs (Wagenaar et al., 1999) have also identified important components of
coalition development. They include:
- Assessing community interests,
- Building a core base of support in the community,
- Expanding the base,
- Developing a plan of action,
- Implementing the plan,
- Maintaining the effort and institutionalizing it, and
- Evaluating and disseminating results.
Panel Recommendations: What Colleges and Universities Can Do Now
The Panel recommends that colleges and universities:
- Create and/or participate in joint college-community interventions to reduce student drinking
problems. Community coalitions have been effective in addressing alcohol and other health issues,
although there has been no research on campus-community activities to reduce high-risk drinking
and related problems.
- Create a task force or coalition representing relevant constituencies on campus (including
students) and in the community (including local businesses) to develop and monitor college
drinking initiatives.
- Plan coalition activities strategically, including setting measurable objectives, establishing
target timelines, clearly defining member responsibilities, and collecting and evaluating data on
both the process of working together and the results of the interaction.
Panel Recommendations: What Researchers Can Do To Fill Gaps in
Knowledge
The Panel recommends that researchers address the following questions to fill key gaps in
knowledge:
- Are comprehensive college-community interventions to reduce high-risk college drinking
effective? What is the most effective mix of policy and program elements? What are the assets and
liabilities for colleges and communities?
- Is it more effective to focus such efforts on drinking practices or on the health and social
problems high-risk drinkers cause for themselves and others?
- Where should decision-making responsibility be focused: in city government, the college and
university, another group or institution, or a combination of players?
- What are the best strategies for mobilizing and optimizing the effectiveness of
campus-community coalitions?
- Do effects of college-focused programs extend to others in the community?
- What is the best way to enforce community alcohol-related ordinances?
- How can the results of alcohol research be effectively disseminated to community audiences
such as chiefs of police, parents, and legislators?
- How effective are State-level coalitions that support individual campus-community
collaborations?
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Last reviewed: 9/23/2005
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