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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:

  1. 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.

  2.  
  3. 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.

  4.  
  5. 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.
     
  6. 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.

  7.  
  8. 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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Historical document
Last reviewed: 9/23/2005


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