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Environmental Strategies for Preventing Underage Drinking

Introduction

Alcohol remains the drug of choice for youth. The most recent Monitoring the Future data show that more than two-thirds of high school seniors have used alcohol in the past year, and nearly half have reported being drunk.¹ Strategies to reduce youth drinking have traditionally focused on individual students, seeking to educate them about the dangers of drinking and to give them the skills to resist peer pressure. These strategies have demonstrated short-term successes, but longer term results have been mixed. Prevention researchers have learned that prevention of underage drinking needs to look beyond the individual and, instead, seek to change the environment in which drinking occurs.

What Are Environmentally-Based Strategies?

Strategies that focus on the individual have long been the cornerstone of drug prevention efforts. These strategies take the individual’s community and environment as a given and concentrate on developing the proper personal characteristics to effectively reduce the probability of substance use and abuse. Individually focused strategies generally are school-based and start in middle school, when children are thought to be most vulnerable.

To complement individual strategies, prevention researchers have considered factors external to the individual that may influence a slide toward substance abuse. This includes looking at the environment as part of a continuum to see what shapes behavior for the community as a whole, as well as for the individual. 

Environmental strategies use law and public policy to develop community standards that lead individuals away from substance abuse and have certain advantages when combined with individual strategies. Changes in the environment affect entire populations rather than only one person, setting up longer-term success. New attitudes and customs are more likely to persist for a long time and, in the case of prevention, community attitudes against use and abuse can last for generations. 

Another advantage of environmental strategies is that they can undercut society’s mixed messages regarding substance use. Resistance training alone can fail an individual when media portray substance use glamorously, when alcohol can be purchased easily, or if laws against underage consumption are not enforced.

Principles of Prevention

The National Institute on Drug Abuse (NIDA) has developed 16 principles for prevention. These principles were developed from NIDA research studies on the origins of drug abuse and the common elements found in research on effective prevention programs. The principles fall under three categories: risk factors and protective factors; prevention planning; and prevention program delivery.²

Risk Factors and Protective Factors

• Principle 1 – Prevention programs should enhance protective factors and reverse or reduce risk factors.
• Principle 2 – Prevention programs should address all forms of drug abuse, alone or in combination, including the underage use of legal drugs; the use of illegal drugs; and the inappropriate use of legally obtained substances, prescription medications or over-the-counter drugs.
• Principle 3 – Prevention programs should address the type of drug abuse problem in the local community, target modifiable risk factors, and strengthen identified protective factors.
• Principle 4 – Prevention programs should be tailored to address risks specific to population or audience characteristics - such as age, gender and ethnicity - to improve program effectiveness.

Prevention Planning

Family Programs

• Principle 5 – Family-based prevention programs should enhance family bonding and relationships and include parenting skills; practice in developing, discussing and enforcing family policies on substance abuse; and training in drug education and information.

School Programs

• Principle 6 – Prevention programs can be designed to intervene as early as preschool to address risk factors for drug abuse, such as aggressive behavior, poor social skills and academic difficulties.
• Principle 7 – Prevention programs for elementary school children should target improving academic and social-emotional learning to address risk factors for drug abuse, such as early aggression, academic failure and school dropout.
• Principle 8 – Prevention programs for middle or junior high and high school students should increase academic and social competence.

Community Programs

• Principle 9 – Prevention programs aimed at general populations at key transition points, such as the transition to middle school, can produce beneficial effects even among high-risk families and children. Such interventions do not single out risk populations and, therefore, reduce labeling and promote bonding to school and community.
• Principle 10 – Community prevention programs that combine two or more effective programs - such as family-based and school-based programs - can be more effective than a single program.
• Principle 11 – Community prevention programs that reach populations in multiple settings are most effective when they present consistent, community-wide messages in each setting.

Prevention Program Delivery

• Principle 12 – When communities adapt programs to match their needs, community norms or differing cultural requirements, they should retain core elements of the research-based intervention.
• Principle 13 – Prevention programs should be long-term, with repeated interventions to reinforce the original prevention goals.
• Principle 14 – Prevention programs should include teacher training on good classroom management practices, such as rewarding appropriate student behavior.
• Principle 15 – Prevention programs are most effective when they employ interactive techniques - such as peer discussion groups and parent role-playing - that allow active involvement in learning about drug abuse and reinforcing skills.
• Principle 16 – Research-based prevention programs can be cost-effective. Similar to earlier research, recent research shows that for each $1 invested in prevention, a savings of up to $10 in treatment can be seen.

Strategic Prevention Framework

The Strategic Prevention Framework (SPF), developed by the Substance Abuse and Mental Health Services Administration (SAMHSA), uses multiple funding streams to create community-based approaches to substance abuse prevention. SAMHSA provides funding directly to states and territories employing these methods. The SPF uses the following five-step approach to implementing prevention:³

1. Profiling needs and response capacity;
2. Mobilizing and building needed capacity;
3. Developing a prevention plan;
4. Implementing programs, policies and strategies based on what is known to be effective; and
5. Evaluating program effectiveness and sustaining what has worked well. 

Examples of Successful Environmental Strategies

Environmental strategies generally are not program-based. Instead, they focus on changing law and public policy to influence community norms and reduce access.

Law Enforcement

Law enforcement has proven to be successful in reducing youth access to alcohol. The strategy uses punitive measures such as warning letters and citations against retailers who sell to underage buyers. Studies of alcohol sales have shown that even moderate enforcement can reduce sales to minors by 35 percent to 40 percent.⁴

Server training programs demonstrate a strategy that melds policy changes with the community. These programs train managers, bartenders and waiters to recognize fake and legitimate IDs. Servers also learn to recognize when patrons are already intoxicated and refuse to sell them additional liquor. When combined with law enforcement efforts, this program has effectively reduced illegal sales to intoxicated and underage patrons.⁵

Public Policy

Both the federal and state governments have taken action to reduce the number of underage drinkers and the societal harm caused by them. The first public policy response was to raise the minimum drinking age. Minnesota was first to implement this policy in 1976, responding an increase in youth binge drinking in the early 1970s. From 1976 to 1984, 27 other states followed Minnesota’s lead. In 1984, Congress passed the Federal Uniform Drinking Age Act. This law forced states to raise their minimum legal drinking ages to 21, or face the loss of highway funding. By 1987, all states had done so. Enactment of these laws has saved an estimated 21,887 lives through reduced drunk driving accidents, according to the National Highway Traffic Safety Administration.⁶

Some states have added zero tolerance laws to combat drunk driving among youth. The laws set very low legal blood alcohol content (BAC) levels for drivers under age 21. The federal government once again followed the states lead and passed the National Highway Systems Designation Act in 1995, requiring all states to adopt such laws or lose highway funding. This law mandates a BAC level of .02 and temporary driver’s license revocation for youths found to be in violation. Zero tolerance laws have been effective at reducing heavy alcohol consumption. Reductions of 13percent to18 percent have been seen in heavy episodic drinking for both males and females. In addition, zero tolerance laws reduce the number of drinks consumed in a month by 20 percent for males. Females, however, did not have a statistically significant reduction.⁷

Keg registration laws have helped to curb underage drinking. These laws require unique identification for kegs and collection of basic information from the purchaser. The intent is to encourage responsible selling and to discourage adults from purchasing kegs for younger drinkers. This policy has reduced alcohol-related traffic fatalities.⁸

Efforts to affect the price of alcohol also play a key part in youth prevention efforts. Teenagers are far more sensitive to changes in price than are adults, and even small price increases have led to decreased alcohol use in this age group. This is an important point for lawmakers, since public policy can directly affect on the price of alcohol. The primary method lawmakers can use to influence the price of alcohol is taxation. During the past half-century, little movement has occurred on alcohol taxes, and inflation has eroded the few increases that were made. The federal government increased alcohol taxes in 1951, and then not again until 1991. State and local governments have raised taxes infrequently as well. This has partly contributed to the decline in the real price of alcohol over time. For example, between 1975 and 1990, real prices for liquor fell by 32 percent, wine by 28 percent, and beer by 20 percent. ⁹

Subsequent tax increases have fallen short of inflation’s impact, making alcohol cheaper and more attractive to youth.

Studies have shown an inverse relationship between beer consumption and its price.¹⁰ One study has shown that higher excise taxes led to a significant reduction in youth drinking, with a price elasticity of -0.29. ¹¹ (Elasticity is a measure of how demand for a product changes in response to a change in price.) In this case, for a 10 percent rise in price, demand would fall by just under 3 percent. Another study has shown that, if beer prices were indexed to inflation, then overall youth drinking during any past year would drop by 9 percent and heavy drinking by 20 percent.¹² 

The price of alcohol can influence the deleterious behaviors associated with alcohol consumption. Estimates have shown that a 10 percent increase in price would reduce drinking and driving by 7.4 percent for males and by 8.1 percent for females. For those under age 21, a 10 percent price increase would reduce drunk driving rates by 12.6 percent for males and by 21.1 percent for females. In addition, this price change would reduce youth motor vehicle fatalities by between 7 percent and 17 percent.¹³ If the 1951 alcohol taxes kept pace with inflation, fatalities among 18-to-20-year-old drivers would fall by 15 percent.¹⁴

Analyses of state-level data on violent crime rates also conclude that higher beer taxes would result in fewer rapes and robberies.¹⁵

The price of alcohol also can affect a student’s education level. There is strong evidence that increased alcohol consumption reduces the probability of a student’s high school graduation. On the other hand, a 10 percent increase in price would increase graduation rates by 3 percent.¹⁶

Further studies have shown that drinking during high school significantly reduces one’s higher education, with frequent drinkers completing 2.3 fewer years of college than those who drink less. These studies also estimate that an additional $1 tax on each case of beer would increase the probability of college graduation by 6.3 percent.¹⁷

Examples from Colleges and Universities

State-level policies directly influence college campuses, both public and private. Legislators can use legislative and policy structures to support campus and community-wide efforts to reduce and prevent underage drinking.

Colleges and universities have been instrumental in developing environmental strategies to curb alcohol use and abuse. Alcohol is the drug of choice for most campuses, and drinking – underage drinking in particular – has ingrained itself in college culture; many students come to campus with the expectation that drinking is part of college life. The 2003 Monitoring the Futures Study and the 2003 Core Institute Alcohol and Drug Survey report that between 82 percent and 86 percent of students had used alcohol in the last year.¹⁸ The surveys also found use rates of between 66 percent and 71 percent within the last 30 days.¹⁹ Alcohol is the primary cause of many related problems. For example, at one northeastern research university, alcohol use was related to 75 percent of campus arrests, 80 percent of residence hall damage, 85 percent of sexual assaults, and 50 percent of all suicide attempts.²⁰

Colleges and universities offer an ideal setting for implementation of environmental strategies. At traditional four-year schools, students live, study, work and socialize within the campus and the surrounding community. Therefore, the administration has a direct connection to many of the environmental factors that may influence student’s drinking patterns.

Recognizing that drinking is an ingrained part of college culture, administrators realized prevention efforts would not succeed unless this mindset changed. Some colleges have taken a hard line. In 1995, the president of the University of Rhode Island banned alcohol at all social and athletic events and instituted fines and suspensions for underage students who were caught drinking. The president claims a number of benefits from this policy, such as increases in enrollment applications and increased participation in student activities.

Schools also have developed less punitive measures. Pennsylvania State University spends $111,000 per year for activities scheduled from 10 p.m. to 2 a.m. on weekends, which are generally prime drinking hours. Attendance at these events has tripled in two years to 24,000 students per semester.²¹ Penn State’s president also has made public statements to the effect that, “if students think they are coming to Penn State to drink, they should go somewhere else.” The university has seen a significant increase in applications since then.²²

The University of North Carolina at Chapel Hill uses the Sunday before classes begin to organize an alcohol-free street festival Fall Fest. It was designed to counter the long-standing student tradition of heavy drinking on that day. Participation at Fall Fest was high, and a positive effect was zero alcohol-related hospital visits, compared to eight the year before, and fewer alcohol-related events on or near campus (30 vs. 19) during the school year.²³

Conclusion

Environmental strategies provide lawmakers with an ideal opportunity to become involved with prevention efforts. Alcohol is a legal substance that is subject to regulation and taxes, and a wide variety of public policies can be implemented to curb youth drinking. In addition, changes to law and policy affect entire communities and can last for generations. By focusing on proven research-based environmental strategies, lives can be saved and states can reduce the money spent on the health and criminal problems that result from underage drinking.

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