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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 to compliance 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.


  • The overview is adapted from Making the Link, a paper commissioned by the American Medical Association for the 1998 Alcohol Policy Conference. Authored by James E. Mosher and David H. Jernigan, Marin Institute for the Prevention of Alcohol and Other Drug Problems.
  • The table is adapted from the Pacific Institute for Research and Evaluation.

1 See for example, Holder, H.D., & Wagenaar, A.C. (1994). Mandated server training and reduced alcohol-involved traffic crashes: A time series analysis of the Oregon experience. Accident Analysis and Prevention, 26(1), 89-97.
McKnight, A.J. (1991). Factors influencing the effectiveness of server-intervention education. Journal of Studies on Alcohol, 52(5), 389-397.
Wolfson, M., Toomey, T. L., Forster, J.L., Wagenaar, A.C., McGovern, P.G., & Perry, C.L. (1996). Characteristics, policies and practices of alcohol outlets and sales to underage persons. Journal of Studies on Alcohol, 57(6), 670-674.

2 Blomberg, R.D. (1993). Lower BAC limits for youth: Evaluations of the Maryland .02 law. In Alcohol and other drugs: Their role in transportation (Transportation Research Circular No. 413, pp. 25-27). Washington, DC: Transportation Research Board.
Wallack, L., & DeJong, W. (1995). Mass media and public health: Moving the focus from the individual to the environment. S.E. Martin & P. Mail (Eds.), In Effects of the mass media on the use and abuse of alcohol (NIAAA Research Monograph No. 28, NIH Publication No. 95-3743, pp. 253-268). Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism.
3 Preusser, D.F., Ferguson, S.A., Williams, A.F., & Farmer, C.M. (1995). Underage access to alcohol: Sources of alcohol and use of false identification. Arlington, VA: Insurance Institute for Highway Safety.
4 See for example, Scribner, R.A., MacKinnon. D.P., & Dwyer, J.H. (1994). Alcohol outlet density and motor vehicle crashes in Los Angeles county cities. Journal of studies on Alcohol, 55(4), 447-453.
Alaniz, M.L., Parker, R.N., Gallegos, A., & Cartmill, R.S. (n.d.). Final progress report: Alcohol outlet density and Mexican American youth violence. Unpublished manuscript.
5 See for example, Saffer, H., & Grossman, M. (1987). Beer taxes, a the legal drinking age, and youth motor vehicle fatalities. Journal of Legal Studies, 16, 351-374.
Manning, W.G., Blumberg, L., & Moulton, L.H. (1995). The demand for alcohol: The differential response to price. Journal of Health Economics, 14, 123-148.

6 Smith, D.J. (1988). Effect on traffic accidents of Sunday alcohol sales in Brisbane, Australia. International Journal of the Additions, 23(10), 1091-1099.
Olsson, O., & Wikstrom, P,H. (1982). Effects of the experimental Saturday closing of liquor retail stores in Sweden. Contemporary Drug Problems, 11(3), 325-353.