Binge drinking

[Winter 2009]

Harvard College Alcohol Study calls for changes at U.S. Schools

Fed up with their inability to deter underage students from binge drinking on campus, 120 U.S. college presidents proposed this past summer to open up a national debate about the legal drinking age. “21 is not working,” the presidents opined. Younger students were flouting the law.

But in raising the possibility of a lower legal age—perhaps as low as 18—the presidents met with a din of protest.

Experts in law enforcement and highway safety cried foul. Leaders in education, substance abuse, and neurology—not to mention parents, including Mothers Against Drunk Driving—blew their collective stacks. Still more kids would start drinking in high school, they charged. And, according to the National Highway Traffic Safety Administration, about 900 more young people would die in alcohol-related crashes each year.

Many protesters, including op-ed writers at the New York Times and theWashington Post, have drawn support for their argument from the father-of-all-drinking studies: the Harvard School of Public Health’s College Alcohol Study (CAS). According to CAS director Henry Wechsler, “Lowering the drinking age would be like using gasoline to put the fire out.”

His 14-year study shows that the key difference between alcohol-steeped, “wet,” so-called “party schools” and “drier” schools boils down to a simple concept: environment. Students’ drinking habits depend to a great degree on the availability of alcohol and their access to it. Both variables are heavily influenced by college, community, and state policies.

“College presidents do need more help,” Wechsler says. “But instead of giving up, they should join forces with the community. They’ve got to strengthen existing policies and restrict easy access to alcohol.”

PARTNERSHIPS KEY
The College Alcohol Study surveyed more than 50,000 students at 120 four-year schools in 40 states in 1993, 1997, 1999, and 2001.

The study defined “binge drinking” as consuming enough alcohol to produce a host of problems for the drinker and others in the same orbit: five drinks for men and four for women, at least once during the previous two weeks. (See graph “Binge-drinking’s consequences for students.”)

In the July 2008 issue of the Journal of Studies on Alcohol and Drugs, Wechsler and College Alcohol Study Co-director Toben Nelson summed up the CAS findings. “There is no one size fits all” solution to underage drinking on campus, they emphasized. But schools and communities with fewer problems had:

  • A comprehensive set of state minimum drinking-age laws (possession, sale, age of workers at outlets)
  • Stronger enforcement of these laws (e.g., through identification checks and keg registrations)
  • Fewer alcohol outlets
  • More laws controlling high-volume sales (drinks served in pitchers, fish bowls, boots, buckets; limits on so-called happy hours)
  • Limits on irresponsible marketing practices (e.g., prohibit 25-cent beers, all-you-can-drink specials, and “ladies nights,” when women drink for free)

By changing the environment, “You can change people’s behavior,” says Wechsler, a semi-retired lecturer in HSPH’s Department of Society, Human Development, and Health. “But you have to go far beyond educational, psychological, clinical, and motivational programs for individuals,” he says. “Changing the environment is the best way to go, because crops of students come and go.”

According to Toben Nelson, an assistant professor of epidemiology and community health at the University of Minnesota, binge drinking rates among schools range from 1 to 80 percent. But for any given college or university, the rate has remained remarkably stable over time. “This suggests there is something about ‘party schools’ that has earned them their reputation,” Wechsler notes.

Cultural factors, too, can be influential, the College Alcohol Study found. Relatively higher binge drinking rates prevail at colleges that:

  • Have many sororities and fraternities
  • Have highly competitive athletic programs as members of National Collegiate Athletic Association
    (NCAA) Division I
  • Normalize student drinking as historical tradition

Some schools have launched campaigns aimed at making heavy drinking socially unacceptable. That’s all fine, Wechsler says, except that students are bombarded daily with inducements to drink. Their campuses are ringed by bars and liquor stores offering large drinks at low prices. They see peer leaders in athletics and fraternities drinking heavily.

“For interventions to be effective,” Wechsler says, “this super-wet environment must change.”

LESSONS FROM TOBACCO
By way of example, Wechsler points to the enormous success of tobacco-control efforts. In Massachusetts and elsewhere, five basic principles were used to slash smoking rates. According to HSPH experts who led the Massachusetts “Make Smoking History” campaign, price controls, laws and regulations governing access, support programs, and mass communications to educate the public all helped turn people against smoking (see “Five steps to changing behavior”).

A mass-media campaign was also critical to lowering drunk-driving fatalities through the HSPH-led “Designated Driver” campaign. Begun in 1988, this nationwide effort is credited with helping cut alcohol-related fatalities by 25 percent within four years.

“There’s a lot colleges and their communities can do” with regard to problem drinkers, Wechsler says. “While lowering the legal drinking age to 18 has very little support from the scientific community, I hope college presidents will take this opportunity to meet and discuss all that they can do to improve the situation on their campuses.

“Instead of spending their political capital to weaken an effective policy, they should show leadership in enacting policies firmly backed by research,” he adds.

Wechsler rattles off a few ideas: Schedule exams on Fridays. Impose community service for underage drinkers. Ask local officials to regulate alcohol pricing and the size of containers, and to shutter stores, bars, and restaurants that repeatedly sell to minors. And lobby states to lower the legal blood-alcohol level for drivers from 0.08 to 0.05 or lower, as is the case in parts of Europe.

“Rather than punish students one by one, I’d penalize the purveyors,” Wechsler urges. “Do it to improve the quality of life for everyone on campus.”

SECOND-HAND TROUBLE
Alcohol has flowed like a river on college campuses for centuries. Thomas Jefferson complained about student drinking when he was president of the University of Virginia. And, as former Harvard president Neil Rudenstine has noted, sheriffs first began leading undergraduate processions at Harvard’s first commencement, “to keep the drunkards in line.”

Students under the influence harm not only themselves. A huge body of research links alcohol consumption with sexual assaults and other forms of violence. And then there are the injuries and deaths, most often traced to drunk driving.

At Harvard, about 140 students a year (out of 6,700 undergraduates and 12,300 graduate and professional students) are treated at Harvard University Health Services for alcohol poisoning or transported to area hospitals, according to physician director David S. Rosenthal. He says these numbers are holding steady.

Director of Alcohol & Other Drug Services Ryan Travia says Harvard’s bingepiechartundergraduates are unusual, compared to their counterparts across the country. A large percentage of its academically gifted freshmen say they are “abstainers”—70 percent in the fall of 2007. Although that figure fell to 57 percent later in the semester, when the survey was repeated, it was still considerably higher than the College Alcohol Study estimates of the average percentage of non-drinking U.S. freshmen at four-year schools: not quite 25 percent.

Administrators also work hard to nurture an environment and a culture that supports students with alcohol problems while discouraging drinking. “We maintain close relationships with alcohol licensing boards  in Cambridge and Boston,” which exert strict oversight of alcohol sales by package stores and bars/restaurants, Travia notes. And all freshmen are asked to complete an online alcohol survey and education course before matriculating. In 2008, 100 percent complied.

Another feature of Harvard probably deters carousing, Travia points out. Faculty members and graduate students also serve as “residential life staff,” he says, and have lived in student dorms “for hundreds of years.”

Each school and community has a unique environment and set of issues. The universities of Massachusetts, Virginia, and Florida have launched new anti-binging campaigns. But such efforts won’t make a dent, Wechsler counters, unless colleges and communities unite to stem the alcohol tide.

Karin Kiewra is the associate director of Development Communications at HSPH and editor of the Review.

MORE TO EXPLORE
To learn more about the CAS, visit http://www.hsph.harvard.edu/cas/. For the study’s questionnaire and student responses, see the Inter-University Consortium for Political and Social Research at the University of Michigan at http://www.icpsr.umich.edu/.