Magnitude of Alcohol-Related Mortality and Morbidity among U.S. College Students Ages 18-24
RALPH W. HINGSON, Sc.D., TIMOTHY HEEREN, Ph.D.,
RONDA C. ZAKOCS, Ph.D., ANDREA KOPSTEIN, Ph.D.,
and HENRY WECHSLER, Ph.D.
Social and Behavioral Sciences Department, Boston University School of Public
Health, 715 Albany Street, T2W, Boston,Massachusetts 02118
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ABSTRACT. Objective: This report estimates the numbers of 18-24
old United States college students who annually experience alcohol-related
deaths, injuries and other health problems. Method: We examined traffic
and unintentional injury deaths in 1998 reported by the National
Highway Traffic Safety Administration and the Centers for Disease Control
(CDC). We also examined results of national coroner studies, Department
of Education college enrollment data, the National Household
Survey on Drug Abuse (NHSDA), the CDC National College Health
Risk Behavior Survey and the Harvard School of Public Health College
Alcohol Survey (CAS). All survey participants were ages 18-24:
6,930 college and 12,394 noncollege respondents in the NHSDA survey;
3,077 college students in the CDC survey; and 12,217 full-time 4-year college students in the CAS. Based on the number and proportion
of 18-24 year olds enrolled in college, data on alcohol involvement in
injury deaths among 18-24 year olds and survey responses, we calculated
the numbers of 18-24 year old alcohol-related injury deaths and
other health problems. Results: We estimate that over 1,400 students
18-24 and enrolled in 2- and 4-year colleges died in 1998 from alcohol-related unintentional injuries, including motor vehicle crashes. According
to surveys conducted in 1999, in the preceding year, over 2
million of the 8 million college students in the United States drove under
the influence of alcohol and over 3 million rode with a drinking
driver. Over 500,000 full-time 4-year college students were unintentionally
injured under the influence of alcohol and over 600,000 were hit
or assaulted by another student who had been drinking. Conclusions:
There is an urgent need for expanding prevention and treatment programs,
to reduce alcohol-related harm among U.S. college students and
other young adults. (J. Stud. Alcohol 63: 136-144, 2002)
NATIONAL SURVEYS of college-student drinking practices have focused attention
on the heavy drinking patterns of many college students. In 1993, 1997 and 1999,
the Harvard School of Public Health College Alcohol Surveys (CAS) monitored
heavy episodic or "binge" drinking among college students. This was
defined, for male student drinkers, as the consumption of five or more drinks
in a single drinking session and, for female students, as four or more drinks
(Wechsler et al., 1994, 1998, 2000). In 1999, of 14,138 full-time students randomly
selected at 128 4-year colleges and universities, 44% reported at least one
heavy-drinking episode in the year prior to the survey, a percentage that has
not changed since 1993 (Wechsler et al., 2000). About one fourth (23%) drank
in this way frequently (three or more times in the past 2 weeks), up from 20%
in 1993. Frequent heavy episodic drinkers were 21 times more likely than were
other drinkers to experience five or more of 12 alcohol-related problems asked
about in the survey. The National Monitoring the Future Survey (Johnston et
al., 2000) produced similar results. Of the 1,440 full-time 2- and 4-year college
students surveyed in 1999, 40% reported consuming five or more drinks on a single
occasion at least once in the previous 2 weeks, a greater proportion than found
among same age noncollege peers (35%) and high school seniors (31%).
These surveys have determined that a large proportion
of college students drinks heavily, an even larger proportion
than that of persons of the same age not in college.
The exact numbers of college students nationwide who are
fatally injured or experience specific health problems each
year as a result of this heavy alcohol consumption have not
been determined, however. Documenting the magnitude of
alcohol-related mortality and health problems among college
students can help stimulate and target efforts by the
institutions to reduce these problems, and can serve as a
baseline against which to measure potential progress in
achieving this goal. Colleges and universities may be in an
opportune position to address these problems because of
the control they can exercise over programs and policies
offered to their students.
In 1998, the National Advisory Council of the National Institute on Alcohol
Abuse and Alcoholism (NIAAA) created a commission to review the research literature
on college drinking in order to advise administrators on implementing and evaluating
campus programs, as well as advising NIAAA on future research directions. During
this 3-year process more than two dozen college presidents and scientists reviewed
epidemiologic data, as well as individual and community programs, to evaluate
the current state of knowledge about the problem and the effectiveness of interventions.
This article, one of 24 papers written for that commission, many of which are
published in a recent supplement of this Journal, estimates the numbers
of college students harmed by alcohol annually.
There were two major tasks pursued in this report: (1)
determining the number of alcohol-related traffic and other
unintentional injury deaths in 1998 among 18-24 year old
part-time and full-time college students; and (2) estimating
the numbers of 18-24 year old college students who engaged
in a variety of related behaviors that pose health
risks. The methods used to approach these issues are described
Calculation of alcohol-related traffic and unintentional
This article estimates the annual number of traffic and
other unintentional injury deaths among 18-24 year olds in
the U.S. who are full- or part-time college students attending
either 2- or 4-year colleges. To derive these figures, it
was necessary to examine multiple data sources because
whether or not persons who die in motor vehicle crashes
are college students is not routinely recorded in the Department
of Transportation Fatality Analysis Reporting System
(FARS; NHTSA, 1999). In addition, people who die from
other types of other unintentional injuries are not systematically
tested for blood alcohol concentrations (BACs). To
our knowledge, this is the first time that estimates have
been made based on these multiple datasets. The sources of
data are described below.
First, the Centers for Disease Control and Prevention's
National Center for Injury Prevention and Control annually
records the numbers of unintentional injury deaths and the
ages of the fatally injured persons (Centers for Disease Control
and Prevention [CDC], 2000). Second, a recent metaanalysis
of 331 medical examiner studies (Smith et al., 1999)
from 1975-1995 revealed that 84% of unintentional
nontraffic fatalities were tested for BACs. Of those tested,
38% had positive blood alcohol content, and 31% had BACs
of 0.10% or higher, a level that would make them legally
intoxicated in any state in the United States (Smith et al.,
A third measure of deaths comes from the National Highway
Traffic Safety Administration (NHTSA) Fatality Analysis
Reporting System (FARS), which records all motor
vehicle crash deaths in the United States (NHTSA, 1999)
and calculates the proportion that are alcohol related and
involved either a driver or pedestrian with a positive BAC.
The ages of the decedents are recorded, as are their blood
alcohol concentrations. Because BACs are not drawn on all
motor vehicle crash deaths, an imputational formula projects
the likelihood of alcohol involvement in those crashes for
which test results are unavailable. The National Highway
Traffic Safety Administration has used a linear discriminant
model to estimate the probability that a driver or
nonoccupant has a BAC in grams per deciliter (g/dl) of
0.00, 0.01 to 0.09, and 0.10 and greater. These estimates
are generated only for drivers and nonoccupants (e.g., pedestrians
or pedalcyclists) for whom alcohol test results were
not reported. The model projects the likelihood of alcohol
involvement based on characteristics of fatal traffic crashes
and drivers most likely to involve alcohol (e.g., whether
the crash involved a single vehicle or occurred on a weekend
or at night, the driver's age, gender, lack of restraint
use, and history of traffic violations). The approach was
validated by comparing estimates to actual alcohol test results
in states with the most comprehensive testing of persons
in fatal crashes. State Annual state projections and
actual test results have produced very similar estimates of
the proportion of fatal crashes and persons in fatal crashes
who were alcohol positive (Klein 1986). National estimates
of alcohol involvement in fatal crashes using this method
have been reported since 1982, and state and national estimates
of alcohol traffic crash involvement have been used
in numerous National Highway Traffic Safety Administration
reports and scientific articles.
Calculation of numbers of college students aged 18-24
Data on the numbers of undergraduate college students in the United States
ages 18-24 have been tabulated by the Department of Education's National Center
for Education Statistics: Integrated Post Secondary Education Data System (National
Center for Education Statistics, 1999). In 1997, of the 25,470,210 18-24 year
olds living in the United States (Department of Commerce, 2000), 31% (8,000,106)
were enrolled as full- or part-time students in either 2- or 4-year colleges:
21% (n = 5,320,295) in 4-year colleges and 10% (n = 2,679,811)
in 2-year colleges. A majority (60%) of students enrolled in 4-year colleges
were aged 18-24; nearly half (48%) of those enrolled in 2-year colleges fell
in that age group.
The National Household Survey of Drug Abuse
(NHSDA; described below) surveyed 18-24 year olds
whether or not they were college students. The 18-24 year
old college students were more likely than same age
noncollege respondents to report drinking five or more
drinks on at least one occasion in the past month and driving
under the influence in the past year. Based on those
survey results, we projected that the proportions of traffic
and other unintentional injury nontraffic deaths positive for
alcohol would be at least as high among college as among
noncollege 18-24 year olds.
Because college students constitute 31% of 18-24 year
olds in the United States, we estimate that 18-24 year old
college students experience 31% of the traffic and other
unintentional injury deaths experienced by the 18-24 year
old U.S. population.
Calculation of students at risk
Based on the results of three national surveys and data
on the numbers of 18-24 year old college students in the
U.S., we estimated the numbers of college students that
age who annually drive under the influence of alcohol and
are unintentionally injured as a result of consuming alcohol.
Three national surveys have explored patterns of drinking
and risky behaviors that college students engage in after
drinking: the National Household Survey on Drug Abuse
(NHSDA; Department of Health and Human Services
[DHHS], 2000); the CDC National College Health Risk
Behavior Survey (NCHRBS; CDC, 1997); and the Harvard
School of Public Health College Alcohol Survey (CAS;
Wechsler et al., 2000).
The National Household Survey of Drug Abuse (NHSDA; SAMHSA, 2000) is
the primary source of statistical information on the use of illegal drugs by
the U.S. population. Sponsored by the Substance Abuse and Mental Health Services
Administration (SAMHSA), the survey consists of computer-assisted interviews
with a representative sample of the United States: residents of households and
noninstitutional group quarters (e.g., shelters, rooming houses, dormitories)
and civilians living on military bases. The 1999 NHSDA used an independent multistage
area probability sample for each of the 50 states and the District of Columbia.
Youths and young adults were oversampled so that each state's sample was approximately
equally distributed among people aged 12-17, 18-25 and 26 and older. Across
the United States, 169,166 addresses were screened and 66,706 persons were interviewed
within screened addresses. Weighted response rates for households screened and
interviewed were 89.6% and 68.6%, respectively. The sample included 19,438 respondents
aged 18-24, of whom 19,324 responded to the questions of interest. Of the latter,
6,930 (36%) were enrolled in college: 5,796 (30%) as full-time students and
1,134 (6%) as part-time students.
Respondents were asked how often they drank five or
more alcoholic drinks on the same occasion in the past 30
days. They were also asked, "During the past 12 months
. . . has your use of alcohol caused you to have any health
problems? . . . have you driven a vehicle under the influence
of alcohol? . . . have you received treatment or counseling
for your use of alcohol?"
It should be noted that the NHSDA examines both full- and
part-time students at both 2- and 4-year colleges, and
represents students who live in dormitories, other college
housing, fraternities and sororities. Results from this survey
that are specific to college students have not been published
The CDC National College Health Risk Behavior Survey United States 1995,
a two-stage cluster sample design, produced a nationally representative sample
of full- and part-time undergraduate college students ages 18 and older (CDC,
1997). From a list of 2- and 4-year colleges nationwide, 4-year (n =
74) and 2-year (n = 74) colleges were selected from 16 strata formed
on the basis of the relative percentage of black and Hispanic students in the
institutions. The schools were selected with probability proportional to undergraduate
enrollment size. Of the 148 schools, 136 (92%) participated. Students at participating
schools were randomly selected, and 65% (n = 4,838) of 7,442 eligible
students completed mailed self-administered surveys. The overall response rate
was 60%. The sample included 3,077 students ages 18 through 24 (63.6% of respondents).
Respondents were asked whether, in the 30 days prior to the survey, they had
ridden with a driver who had been drinking alcohol; drunk alcohol and driven
a car or vehicle; or drunk alcohol while boating or swimming.
The Harvard School of Public Health College Alcohol Survey (CAS) began
in 1993 with a sample of 140 colleges selected from a list of accredited 4-year
colleges provided by the American Council on Education using probability sampling
proportionate to the size of undergraduate enrollment at each institution. At
each college, a random sample of 225 undergraduates was drawn from the total
enrollment of full-time students. In 1999, another survey was conducted of students
from 128 of the 140 original 4-year colleges. The inability of 10 colleges in
1997 and two in 1999 to provide a random sample of students and their mailing
addresses resulted in the attrition of those schools. In 1999, 12,317 full-time
students, ages 18-24 and from 40 states, were surveyed; nearly half of these
lived in dormitories, college housing, fraternities or sororities (response
rate: 60%; Wechsler et al., 2000). Respondents were asked their frequency and
usual quantity of drinking, whether during the current school year they experienced
a variety of health and social problems because of their drinking, and whether
the drinking of other college students posed any of a series of social and health
problems for them.
Statistical analyses of surveys
All three surveys (NHSDA, NCHRBS and CAS) presented
weighted results that took into account their respective
sample designs and nonresponse. All statistical estimates
of percentages for the survey data were conducted using
the SUDAAN statistical package to account for each
survey's design (Shah, 1996). The SUDAAN package accounts
for sampling weights in calculating both estimates
and standard errors, using first-order Taylor series approximations
to provide standard errors that appropriately account
for sampling design.
Using the information noted above, we identified the
percentages of 2- and 4-year college students ages 18-24
who responded affirmatively to the survey questions regarding
alcohol related problems, and calculated 95% confidence
intervals for those responses. To estimate the
numbers of 18-24 year old college students nationwide who
experienced these problems, we then multiplied those percentages
and confidence intervals by the appropriate population
count from the Department of Education of students
18-24 years old enrolled in 2- and 4-year colleges in the
United States. Data from the Department of Education are
considered as true population totals; therefore, our confidence
intervals only reflect the sampling variability in the
percentage estimates. We also made projections from the
CAS responses to the full-time 4-year college population
using this same analytic strategy.
Alcohol-related unintentional injury deaths
As explained below, we estimate that in 1998 there were
approximately 1,400 unintentional, alcohol-related fatal injuries
among college students ages 18-24: approximately
1,100 traffic and 300 nontraffic unintentional, alcohol-related
fatal injuries (Table 1).
Motor vehicle crash deaths
The NHSDA survey revealed that, in the year prior to
the survey, a significantly greater percentage of 18-24 year
old college students, compared with same age noncollege
respondents, drank five or more drinks on a single occasion
in the past month (41.7% vs 36.5%) and drove under
the influence of alcohol (26.5% vs 19.8%) (Table 2). Similar
proportions of college students living in dormitories and
other congregate residences (e.g., fraternities) reported driving
under the influence of alcohol, relative to those not
living in dormitories.
In 1998, in the United States, there were 3,674 alcohol-related
traffic deaths among those aged 18-24 years (49%
of 7,444 traffic fatalities in that age group). Based on the
assumption that college students (31% of the U.S. population
ages 18-24) experienced alcohol-related traffic deaths
at the same rate as the entire 18-24 population, 1,138 (31%)
of the 3,674 alcohol-related traffic deaths in that age group
would have been college students.
Unintentional nontraffic deaths
In the NHSDA survey, 18-24 year old college students
and same age noncollege students were equally likely to
experience alcohol-related health problems (1.9% vs 2.0%)
(Table 2). Furthermore, in the Harvard Survey (CAS), college
students living in dormitories, sororities, fraternities
and college residences were also as likely as other college
students to have been injured while or after drinking. Only
1.4% of 18-24 year old college students were arrested in
the past year for an alcohol-related offense and only 1.2%
received alcohol or drug treatment. Among same age
noncollege students, these percentages were 2.4% and 2.8%,
respectively (Table 2).
According to the CDC, there were 10,052 unintentional injury deaths of persons
ages 18-24 in 1998 (CDC, 2000). Subtracting traffic deaths (n = 7,444),
there were 2,608 unintentional injury deaths from other causes (e.g., falls,
drowning, burns, suffocation and unintentional gunshot wounds). If 38% were
alcohol-related, as reported in national analyses of coroner studies (Smith
et al., 1999), 991 persons ages 18-24 died from unintentional alcohol-related
nontraffic injuries. In addition, if 31% of those fatal injuries occurred among
college students, we can conclude that 307 college students died that year from
alcohol-related nontraffic unintentional injury deaths.
Heavy episodic drinking
Table 3 summarizes the proportions and numbers of full and part-time college
students ages 18-24 in the NHSDA who had five or more drinks on an occasion
at least once in the last 30 days. Approximately 42% (95% CI: 39.7-43.6) of
these students reported having five or more drinks on an occasion in the past
30 days, indicating that over 3.3 million of the 8 million college students
ages 18-24 nationwide engaged in this behavior during the past 30 days.
Driving while intoxicated
Consistent with the alcohol-related mortality data, the
most common alcohol-related health risks reported by college
students in national surveys were riding with a drinking
driver and driving after drinking. Table 4 provides results
from the CDC National College Risk Behavior Survey
(CDC, 2000). In the CDC survey, 38.9% (95% CI: 36.2-41.6) of college students ages 18-24 reported riding with a
drinking driver during the previous month. Projected to the
8 million 2- and 4-year college students that age in the
United States, an estimated 3.1 million students engage in
this behavior each month. Nearly 28% (95% CI: 25.4-30.2)
of college students this age in the CDC survey reported
driving after drinking in the month prior to the survey (i.e.,
an estimated 2.2 million college students ages 18-24).
In the NHSDA survey (SAMHSA, 2000), 26.5% reported
driving under the influence of alcohol in the past year (95%
CI: 25.0-27.9): an estimated 2.1 million college students
(Table 2). Note that the different wording of the questions
in the CDC and NHSDA surveys may account for the similarity
in responses even though the time periods asked about
Other alcohol-related problems
Table 3 provides percentages of college students ages
18-24 who reported in the NHSDA (SAMHSA, 2000) other
alcohol-related social and health problems during the year
prior to the 1999 survey. Just under 2% (1.9%) reported a
health problem in the past year (95% CI: 1.4-2.4), representing
150,000 college students.
Table 5 reports alcohol-related health and social problems
of full-time 4-year college students based on the CAS
survey. In the Harvard CAS survey, 10.6% (95% CI: 10.1-11.1) reported being hurt or injured because of their drinking.
Of the 5,320,295 4-year college students in the U.S.,
4,758,636 are full-time students. Thus, we estimate just over
500,000 full-time 4-year college students were hurt or injured
annually because of their drinking. Table 5 also lists
problems that full-time students at 4-year colleges experienced
in the past year because of other students' drinking.
An estimated 630,000 students nationwide were assaulted
or hit, a problem reported by 13.3% of respondents (95%
CI: 12.7-13.9). In the CAS, 8.4% reported having unprotected
sex because of drinking alcohol (95% CI: 7.9-8.9).
This means that, in that year, nearly 400,000 full-time students
nationwide may have had unprotected sex as a result
of drinking. Over 70,000 were victims of a sexual assault
or date rape, a problem reported by 1.5% of respondents
(95% CI: 1.3-1.7)
Whereas a small number of alcohol overdose deaths have
drawn attention to college drinking problems, the number
of unintentional alcohol-related injury deaths among 18-24
year-olds attending 2- and 4-year colleges probably exceeds
1,400 annually. In addition, the number of 4-year college
students that are unintentionally hurt or injured under the
influence each year may reach 500,000, and the number hit
or assaulted by drinking college students is over 600,000.
These numbers are disturbingly high; however, for several
reasons we believe our estimates are conservative.
First, the NHSDA rates of heavy episodic drinking and
driving under the influence of alcohol were greater for college
students than for same age noncollege students. Among
college students, those living in dormitories reported driving
under the influence in similar proportions to those who
lived elsewhere. As a consequence, our projection that college
and noncollege 18-24 year olds experience traffic injury
deaths at the same rate per population was intended to
be a conservative estimate for college students. The amount
and circumstances of driving and driving after drinking by
college students relative to same age noncollege students
has not been studied; such research could help us test the
validity of our assumption. The National Highway Traffic
Safety Administration collects data in 22 states regarding
the occupational and/or student status of persons fatally injured
in traffic crashes. The results of such alcohol testing
showed the same percentage of traffic fatalities for 18-24
year old college students and their noncollege counterparts.
Second, the meta-analyses of coroner studies (Smith et
al., 1999) did not provide age-specific estimates of alcohol
involvement in nontraffic unintentional injury deaths. Persons
ages 18-24 are known to drink more than older adults.
Also, in the 18-24 year old population a higher proportion
of traffic fatalities are alcohol-related (49%) than among
all age groups (38%). It is therefore possible that our estimate
of the numbers of unintentional alcohol-related
nontraffic injury deaths among 18-24 year old college students
is also conservative.
Third, responses to survey questions may be subject to
social desirability biases. Respondents may underreport
some behaviors, particularly illegal behaviors (e.g., driving
under the influence of alcohol or being arrested after drinking).
If such is the case, the estimates of the magnitude of
these problems among college students ages 18-24 may have
Fourth, for consistency we calculated estimates and confidence
intervals of the numbers of college students with
alcohol-related problems for all three surveys, including
NHSDA, based on the percentage of college respondents in
each survey reporting a problem and on the numbers of
college students 18-24 in the U.S. as recorded by the Department
of Education. Using this approach, the numbers
of students that we estimate had alcohol problems are lower
than if we had used NHSDA population estimates.
Fifth, response rates for the NHSDA, the NCHRBS and the CAS were low. Thus,
the students surveyed may under- or over-represent the problems associated with
alcohol. In order to examine the potential bias introduced by nonresponse in
the CAS, a short form of the questionnaire was sent to nonresponding students
in 1999. There was no significant difference in rates of past-year alcohol use
for those who answered the short survey compared with those that responded to
the entire questionnaire. Moreover, the rates of heavy episodic drinking and
other substance use observed by the CAS were consistent with those obtained
by other major national surveys (e.g., the Monitoring the Future Survey; Johnston
et al., 2000). Comparisons between respondents and nonrespondents on the CAS
were not made, however, on other variables (e.g., unprotected sex or injury
after driving). Compared to the CDC-sponsored NCHRBS, the NHSDA produces lower
estimates of substance use. These lower estimates are probably due to the fact
that the NHSDA respondents are most often surveyed in the home, closer to parents
or family members, compared with NCHRBS respondents who are surveyed in classrooms.
Sixth, this analysis focused only on college students ages
18-24. Because only 60% of 4-year college students and
48% of students at either 2- or 4-year colleges are ages 18-24, these estimates do not reflect all college students, but
rather those in the age group at highest risk of alcohol-related
problems. We have calculated estimates for all college
students based on responses to the NHSDA study; they
are available upon request.
We should note that none of the surveys that record
students' consumption of five or more drinks on an occasion
specifically asks the duration of those drinking occasions.
The number of hours during which drinking occurred
could influence respondents' blood alcohol content.
The magnitude of problems posed by excess college student
drinking should stimulate both efforts to improve our
measurement of these problems and interventions to reduce
them. First, without consistent recording of blood alcohol
concentrations and college-student status of people who die
from motor vehicle and other unintentional injuries, the
number of alcohol-related unintentional injury deaths involving
college students can only be estimated based on
examination of multiple data sources and acceptance of
some underlying assumptions. No matter how cautious the
assumptions used, it would be preferable to have direct
systematic alcohol test results and consistent information
on student status. Data systems must be improved to more
accurately count and monitor over time the exact numbers
of college students who die from unintentional and intentional
injury deaths annually. Existing mortality data sets
(e.g., the Department of Transportation's Fatality Analysis
Reporting System [FARS] and the CDC's Vital Statistics
Mortality file) should include occupation and student status
categories so that the absolute number of annual college
student deaths can be tabulated. Second, all motor vehicle
and other unnatural deaths should be tested for alcohol (and
other drugs if possible). In some states, this type of testing
is done frequently; however, consistency of testing varies
from state to state and even within the same state over time.
The most comprehensive testing is found among fatally
injured drivers in traffic crashes. In 1999, 62% of fatally
injured drivers had known alcohol test results and 21 states
tested over 80% of driver fatalities. In contrast, only 25%
of drivers who survived fatal crashes were tested and only
two states tested 80% or more of surviving drivers in fatal
crashes. Of the 56,352 drivers involved in fatal crashes nationwide
in 1999, 31,142 (55%) survived the crash.
The testing rates are high enough in some states that
statistical models based on crash factors, vehicle factors
and person factors have been used to estimate overall alcohol
involvement in fatal crashes in all states (Klein, 1986).
This has proven invaluable to researchers seeking to study
the effects of state level legislative interventions to reduce
Testing needs to be increased in all types of injury and
unnatural deaths so that similar types of analyses can be
undertaken to explore policies and programs to reduce these
and other types of alcohol-related deaths.
Interventions to reduce college drinking and related problems
must also be strengthened. Individually oriented prevention
and treatment strategies (Cronin, 1996, Darkes and
Goldman, 1993, 1998; Fleming et al., 1997, 2000; Garvin
et al., 1990; Gentilello et al., 1999; Marlatt et al., 1998;
Monti et al., 1999), environmental alcohol regulations
(Gruenewald et al., 1996; Kenkel and Manning, 1996;
O'Malley and Wagenaar, 1991; Toomey et al., 1996), a
variety of drunk-driving laws (Hingson et al., 1999; Voas
et al., 2000), social norms marketing campaigns (DeJong
and Linkenbach, 1999; Haines 1998) and comprehensive
community campus interventions (Hingson et al., 1996;
Holder et al., 2000; Wagenaar et al., 2000) appear to have
reduced alcohol-related problems and traffic deaths among
college-age populations. These initiatives should be expanded.
Of college students with drinking problems, only a
small minority recognizes problems, asks for treatment or
is exposed to individually oriented programs shown in experimental
studies to reduce drinking problems. Colleges
and their surrounding communities nationwide should also
consider (1) regulations to increase prices and reduce availability
of alcohol, (2) a variety of drunk-driving laws and
(3) comprehensive community interventions, all of which
have been demonstrated to reduce alcohol consumption and
related health problems among college-age students.
It is important that colleges and their surrounding communities
collaborate in these efforts. College restrictions
regarding on-campus drinking absent parallel community
support may simply push problematic drinking off campus.
Community crackdowns, if not supported by colleges, similarly
can drive drinking problems back onto the campus.
Although a higher percentage of college students than same
age noncollege students report heavy episodic drinking and
driving under the influence of alcohol, the absolute numbers
of 18-24 year-olds who engage in these behaviors are
greater among noncollege students because only 31% of
persons that age attend college. Whereas 3.3 million 18-24
year old college students engage in episodic heavy drinking
each month, 6.4 million same age noncollege students
engage in that behavior. Whereas 2.1 million 18-24 year
old college students drove under the influence of alcohol in
the past year, so, too, did 3.3 million noncollege 18-24
year-olds. Whereas over 1,400 18-24 year old college students
died in 1998 from alcohol-related unintentional and
motor vehicle injuries, more than 3,200 18-24 year olds
not in college died from the same causes. It is to be hoped
that heightened attention to problems posed by excessive
alcohol consumption will stimulate initiatives and policy
changes to protect all 18-24 year old young adults from
these consequences. Moreover, it would be most useful to
involve college students and other young adults in campus/community collaborations. If college students and other
young adults are represented in these efforts, they may be
less likely to regard the policies and programs developed
and implemented as authoritarian and more likely to accept
new programs and policies to reduce college drinking
This article is dedicated to the memory of Jonathan Levy and Dr.
Margaret Moore, student and faculty member, respectively, of Radford
College in Virginia, who died on October 31, 1997, in separate vehicles
involved in a crash caused by a college student alleged to have been
driving while intoxicated. Travis Steadman, also a college student at the
time, survived the crash despite sustaining severe injuries.
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Received: November 20, 2001. Revision: December 21, 2001.
Correspondence may be sent to Ralph W. Hingson
at the above address or via email at: firstname.lastname@example.org. Timothy Heeren is with
the Biostatistics Department, Boston University School of Public Health, Boston,
MA. Andrea Kopstein is with the Office of Applied Studies, Substance Abuse and
Mental Health Services Administration, Rockville, MD. Henry Wechsler is with
the Department of Health and Social Behavior, Harvard School of Public Health,
Last reviewed: 9/23/2005