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Effectiveness of Public Health Strategies to Reduce College Binge Drinking and Underage Alcohol Use
An Overview:
Scientific research into the effectiveness of public health strategies to reduce youth alcohol abuse is a rapidly expanding field.Over the years, researchers have broadened their focus, from looking primarily at alcohol abuse as an individual problem to an environmental or community perspective, which examines the social, economic, cultural, physical, and political contexts in which alcohol problems occur.Hundreds of research studies now document the impact of this public health approach to alcohol problems, including alcohol-related crime and violence.Studies show that reducing alcohol availability does reduce alcohol problems.
This shift has led to prevention strategies that share a common focus on community action and change.A dramatic example of this public health strategy are laws that raised the minimum drinking age in the 1980s.Researchers estimate that 16,500 lives young lives were saved between 1975 and 1996 as a result of this policy change.
The following table summarizes a number of public health strategies to reduce alcohol abuse and their level of effectiveness based on existing research.Because of their relative newness, some strategies have not been fully tested or evaluated.In most cases, however, these strategies are based on well-established prevention principles or are similar to other strategies that have been scientifically proven to reduce tobacco use and other high-risk behaviors.
As part of A Matter of Degree, the Harvard School of Public Health is currently researching the effectiveness of several of the following strategies.Results are expected to be released over the next several years.
Strategy Level of Effectiveness

Responsible beverage service training and education on techniques that can reduce sales to minors as well as reduce sales of alcohol to intoxicated persons

Some studies have shown improvements in ID checking as a result of training.Stronger effects have been shown on reducing service to intoxicated patrons, especially when combined with enforcement.1

Media campaigns, media advocacy, and counteradvertising

Media campaigns have been found to be very important components of enforcement efforts, greatly magnifying their effectiveness.Counteradvertising has been found to have an effect on attitudes toward alcohol and intentions to use.2

Conditional use permits for alcohol outlets, including 21-and-over entry restrictions

This strategy has not been specifically evaluated, but it may be a way of reducing access.

Application of appropriate sanctions to violating merchants

This strategy has not been specifically evaluated.It is an important adjunct tocompliance checks.

Enforcement of laws against buying alcohol for minors

This strategy has not been specifically evaluated, but it may be a way of reducing access.

Controls on alcohol advertising (especially on billboards, sides of buses, and in other public areas)

Exposure to alcohol advertising has been found to have an effect on attitudes toward alcohol and intentions to use.3

Prohibitions of alcohol sponsorship of public events (e.g., a beer company sponsoring a boat race)

This strategy has not been specifically evaluated, but it can be a strong expression of community norms.

Prohibitions or controls on alcohol use at community events or in public areas (e.g., at county fairs, in parks, or at beaches), which can also be seen as a control on access

This strategy has not been specifically evaluated, but it can be a strong expression of community norms.

Controls on outlet location and density

Higher density contributes to increased alcohol-related problems.Lower density reduces alcohol-related problems.4

Increases in price through excise taxes

Increase taxes have consistently been found to reduce alcohol consumption and problems, especially among youth.5

Controls on hours of sale

Effects on youth have not been specifically evaluated, but, in general, controls on availability reduce alcohol-related problems.6                                

Keg registration laws

This strategy has not been specifically evaluated but is consistent with general finding that reducing access reduces use.

Community sponsorship of alcohol-free activities for youth

This strategy has been specifically evaluated, but it can be an expression of community norms.

Alcohol and Injury
· 
During spring break, the average male reported drinking 18 drinks per day and the average woman reported 10 drinks per day. More than half of all men and more than 40 percent of all women drank until they became sick or passed out at least once. 

— Journal of American College Health, May 1998

...

· 
Young Americans have suffered injury or even death from automobile accidents, drowning, and falls, in addition to other mishaps.While these accidents are sometimes chance occurrences, many are caused by alcohol or drug abuse. 

— U.S. Department of State, Bureau of Consular Affairs, 

Travel Safety Information for Students

...
· 
Physicians see the effects of intoxication at three to five times the legal limit:injuries from high-speed car and Jet Ski accidents, pumped stomachs, broken legs and spinal compressions from balcony falls, and, maybe once a day, date rape. 

—  USA Today, “Spring Break '00 No Cares,

No Parents, No Inhibitions  

Beach Town Pays Bill with Bacchanalia of Booze, Booty Dances,” 

by Gregg Zoroya, April 5, 2000.

...
· 
Alcohol is a fatal attraction for teens. It is implicated in the three major causes of death of children and teens in this country, which are homicide, suicide, and accidents, like alcohol poisoning. 

—  Joseph Califano, "American Morning with Paula Zahn,"

February 26, 2002

Crime and Law Enforcement
· 
Detailed police records reviewed by the Sun-Sentinel shed light on last year's spike in sexual battery reports at the beachfront: They came mostly during late-night Spring Break and summer partying. Many were reported from Club Atlantis, a beachfront bar that has been at the center of the city's policing efforts. 

Los Angeles Times, “Cancun Rethinks Its Role as a Mecca 

for Los Spring Breakers,” March 11, 2001

...

· 
“So far, officers have been averaging about 25 arrests a day since March 9, the start of Texas Week, the majority for public intoxication. The Town of South Padre collects more than $83,000 in fines in March, nearly all of them disposed of without protest, by credit card, from students who have long departed. There are 18 cheery signs posted throughout the island reminding kids that the South Padre Island Police accepts all major credit cards. "Don't get caught without them," the signs read.”

— Austin American Statesmen,  

 “Temptation Island Takes Credit Cards; Spring Break Brings Debauchery,” March 17, 2001

...
· 
Each year during spring break, more than 2,500 American citizens are arrested abroad. 

—  U.S. Department of State, Bureau of Consular Affairs, 

Travel Safety Information for Students

Destinations
· 
The five top destinations of more than 1.5 million undergraduate students are: 1) Panama City Beach, Florida; 2) Cancun, Mexico; 3) Daytona Beach, Florida; 4) South Padre Island, Texas; Colorado's ski resorts. 

— Sunday Telegram, “Women's History Month, and More,” 

by Diana Scott, March 5, 2000.

...

· 
Panama City Beach, Florida—the nations number 1 spring break destination—drew 450,000 students during the 2001 spring break season. 

— United Press International, “Spring Break Closer to Home,” 

by Les Kjos, February 26, 2002.

...
· 
Daytona Beach drew a little under 200,000 college students last year and expect a little over that figure in 2002. 

—  United Press International, “Spring Break Closer to Home,” 

by Les Kjos, February 26, 2002.

...
· 
South Padre Island averages 150,000 students every year for spring break. 

— United Press International, “Spring Break Closer to Home,”

by Les Kjos, February 26, 2002.

·
Over 100,000 American teenagers and young adults travel to Cancun over their Spring Break each year. 

— U.S. Department of State, Office of the Spokesman, 

Fact Sheet:Spring Break in Cancun

...

A sampling of Spring Break Web Sites for College Students

http://www.partyschool.com/springbreak/springbreak.htm 

http://www.partyschool.com/drinkinggames/ 
http://www.partyschool.com/seduction/ 
http://interoz.com/springbreak/ 
http://www.spring-break.net/ 
http://springbreak.sopadre.com/ 
http://www.springbreax.com 
http://www.springbreakpanamacity.com/photos.php3

Compiled by the American Medical Association “A Matter of Degree” program, March 1, 2002