Young Adult Drinking : Comprehensive Approaches

by National Institute of Health

(Page 3 of 3)

One frequently studied environmental strategy involves training servers, owners, and managers of bars and other alcohol establishments in responsible beverage service. For example, bar employees can be taught to recognize false age identification, to refuse sales to underage or obviously intoxicated patrons, and to offer food and nonalcoholic beverages to reduce patron intoxication levels. Studies have produced mixed results on the effectiveness of these training programs. Some programs result in changes in server attitudes and modest changes in server behaviors. But rates of illegal sales to underage or intoxicated patrons rarely change significantly following training. Some studies show that, at least within controlled environments such as the military, training may lead to lower intoxication levels among patrons. One study found a significant decrease in traffic crashes following implementation of a State law mandating server training. However, responsible beverage service training programs and laws vary greatly in quality and probably in effectiveness. No studies have assessed the effects of responsible beverage training on rates of alcohol use and related problems specifically among 18- to 25-year-olds.

Restrictions on Marketing

Some localities have worked to restrict how alcohol is marketed to the public - for example, by limiting drink specials (such as happy hours or two-for-one promotions) at clubs, bars, and restaurants. Drink specials appear to be associated with increased alcohol consumption or drinking-driving, and some research indicates that drink specials on or near college campuses are associated with increased heavy episodic drinking among college students.

Ultimately, sustained reductions in alcohol-related problems among young adults will require multiple environmental changes. Large-scale community trials have assessed the effects of comprehensive environmental approaches to reducing alcohol consumption and alcohol-related problems.

One community trial, Communities Mobilizing for Change on Alcohol, specifically targeted a segment of the young adult population, 18- to 20-year-olds. The goal of CMCA was to mobilize communities to reduce youth access to alcohol through public and institutional policy changes. Fifteen communities were randomly assigned to the intervention or control condition, and a wide range of outcomes were measured before and after a 2.5-year intervention period. In each of the seven intervention cities, community organizers conducted grassroots campaigns to influence local policy changes. Following community organizing efforts, fewer establishments in the intervention communities were likely to sell alcohol to underage youth, and fewer 18- to 20-year-olds in intervention sites reported providing alcohol to other underage youth compared with those in control communities. In intervention communities as compared with control communities, the proportion of 18- to 20-year-olds who tried to buy alcohol decreased 25 percent, the proportion who reported drinking in the last 30 days decreased 7 percent, and arrests for driving under the influence decreased 23 percent.

The Community Trials Project in California and South Carolina induced three communities to implement media advocacy, server training, restrictions on alcohol outlet density, and enforcement of underage sales and drinking- driving laws to reduce high-risk drinking and alcohol-related problems. The project's interventions resulted in a significant decline in alcohol consumption, drinking-driving, traffic crashes, and assaults. The number of alcohol sales to underage youth also significantly decreased in the intervention communities compared with the comparison communities. The Community Trials Project did not assess the effects of this array of environmental approaches on the rates of drinking and alcohol-related problems specifically among young adults.

Finally, the Complying with the Minimum Drinking Age project, using a 20-community time-series trial, tested the effects of enforcing laws governing sales to minors and of training alcohol outlet owners and managers. The propensity of alcohol retailers to sell to those under age 21 was measured biweekly over 4 years. Training had little effect, but enforcement significantly reduced sales to those under the legal drinking age.

In summary, several community intervention trials demonstrated that various dimensions of alcohol policy affect important outcomes such as sales of alcohol, drinking, and indices of alcohol-related problems among teens and young adults.

Future Directions

A substantial amount of research demonstrates the effectiveness of alcohol control policies aimed at teenagers, especially the legal drinking age of 21 and measures that take advantage of teens' sensitivity to alcohol prices (e.g., raising taxes on alcohol). (For a discussion of the effectiveness of laws lowering the maximum legal blood alcohol content of drivers, see the sidebar.) The literature on alcohol control policies targeting the general adult population is extensive as well, providing support for raising alcohol taxes and prices and limiting the density of retail alcohol outlets. Recently, the alcohol policy environment as it specifically affects college students has been the subject of an increasing number of studies, indicating that schools with tighter controls on alcohol sales, marketing, and use experience lower rates of drinking and alcohol-related problems. The college studies to date have yielded mixed findings, however, probably because of the low number of controlled randomized or time-series trials and because some studies have used nonprobability samples at small numbers of colleges, which are not representative of college students as a whole.

About the Author

NIH is the nation's medical research agency - making important medical discoveries that improve health and save lives. The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting medical research.