Report to the Pennsylvania General Assembly on Highrisk and Underage Drinking

					Report to the Pennsylvania General Assembly on High Risk and Underage Drinking by the Pennsylvania Liquor Control Board As prescribed by ACT 85 of 2006


This report, mandated by ACT 85 of 2006, would not be possible without the help of the state agencies who assisted the Pennsylvania Liquor Control Board, Bureau of Alcohol Education, in its development. The PLCB gratefully acknowledges the help given to it by: Pennsylvania Commission on Crime and Delinquency Pennsylvania State Police, Bureau of Liquor Control Enforcement Pennsylvania Department of Health, Bureau of Drug and Alcohol Programs Pennsylvania Department of Transportation Pennsylvania Department of Education Together, through collaborative efforts and use of researched information and science based and proven effective programs, Pennsylvania is viewed as a national leader in the prevention of high risk and underage use of alcohol.


Table of Contents
Act 85 Overview ---------------------------------------------------------------------- 4 Act 85 as created by House Bill 2383 of 2006 ------------------------------------ 5 Synopsis of the Issue ---------------------------------------------------------------- 10 Executive Summary ------------------------------------------------------------------ 15 Current Levels and Trends of Underage and High Risk Drinking ------------- 15 CORE Data – Pennsylvania versus National -------------------------- 16 Monitoring the Future Data ---------------------------------------------- 18 Student Assistance Data from PA Department of Education -------- 22 Pennsylvania Youth Survey (PAYS) ----------------------------------- 23 Pennsylvania Department of Transportation Data -------------------- 25 Center for Alcohol Marketing to Youth News Summary ------------ 26 Current Programs by State Agencies to prevent Underage and High Risk Drinking ------------------------------------------------------------------- 27 Pennsylvania Liquor Control Board ------------------------------------ 28 Pennsylvania State Police-Bureau of Liquor Control Enforcement 49 Pennsylvania Commission on Crime and Delinquency -------------- 51 Pennsylvania Department of Health-Bureau of Drug and Alcohol Programs --------------------------------------------------------- 52 Pennsylvania Department of Transportation -------------------------- 56 Pennsylvania Department of Education -------------------------------- 57 Current Science that Better Defines and Suggests Proven Prevention Strategies ----------------------------------------------------------------- 63 National Institute of Alcoholism and Alcohol Abuse Report ------- 63 Alcohol and Related Mortality and Morbidity Rates Among U.S. College Students Age 18 – 24 --------------------------- 73 Office of Juvenile Justice and Delinquency Program ---------------- 87 Binge Drinking on American College Campuses -------------------- 92 Appendices ----------------------------------------------------------------------------104


ACT 85 Overview
Broad Requirements of ACT 85 of 2006 1. Biennial Reports. -- The PA Liquor Control Board's Bureau of Alcohol Education shall prepare a report on underage alcohol drinking and high risk college alcohol drinking in this Commonwealth to be submitted to the Legislature by February on odd numbered calendar years. 2. The report shall address the following: A. Current levels and trends of underage alcohol drinking and high risk college alcohol drinking in this Commonwealth. B. Current programs conducted by State agencies to prevent underage alcohol drinking and high risk college alcohol drinking. C. Current science that better defines and suggests proven prevention strategies for underage alcohol drinking and high risk college alcohol drinking.

Broad Issues Related to this Report 1. 2. 3. 4. 5. National Trends on Underage and High Risk Drinking Pennsylvania Trends on Underage and High Risk Drinking Pennsylvania Statistics related to Underage and High Risk Drinking Efforts to Address the Issue by State Governmental Agencies and Organizations Current State Statutes to Address the Problem


ACT 85 of 2006 as proposed in the General Assembly
PRIOR PRINTER'S NOS. 3399, 3456, 3574, PRINTER'S NO. 4459, 4041, 4400


Session of 2006

INTRODUCED BY DONATUCCI, BELARDI, RAYMOND, BLACKWELL, CALTAGIRONE, CORRIGAN, CRAHALLA, CREIGHTON, DeWEESE, FABRIZIO, FRANKEL, GEIST, GOODMAN, W. KELLER, KOTIK, O'NEILL, SHANER, SIPTROTH, SOLOBAY, SONNEY, STABACK, TIGUE, YOUNGBLOOD, JOSEPHS, BEYER AND COSTA, JANUARY 24, 2006 AMENDMENTS TO SENATE AMENDMENTS, HOUSE OF REPRESENTATIVES, JUNE 30, 2006 AN ACT Amending the act of April 12,1951(P.L.90, No.21)entitled, as reenacted,"An act relating to alcoholic liquors, alcohol and malt and brewed beverages; amending, revising, consolidating and changing the laws relating thereto; regulating and restricting the manufacture, purchase, sale, possession, consumption,importation, transportation, furnishing, holding in bond, holding in storage, traffic in and use of alcoholic liquors, alcohol and malt and brewed beverages and the persons engaged or employed therein; defining the powers and duties of the Pennsylvania Liquor Control Board; providing for the establishment and operation of State liquor stores, for the payment of certain license fees to the respective municipalities and townships, for the abatement of certain nuisances and, in certain cases, for search and seizure without warrant; prescribing penalties and forfeitures; providing for local option, and repealing existing laws," FURTHER PROVIDING FOR DEFINITIONS; requiring the Bureau of Alcohol Education to make certain reports to the General Assembly; and further providing for special occasion permits AND FOR LIMITING THE NUMBER OF SPECIAL OCCASION PERMITS. The General Assembly of the Commonwealth of Pennsylvania hereby enacts as follows: Section 1. The act of April 12, 1951 (P.L.90, No.21), known


as the Liquor Code, reenacted and amended June 29, 1987 (P.L.32,

No.14), is amended by adding a section to read: SECTION 1. SECTION 102 OF THE ACT OF APRIL 12, 1951 (P.L.90, <-NO.21), KNOWN AS THE LIQUOR CODE, REENACTED AND AMENDED JUNE , 1987 (P.L.32, NO.14), IS AMENDED BY ADDING DEFINITIONS TO READ: SECTION 102. DEFINITIONS.--THE FOLLOWING WORDS OR PHRASES, UNLESS THE CONTEXT CLEARLY INDICATES OTHERWISE, SHALL HAVE THE MEANINGS ASCRIBED TO THEM IN THIS SECTION: * * * "PUBLIC HEARING" SHALL MEAN A HEARING HELD PURSUANT TO PUBLIC NOTICE. "PUBLIC NOTICE" SHALL MEAN NOTICE PUBLISHED ONCE EACH WEEK FOR TWO SUCCESSIVE WEEKS IN A NEWSPAPER OF GENERAL CIRCULATION IN THE MUNICIPALITY. SUCH NOTICE SHALL STATE THE TIME AND THE PLACE OF THE HEARING AND THE PARTICULAR MATTER TO BE CONSIDERED AT THE HEARING. THE FIRST PUBLICATION SHALL NOT BE MORE THAN 30 DAYS AND THE SECOND PUBLICATION SHALL NOT BE LESS THAN SEVEN DAYS FROM THE DATE OF THE HEARING. * * * SECTION 2. THE ACT IS AMENDED BY ADDING A SECTION TO READ: Section 217. Biennial Reports.--(a) The board's Bureau of Alcohol Education shall prepare a report on underage alcohol drinking and high risk college alcohol drinking in this Commonwealth. (b) A report shall be prepared biennially and shall address the following: (1) Current levels and trends of underage alcohol drinking and high risk college alcohol drinking in this Commonwealth. (2) Current programs conducted by State agencies to prevent underage alcohol drinking and high risk college alcohol drinking.

(3) Current science that better defines and suggests proven prevention strategies for underage alcohol drinking and high risk college alcohol drinking. (c) The first report to the General Assembly shall be presented prior to February 1, 2007. Additional reports shall be presented every two years thereafter. A copy of the report shall be sent to the chairman and the minority chairman of the Law and Justice Committee of the Senate and the chairman and the minority chairman of the Liquor Control Committee of the House of Representatives. Section 2 3. Section 408.4 of the act is amended by adding a subsection to read: Section 408.4. Special Occasion Permits.-* * * (q) Notwithstanding any provision of law to the contrary, the board may issue a special occasion permit to an eligible entity located in a dry municipality if the board is provided with a copy of a resolution adopted by the municipality's governing body confirming support for the issuance of the special occasion permit. This subsection shall expire on January













Synopsis of the Issue
No substance of abuse is more widely used in America by persons under the age of 21 than alcohol. The wide-spread prevalence of underage drinking and the negative consequences it creates for youth, their families, communities, and society as a whole remains a stubborn and destructive problem despite decades of efforts to combat it. This report to the General Assembly gives statistical information on the problem, the agencies and programs of the Commonwealth engaged in prevention and the latest in the science to prevent high risk and underage drinking. Current Levels and Trends On the campuses of Pennsylvania institutions of higher education alcohol is seen as central to the social life of students. In 2005 Pennsylvania college students responded to the CORE Survey overwhelming (70% plus) when asked the question about alcohol and its role in the social life of students. Ninety three percent (93%) of students have the perception that their fellow students drink at least once a week or more. Seventy five percent (75%) stated alcohol helps break the ice in social settings and sixty three percent (63%) stated alcohol allowed people to have more fun. Forty nine percent (49%) stated use of alcohol facilitated sexual opportunities and eighteen percent (18%) admitted to using alcohol the last time they had sex. Alcohol is a component of unwanted sexual advances, unplanned sexual activity, and sexual assaults. Thirty nine percent (39%) of Pennsylvania college students completing the CORE survey stated they had committed public misconduct (police involvement, fighting, DUI arrest, and vandalism) due to their drinking. Some good news is that over ninety two percent (92%) of students realize that the university or college has drug and alcohol policies and assistance for students who are having problems with alcohol. When compared to college students across the nation, Pennsylvania students are very similar. Eighty four percent (84%) of students in the nation and Pennsylvania stated they have used alcohol at least once in their life. When it comes to use of alcohol in the past thirty days, Pennsylvania students registered at seventy percent (70%) versus seventy two percent (72%) for the nation. Data on high school and middle school students, the future college students, has also been collected for this report. Nationally the Monitoring the Future survey shows promise in the reduction of alcohol use by youth. Between the years 2000 and 2005 (latest that data is available) lifetime use of alcohol by eighth, tenth, and twelfth graders has dropped anywhere from five (5%) to ten (10%) percent. Also the past thirty (30) day use of alcohol by the same students during the same time period fell anywhere from three (3%) to seven (7%) percent. When a comparison of the national Monitoring the Future Survey results and the Pennsylvania Youth Survey Results are made, Pennsylvania students in the eighth, tenth, and twelfth grades register higher on the same issues. Historically students who live in


the northeastern United States report higher uses of alcohol than students in other sections of the country. The Pennsylvania State Police, Bureau of Liquor Control Enforcement operated a hotline to report underage drinking. To date in 2006 over 200 calls have been made to this hotline. Over 6,000 hours have been dedicated to minor patrols in licensed establishments and through September 1,822 underage drinking citations have been made. This statistic does not take into account the citations made by local police units across the Commonwealth. In 2004 twenty seven (27%) percent of the driver deaths in the 16 – 20 age group were drinking drivers, up from 25% in 2003. On a more positive note, however, underage drinking drivers decreased in 2004 12% from 2003. With Pennsylvania being primarily a rural area, data related to rural Pennsylvanians and alcohol is also available. Of the 18,640 rural residents treated for drug and alcohol issues in 2004 (latest data available), forty five (45%) were treated for alcohol use. Nine percent (9%) of juvenile arrests in rural Pennsylvania were for alcohol use. Between 1994 and 2004 alcohol related crime in rural areas increased eight (8%) percent. Current Programs The state agencies involved in programming and activities to reduce and prevent underage and high risk drinking use a multitude of proven scientific models and strategies that can prevent the problem of alcohol consumption by Commonwealth youth. The Pennsylvania Liquor Control Board (PLCB) utilizes environmental management strategies and what are known as Tiers of Effectiveness in its programming with institutions of higher education to reduce underage and high risk drinking. These programs include: • • Brief Alcohol Screening and Interventions for College Students Social Norming Strategies

The following are additional programs utilized not only in prevention at the collegiate level but for school district, municipal, and community organizational activities: • • • • • • • • • Controlled Party Dispersal Training and Programming False Identification Training and Programming Source Investigation Training and Programming SAME Page Cops in Shops Responsible Alcohol Management Programming PLCB Grant Program Prevention Materials Website


Additionally, the PLCB offers technical assistance and funding to entities for additional activities such as: • • • • • • • Geographic Information System Mapping (GIS) Court Watch Programs SAFE Homes Campaign Project Sticker Shock College Alcohol Risk Assessment (CARA) activities Project Northland Additional CSAP Model type programs

The Pennsylvania State Police, Bureau of Liquor Control Enforcement offer additional programming and activities to reduce high risk and underage drinking. Included in their services are: • • • • Hotline Number (1-888-863-3721) 1-888-Under 21 Minor Patrols Age Compliance Program Choices Program

These activities include education as well as enforcement components. The Pennsylvania Commission on Crime and Delinquency offers funding to organizations to prevent and reduce alcohol consumption by Commonwealth youth. The Commission serves as a catalyst for the prevention of crime and delinquency within the Commonwealth. It supports local efforts of prevention through technology, funding, technical assistance and personnel as needed. The Pennsylvania Department of Health, Bureau of Drug and Alcohol Programs (BDAP) mandates that the Single County Authorities use the Strategic Prevention Framework (SPF) to advance community-based programs, policies and practices for substance abuse prevention and mental health promotion, and align them with the U.S. Department of Health and Human Services Healthier US initiative. The idea is to use public health research findings and apply this knowledge, along with evidence-based prevention programs that promote mental health and prevent substance abuse, to create healthier communities. The Framework uses a five-step process know to promote youth development, reduce risk-taking behaviors, build on assets, and prevent problem behaviors across the lifespan. The five-steps are: (1) profile needs and response capacity; (2) mobilize and build needed capacity; (3) develop a comprehensive strategic plan; (4) implement evidence-based prevention programs, policies and strategies; and (5) evaluate program effectiveness, sustaining what has worked well. The Pennsylvania Department of Transportation operates jointly with the PLCB the Cops in Shops program. PennDOT also provides statistical information and data as requested by other state agencies applying for grants. 12

The Pennsylvania Department of Education operates in conjunction with school districts, intermediate units, the Pennsylvania Department of Public Welfare and county drug and alcohol programs and mental health program operators the Student Assistance Program. (SAP). SAP identifies students who are having behavior issues that can be attributed to use of alcohol and other drugs. Data on Student Assistance Programs in school districts for school year 2005-06 include: 84,898 referrals to the program. Of these referrals 43,446 or 51.17% were for behavioral concerns (that include alcohol) and 5,051 or 5.95% of the referrals were due to violations of the school’s drug and alcohol policy. Current Science Research strongly supports the use of comprehensive, integrated programs that target individuals, targeted populations and the general population. Several scientifically researched avenues of prevention are utilized in Pennsylvania to reduce high risk drinking and underage consumption. They include: • The 3-in-1 Framework as presented in the final report, A Call to Action: Changing the Culture of Drinking at U.S. Colleges. This report divides prevention activities into Tiers of Effectiveness from the most scientifically proven strategy to activities that work in one population and therefore should work within other populations, to activities that make sense and should work but need research to confirm it to activities that when done alone without being complemented by one or more of the other three tiers, is ineffective. The Harvard School of Public Health’s College Alcohol Study on Binge Drinking in America. This study has demonstrated just how widespread and harmful binge drinking has become on college campuses. The study has made major contributions to understanding the campus culture surrounding high risk drinking. Office of Juvenile Justice and Delinquency Program report on universal and individual prevention. The work of Hawkins and Catalano is featured in this report. These researchers identified risk factors that allow youth to consume alcohol and other drugs or the protective factors that keep a child from becoming involved in substance use and abuse.



Conclusion Commonwealth agencies identified in this report utilize the current science available and the model programs or activities identified through the science to combat underage and high risk drinking of alcohol. Individual, targeted and universal prevention practices have been adopted by community prevention agencies funded by the Pennsylvania Department of Health. The Pennsylvania Liquor Control Board encourages and supports institutions of higher education practices in using environmental management strategies to reduce high risk drinking on their campuses. Pennsylvania Commission on Crime and Delinquency and the Pennsylvania State Police provide law enforcement techniques and activities as well as education and technical assistance to communities and organizations in their prevention efforts. The Pennsylvania Department of Education in coordination


with other state agencies and school districts and community agencies provides the successful Student Assistance Program to identify students in elementary, middle schools and high schools who are having issues with alcohol. While the abundance of programming listed above and in the main body of this report should indicate a comprehensive coverage for Pennsylvania youth regarding the use of alcohol, the problem still exists. There are many reasons why the problem is so difficult to eliminate. They include curiosity of youth regarding the product, availability of the product, consistent heavy marketing of the product to the youth market (see Center for Alcohol Marketing to Youth report, friends who use, insufficient coping skills to deal with life issues, and lack of community, school, university and state resources (manpower, time and funding) for a complete and comprehensive prevention programming to address these issues in the manner required. The strategies discussed in this report, when used as indicated do prevent high risk and underage drinking by Pennsylvania youth. The biggest issue for communities and schools is that each year the process must be started again because the targeted individual (youth) is constantly advancing through the stages of development and when a community, agency or school has worked with their youth to a point of the youngsters understanding the message and the providers of the service begin to see results, a new group of youth emerge and the process must begin again.


Executive Summary Current Levels and Trends of Underage and High Risk Drinking


Comparison of Pennsylvania College Student Alcohol Usage and Perceptions to a National Average. Calendar Year 2005 The following is a comparison of Pennsylvania student behavior and perceptions data to national data on alcohol use. The information was supplied by the CORE Institute of the Southern Illinois University. The data is from Calendar Year 2005 for both national statistics and the Commonwealth statistics. Legend: PA = Pennsylvania Students, NA = National Sample of Students from across the nation.
Following are some key findings on the use of alcohol: PA 84.2 % 70.5 % 64.7 % 45.9 % NA 84.4 % 72.7 % 68.1 % 47.3 % of the students consumed alcohol in the past year ("annual prevalence"). of the students consumed alcohol in the past 30 days ("30-day prevalence"). of underage students (less than 21) consumed alcohol in previous 30 days. of students reported binge drinking in the previous two weeks. Following are some key findings on the consequences of alcohol and drug use: PA 39.2 % 24.4% NA 37.0 % 24.80%

reported some form of public misconduct (trouble with police, fighting/argument, DWI/DUI, vandalism) reported experiencing some kind of serious personal problems (such as Following are some key findings on opinions about the campus environment:

PA 92.2% 7.4 % 0.4% 50.30% 47.1 % 2.5 % 78.90% 13.3 % 7.8 %

NA 91.1 % 8.50% 0.5 % 49.60% 46.20% 4.2 % 78.20% 12.40% 9.4 %

of students said the campus has alcohol and drug policies; said they "don't know"; and said there wasn't a policy. of students said the campus has an alcohol and drug prevention program; said they "don't know"; and said there wasn't a program students said campus is concerned about prevention of drug and alcohol use. said they "don't know"; and said the campus is not concerned. With regard to students' perceptions of other students' use:

PA 93.2 % 29.8 %

NA 91.6 % 26.0 %

students believe average student on campus uses alcohol once a week or more of students indicated they would prefer not to have alcohol available at parties they attend


The following percentages of survey respondents said they saw drinking as a central part of the social life of the following groups: PA 87.10% 79.4 % 14.2 % 31.1 % 70.2 % 82.3 % 78.0 % 50.1 % 8.2 % NA 87.9% 76.8% 17.50% 41.00% 66.00% 78.80% 71.20% 60.90% 7.10%

said they saw drinking as central in the social life of male students. said they saw drinking as central in the social life of female students. said they saw drinking as central in the social life of faculty/staff. said they saw drinking as central in the social life of alumni. said they saw drinking as central in the social life of athletes. said they saw drinking as central in the social life of fraternities. said they saw drinking as central in the social life of sororities. said they believe the social atmosphere on campus promotes alcohol use. said they do not feel safe on campus. Sexual Behavior

PA 69.4 % 18.8 %

NA 62.40% 22.50%

of students reported engaging in sexual intercourse within the past year, of these…… used alcohol the last time they had intercourse The following are some key findings on the perceived effects of alcohol:

PA 75.2 % 75.4 % 42.0 % 61.50% 68.80% 56.20% 47.30% 63.70% 74.60% 17.60% 26.10% 16.90% 16.60% 49.50%

NA 77.10% 75.6 % 40.60% 61.70% 68.70% 59.10% 48.30% 62.30% 74.30% 18.70% 27.80% 17.80% 17.60% 54.00%

say it breaks the ice say it enhances social activity say it makes it easier to deal with stress say it facilitates a connection with peers say it gives people something to talk about say it facilitates male bonding say it facilitates female bonding say it allows people to have more fun say it allows people to have more fun say it makes food taste better say it makes women sexier say it makes men sexier say it makes me sexier say it facilitates sexual opportunity Sample Demographics Following are some summary characteristics of the students who completed the questionnaire.

PA 34.90% 25.10% 20.80% 15.90% 2.70% 63.90% 49.20%

NA 29.40% 23.60% 21.90% 21.20% 3.20% 60.70% 40.70%

Freshmen Sophomores Juniors Seniors Graduate Students Females Off Campus Housed Students


From Monitoring the Future Survey of 2006 (National Data)
Monitoring the Future, begun in 1975 is a long-term study of American adolescents, college students, and adults through age 45. It is conducted by the University of Michigan’s Institute for Social Research and is supported under a series of investigatorinitiated, competing research grants from the National Institute on Drug Abuse. Trends in alcohol use Among 8th graders, 30-day prevalence of alcohol use has declined by more than one third since its peak level in 1996. Among 10th and 12th graders, the proportional declines from recent peaks have been smaller—one sixth among 10th graders since 2000 and one seventh among 12th graders since 1997. Last year nearly all prevalence measures for alcohol use and self-reported drunkenness showed some continuing decline in all grade levels, with a number of them reaching statistical significance. This year, however, only 12th graders showed any further decline in 30-day prevalence of alcohol use (-1.7 percentage points to 43.5 percent, a nonsignificant decline); and there was no further decline in any grade in the 30-day prevalence of self-reported drunkenness. This suggests that the decline in alcohol use may be over in the younger grades but continuing in 12th grade for awhile longer as a result of a cohort effect working itself up the age scale. (There were also statistically significant declines this year among 12th graders in their lifetime and annual prevalence rates.) In 2006, the prevalence of being drunk at least once in the prior month stands at 6 percent of the 8th graders, 19 percent of the 10th graders, and 30 percent of the 12th graders. Despite these impressively high rates, they actually reflect proportional declines from recent peaks of more than one third among 8th graders, one fifth among 10th graders, and one eighth among 12th graders. There was no further improvement this year, however. Past 30-day prevalence of the use of flavored alcoholic beverages (sometimes called “alcopops” or “malternatives”) was first measured in all three grades in 2004. In 2006 it is at slightly lower levels in all grades than in 2005, having declined by 1.1 percentage points among 8th graders (not significant) and 3.7 percentage points among 12th graders (not significant). Use of this class of beverages does not seem to be rapidly expanding, as some had feared. If anything, there appears to have been some decline in the use of these beverages by teens.

Johnston, L. D., O'Malley, P. M., Bachman, J. G. & Schulenberg, J. E. (December 21, 2006). Teen drug use continues down in 2006, particularly among older teens; but use of prescription-type drugs remains high. University of Michigan News and Information Services: Ann Arbor, MI. [Online]. Available:; accessed MM/DD/YY.


Monitoring the Future Survey 2006 Trends in 30-Day Prevalence of Daily Use of Alcohol for Eighth, Tenth, and Twelfth Graders

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 05–06 change Alcohol Any Daily Use 8th Grade 10th Grade 12th Grade Been Drunk Daily 8th Grade 10th Grade 12th Grade 5+ Drinks in a Row in Last 2 Weeks 8th Grade 10th Grade 12th Grade

0.5 1.3 3.6

0.6‡ 1.0 1.2‡ 1.8 3.4‡ 3.4

1.0 1.7 2.9

0.7 1.7 3.5

1.0 1.6 3.7

0.8 1.7 3.9

0.9 1.9 3.9

1.0 1.9 3.4

0.8 1.8 2.9

0.9 1.9 3.6

0.7 1.8 3.5

0.8 1.5 3.2

0.6 1.3 2.8

0.5 1.3 3.1

0.5 0.0 1.4 +0.1 3.0 0.0

0.1 0.2 0.9

0.1 0.3 0.8

0.2 0.4 0.9

0.3 0.4 1.2

0.2 0.6 1.3

0.2 0.4 1.6

0.2 0.6 2.0

0.3 0.6 1.5

0.4 0.7 1.9

0.3 0.5 1.7

0.2 0.6 1.4

0.3 0.5 1.2

0.2 0.5 1.6

0.2 0.4 1.8

0.2 0.4 1.5

0.2 0.5 1.6

0.0 0.0 0.0

12.9 13.4 13.5 14.5 14.5 15.6 14.5 13.7 15.2 14.1 13.2 12.4 11.9 11.4 10.5 10.9 +0.4 22.9 21.1 23.0 23.6 24.0 24.8 25.1 24.3 25.6 26.2 24.9 22.4 22.2 22.0 21.0 21.9 +0.9 29.8 27.9 27.5 28.2 29.8 30.2 31.3 31.5 30.8 30.0 29.7 28.6 27.9 29.2 28.1 26.5 -1.6

Trends in 30-Day Prevalence of Use of Alcohol for Eighth, Tenth, and Twelfth Graders
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 05–06 change Alcohol Any Use 8th Grade 10th Grade 12th Grade Been Drunk 8th Grade 10th Grade 12th Grade

25.1 26.1‡ 24.3 25.5 24.6 26.2 24.5 23.0 24.0 22.4 21.5 19.6 19.7 18.6 17.1 17.2 +0.1 42.8 39.9‡ 38.2 39.2 38.8 40.4 40.1 38.8 40.0 41.0 39.0 35.4 35.4 35.2 33.2 33.8 +0.6 54.0 51.3‡ 48.6 50.1 51.3 50.8 52.7 52.0 51.0 50.0 49.8 48.6 47.5 48.0 47.0 45.3 -1.7

7.6 7.5 7.8 20.5 18.1 19.8 31.6 29.9 28.9

8.7 8.3 9.6 8.2 8.4 9.4 8.3 7.7 6.7 6.7 6.2 6.0 6.2 +0.2 20.3 20.8 21.3 22.4 21.1 22.5 23.5 21.9 18.3 18.2 18.5 17.6 18.8 +1.2 30.8 33.2 31.3 34.2 32.9 32.9 32.3 32.7 30.3 30.9 32.5 30.2 30.0 -0.1

Flavored Alcoholic Beverages 8th Grade ------------------------------------------------------------------------------------------------------------14.6 10th Grade ----------------------------------------------------------------------------------------------------------25.1 12th Grade ----------------------------------------------------------------------------------------------------------31.1

12.9 13.1 +0.2 23.1 24.7 +1.7 30.5 29.3 -1.2




2005-2006 Statistical Breakdown of Statewide Referrals to Student Assistance Programs in School Districts
84898 Form(s) Entered for Statewide (2005-2006)

Number of Referrals by Referral Reason
Answer No Selection Violated school policy, D/A related Violated school policy, violence/weapons Violated school policy, other Behavioral concerns Unexplained drop in grades Attendance Suspected Child Abuse / neglect Continuation of case from another SAP team Suicide ideation, gesture or attempt Re-entry into school Academic Concerns Self-reported problem Social Concerns Suffered recent loss Homelessness Witness/victim of traumatic event Involvement in legal system Other Gender identity issues Self harm/injury Number Percent 1197 1.41% 5051 1353 7200 43446 11934 14241 1700 1884 2853 909 31239 8170 22051 3191 587 1035 1708 12390 363 2248 5.95% 1.59% 8.48% 51.17% 14.06% 16.77% 2.00% 2.22% 3.36% 1.07% 36.80% 9.62% 25.97% 3.76% 0.69% 1.22% 2.01% 14.59% 0.43% 2.65%


Pennsylvania Youth Survey (PAYS) 2005 Results
The 2005 PAYS was sponsored by the Pennsylvania Commission on Crime and Delinquency (PCCD), in collaboration with the Department of Education, Department of Health, Liquor Control Board, and the Department of Public Welfare. The PCCD contracted with Westat, an independent research company, to conduct the survey, which was administered across the state between October and December of 2005. Participating schools were provided detailed instructions for administering the PAYS, including a teacher read script designed to protect students’ privacy by allowing for anonymous and voluntary participation. The final statewide sample frame produced a statewide sample of 232 randomly selected schools. Statewide, 92 of the 232 randomly selected schools participated in the survey. The 92 participating schools yielded 14,926 surveys for an overall student response rate of 40 percent. A weighting factor was applied to each student survey record to adjust for nonresponse and for varying probabilities of selection. Those wishing to read more details about the overall survey methodology may refer to Appendix C. Students completed the self-administered PAYS questionnaire during one class period. Before the survey was conducted, local parental permission procedures were followed. In some schools, some or all of the student respondents completed the survey in a computer lab using an Internet-based survey administration system. All schools administering the Internet survey received formal training for the task. Westat utilized a subcontractor, SmartTrack, Inc., to conduct training and support administration for the Internet-based PAYS. In addition, Westat utilized the services of The Crider Group to recruit schools, and the services of Rothenbach Research and Consulting, LLC, to assist with data analysis and report development. The data gathered in the 2005 PAYS serve two primary needs. First, the survey results provide an important benchmark for alcohol, tobacco, and other drug (ATOD) use and delinquent behavior among young Pennsylvanians, and help to indicate whether prevention and treatment programs are achieving their intended results. Second, the survey assesses risk factors that are related to these behaviors and the protective factors that guard against them. This information allows community leaders and school administrators to direct prevention resources to areas where they are likely to have the greatest impact. Note: The entire Survey is in the appendices of this report. Lifetime Use of Alcohol Surveyed Youth Compared to the Monitoring the Future Study PAYS 2005 8th % 52.9 10th % 74.8 12th % 85.0 2005 Monitoring the Future 8th % 41.0 10th % 63.2 12th % 75.1


Past-30-Day Use of Alcohol for Surveyed Youth Compared to the Monitoring the Future Study PAYS 2005 8th % 14.5 10th % 36.5 12th % 53.7 2005 Monitoring the Future : 8th % 17.1 10th % 33.2 12th % 47.0

PAYS 2005: Overview of Key Findings On many fronts, Pennsylvania was in an unusual place in 2005. When compared to previous administrations of the Pennsylvania Youth Survey (PAYS), younger students in the state, those in grades 6, 8, and 10, have some of the lowest substance abuse and risky behavior prevalence rates ever recorded. On the other hand, older students, those in grade 12, have some of the highest substance abuse and risky behavior rates ever recorded. This tale of two different groups of young Pennsylvanians dominates throughout this 2005 PAYS report. Not only are the 2005 statistical estimates some of the lowest ever for students in grades 6, 8, and 10, but many numbers are also well below national benchmark numbers. For th example, in 2005 past 30-day use of alcohol by 8 graders in Pennsylvania was 14.5 th percent, nearly 3 percentage points lower than what was reported for 8 graders from the 2005 Monitoring the Future (MTF) study, a national survey used to assess substance abuse and risky behaviors. What may be working for younger Pennsylvanians, however, is not necessarily working as effectively for high school seniors in the state, and as readers make their way through this report an extremely clear picture of 12th graders emerges. Not only are many of the statistics for seniors at all-time highs—especially the binge drinking statistics, but seniors in the state also drink, smoke, and use more drugs than their peers nationally. Seniors are also more willing to try alcohol and drugs, and to drive while under the influence.


Pennsylvania Department of Transportation Data
In Pennsylvania drinking and driving remains a top safety issue. In 2004 twenty seven (27%) percent of the driver deaths in the 16 – 20 age group were drinking drivers, up from 25% in 2003. On a more positive note, however, underage drinking drivers decreased in 2004 12% from 2003. Pennsylvania continues to take an aggressive posture to prevent and deter drinking and driving particularly through the widespread use of sobriety checkpoints and saturation patrols. Most (77%) alcohol related crashes were during the hours of darkness, usually on weekends. On average each day, 78 alcohol related traffic crashes occurred and 1.5 persons were killed in alcohol related traffic crashes each day in 2004. In 2004, the latest year figures are available, in the under 21 age group of drinking drivers, twenty one males and two females were under age 16 and accounted for 5.2% of the crashes in this age group while 1,339 were between the ages of 16 and 20 and accounted for 3.7% of crashes in this age group.


News Summary Proliferation of liquor and other alcohol ads on cable TV has contributed to a 41-percent increase in youth exposure to television alcohol advertising. Dated: December 22, 2006 A proliferation of liquor and other alcohol ads on cable TV has contributed to a 41percent increase in youth exposure to television alcohol advertising, according to a new report from the Center on Alcohol Marketing and Youth (CAMY). "More spending on television, especially on cable, translates into kids seeing more and more alcohol ads," said David Jernigan, executive director of CAMY. The report, Still Growing After All These Years: Youth Exposure to Alcohol Ads on TV 2001–2005, found that industry self-regulation standards for TV ads -- including a pledge not to advertise on programs with an underage audience of more than 30 percent -- have provided insufficient protection for young viewers, although fewer ads are now being placed on shows with large youth audiences. "Twenty state attorneys general and the Institute of Medicine (IOM) have said the alcohol industry needs to do a better job of shielding our kids from its advertising," said Jernigan. In 2003, the IOM recommended that alcohol ads be banned from shows with youth audiences of 25 percent or higher, and that the industry then move to a 15-percent standard. "Despite the industry's efforts, youth exposure to alcohol advertising on television is moving in the wrong direction," said Jernigan. "More effective ad placement standards and ongoing, independent monitoring of alcohol-industry practices will help parents and policymakers make certain that our kids are not overexposed to alcohol advertising." CAMY said that spending on alcohol ads rose 34 percent between 2001 and 2005, and the number of ads televised increased 34 percent. The alcohol industry is now spending more than $1-billion annually on TV ads, the report said. Most of the alcohol ads viewed by youth are now on cable television, CAMY said.


Current Programs by State Agency/Organization
Science Based and/or Effective Projects and Activities currently operating in Commonwealth by State Agencies to address the issues covered by ACT 85.


Pennsylvania Liquor Control Board Bureau of Alcohol Education 2006 Strategic Plan Mission: To provide leadership and resources that will reduce alcohol misuse in Pennsylvania. Goal #1: Increase Pennsylvanians awareness of alcohol misuse, its consequences and how they can prevent misuse. Goal #2: Increase the capacity of communities and organizations to prevent the misuse of alcohol. Goal #3: Increase the capacity of licensees to prevent the misuse of alcohol. Programs and Activities • • • • • • • • • • • • • Brief Alcohol Screening and Intervention for College Students (BASICS) Social Norming Campaigns Controlled Party Dispersal Programs and Training False Identification Recognition Training Source Investigation Programs and Training Responsible Alcohol Management Programs (RAMP) PLCB Grant Program to Municipalities, Colleges and Schools to use Environmental Management Strategies to Reduce underage and high risk drinking Responsible Retailing Project L.C. Bee and Lesson Plans Alcohol Awareness Poster Contest Alcohol Education Website Prevention materials Contractual Relationship with the Center for College Health and Safety

Brief Alcohol Screening and Intervention of College Students: BASICS Audience: College Students and Professionals intervening with alcohol use. Definition of the Problem: Is there an effective intervention procedure that works with the 18 to 24 year old age group to decrease alcohol usage and related harms. Definition of Response: BASICS a harm reduction approach, is a preventive intervention for college students 18 to 24 years old. It is aimed at students who drink


alcohol heavily and have experienced or are at risk for alcohol-related problems such as poor class attendance, missed assignments, accidents, sexual assault, and violence. Development of Program: University of Washington staff led by Dr. Alan Marlett and Dr. George Parks. Why was it developed: Students often conform to patterns of heavy drinking they see as acceptable while holding false beliefs about alcohol's effects or actual alcohol-use norms. BASICS is designed to help students make better alcohol-use decisions. The program's style is empathetic, not confrontational or judgmental, and:
• • •

Reduces alcohol consumption and its adverse consequences Promotes healthier choices among young adults

Provides important information and coping skills for risk reduction BASICS is conducted over the course of only two interviews, and these brief, limited interventions prompt students to change their drinking patterns. While research also shows that, over time, the majority of students who drink heavily will reduce consumption without the intervention, BASICS speeds the process. BASICS is designed to affect the individual; however, post-intervention students often comment that their friends respond differently as a result of participation. Developed by the University of Washington, the PLCB brought in the creators of BASICS to train trainers across Pennsylvania institutions of higher education. These trainers are under contract with the PLCB to provide training to other colleges and universities in the Commonwealth. To date, over 120 college personnel have been trained in BASICS. BASICS is recognized by the NIAAA as a Tier One effective program to reduce high risk college drinking. Social Norming Campaigns Audience: Students in elementary, secondary and post secondary schools, community agency and education staff. Definition of the Problem: Student perceptions of how much other youth drink are almost always over projected. A method that is scientifically sound and effective to reduce and eliminate these perceptions is needed. Definition of Response: The social norms approach essentially uses a variety of methods to correct negative misperceptions (usually overestimations of use), and to identify, model, and promote the healthy, protective behaviors that are the actual norm in a given population. Development of the Program: Created by several individuals across the nation with some of the most prominent being Dr. Wes Perkins and Dr. Alan Berkowitz and Dr. Jeff Linkenbach. Why it was developed: Recognized as a Tier 3 NIAAA strategy to reduce high risk drinking, the social norms approach essentially uses a variety of methods to correct negative misperceptions (usually overestimations of use), and to identify, model, and promote the healthy, protective behaviors that are the actual norm in a given population. When properly conducted, it is an evidence-based, data-driven process, and a very costeffective method of achieving large-scale positive results. In October 2006 the PLCB 29

offered training to colleges and universities in developing proper social norming campaigns and has also produced a CD ROM of generic “posters” that universities can use and input their data unto the posters for an effective campaign. Over 50 universities took advantage of the free CD ROM. In June 2007, the PLCB is sponsoring a Social Norms training in conjunction with the Commonwealth Prevention Alliance with guest presenter Dr. Jeff Linkenbach. Controlled Party Dispersal Training Audience: Law Enforcement Personnel Definition of the Problem: How to do effective “Dispersal” techniques which enable a limited number of officers to better manage large groups. Ideally, the techniques will help to keep underage drinking participants from attempting to drive away from parties, helping to eliminate some occurrences of Driving Under the Influence (DUI) and prevent crashes caused by intoxicated partygoers who panic when officers show up. Definition of Response: Controlled dispersal is a systematic operational plan using the concepts of zero-tolerance and education to safely and efficiently close the underagedrinking party. It is a proactive strategy to reduce underage drinking-related problems. Development of the Program: Developed by the Pacific Institute of Research and Education (PIRE) Why it was developed: This is a six hour course that provides “Dispersal” techniques which enable a limited number of officers to better manage large groups. Ideally, they will help to keep underage/drinking participants from attempting to drive away from parties, helping to eliminate some occurrences of Driving Under the Influence (DUI) and prevent crashes caused by intoxicated partygoers who panic when officers show up. Enforcement strategies will include topics such as Briefing, Approach, Entry, Sweep and Control, and Processing of participants. The training will also discuss preventing underage drinking parties, locating and acquiring community resources/assistance, how to involve the media, liability issues, and working with the various state and local laws and ordinances. The main objective of the course is to promote the best use of enforcement resources while keeping the safety of the officers, partygoers, and community in general in mind. In 2004 246 law enforcement personnel from 13 counties were trained in Controlled Party Dispersal. In 2005 212 officers were trained with 8 new counties and 5 counties from 2004 offering the training. On January 26, 2007 fifteen (15) trained Party Prevention and Controlled Party Dispersal trainers met in Harrisburg. The trainers received updated resource materials, new videos and discussion of practical exercise formats were held. Marketing techniques for offering CPD trainings were also discussed. A focus group of Law Enforcement Officials also recommended an annual statewide Law Enforcement Summit as a way to provide the CPD training. Controlled Party Dispersal training is provided free of charge to police forces across the Commonwealth by trainers under contract to the PLCB. Fake Identification Recognition Training Audience: Law Enforcement Personnel


Definition of the Problem: False Identification use by youth under age 21 has become a major issue in the prevention of underage alcohol consumption. Definition of Response: Pennsylvania has a dedicated team of False ID training specialists who are available to instruct other police officers and employees of licensed establishments to better recognize and stop the use of false ID’s. This effort to impact the use of false IDs by underage people will hopefully reduce the number of alcohol sales to minors and possibly benefit our state in matters of homeland security as well. In calendar year 2005 8 trainings were held and 92 law enforcement officers were trained. State College Police, who are instrumental in the training aspect of this program have large quantities of fake and altered identifications that are used for training purposes. Development of Program: As state and national security issues are now everyday concerns, the proper identification of an individual is critical for homeland security as well as for beverage alcohol service. The Pacific Institute on Research and Education was instrumental in the development of this training. Why it was developed: This effort to impact the use of false IDs by underage people will hopefully reduce the number of alcohol sales to minors Source Investigation Program and Training Audience: Law Enforcement Personnel. Definition of the Problem: The “source” of underage drinking has been an area of enforcement not always pursued by law enforcement personnel. Past practice in most law enforcement agencies has been to cite the minor for drinking underage and turn him or her over to a parent or guardian. No further investigation would be conducted and the provider of the alcohol would go scott free; not because the police weren’t doing their jobs in fully investigating the incident, but because time, manpower requirements, training in alcohol enforcement and a host of other issues affecting most departments prevented such cases from being fully investigated. Definition of Response: The Source Investigation Project is designed to address Furnishing Alcohol to Minors – the “source” of underage drinking. Past practice in most law enforcement agencies has been to cite the minor for drinking underage and turn him or her over to a parent or guardian. No further investigation would be conducted and the provider of the alcohol would go scott free; not because the police weren’t doing their jobs in fully investigating the incident, but because time, manpower requirements, training in alcohol enforcement and a host of other issues affecting most departments prevented such cases from being fully investigated. Likewise, licensed liquor establishments share the responsibility for serving minors and visibly intoxicated guests. These patrons subsequently leave the bar or restaurant and become a community problem in alcohol related crimes such as DUI, public intoxication, vandalism and assaults. In State College Borough, where this program was developed, the furnishing to minor cases result in 99 to 100% guilty pleas. To date, none have gone to trial. Development of Program: This course is geared to attack the problem of dangerous drinking behavior by young adults; ages 16-25 and especially prosecute the “furnisher” of the alcohol through investigation. Furnishing alcohol to minors is a criminal offense. Along with dangerous drinking behavior these issues are now at the forefront of


community concern. To adequately address these problems an aggressive and sustained campaign is essential. SIP has discovered that education and awareness through an extensive public relations campaign is a key component to stressing the scope of the problem and to providing valuable information to introduce change in mindset of our young adults. Aggressive enforcement of all alcohol laws and of alcohol associated crimes is likewise crucial to success in changing the behavior of young adults. Drinking underage, party till you puke and binge drinking is Not a “Rite of Passage”. Increasing the risk of getting caught is an effective deterrent which not only affects the minor but impacts the provider of alcohol as well. Why it was developed: The Source Investigation Project is not a course in exact procedure. Rather, it is a foundation of ideas on which to build a program that is “tailor made for your Community” with the common goal of reducing alcohol related crimes and improving the environment by restoring peace and tranquility to your neighborhoods and business districts. Developed by the State College Police Department source investigation is designed to ask the question, “Where did the alcohol come from?” Since its inception, 50 presentations and trainings on Source Investigation have been given around the Commonwealth. Currently three thousand (3,000) booklets on how to do Source Investigation have been printed and will be distributed to law enforcement officials across the Commonwealth. The PLCB will be offering Grant money to enforcement agencies to conduct Source Investigation programs. Rural Initiative Project Audience: Law Enforcement Personnel, School District Personnel, Community Agencies and Municipalities Definition of the Problem: Reducing the availability of alcoholic beverages to, and the consumption of alcoholic beverages by underage persons (those under 21 years old) living in rural communities. Definition of Response: Required activities of the project are that the state (and local sites) commit to implementing the following “best” and “most promising” research-based strategies to enforce underage drinking laws and prevent and reduce underage drinking by: 1. Conducting compliance checks 2. Reduce the social availability of alcohol to youth (e.g., Source Investigations, Cops in Shops, keg sticker projects, Party Dispersal) 3. Implement policy changes related to UD (e.g., model school policy or local ordinance) 4. Strengthen DWI enforcement with a focus on youth 5. Environmental strategies for reducing alcohol consumption on or near school sites (focused enforcement, undercover enforcement). Development of Program: In Pennsylvania, The PLCB developed a broad-based Steering Committee of state organizations and agencies to assist in the selection of rural communities to participate in this UD initiative. Using the federal guidelines (e.g., geographically and culturally diverse rural communities, less than 20,000 populations, etc.), the Steering Committee members were given a project abstract (see Attachments I)


and were asked to recommend appropriate communities. A number of other statewide groups were solicited for recommendations in the same timeframe. Upon receiving the recommendations, the internal PLCB committee selected 10 communities for consideration and contacted a key person in each of those communities to discuss their interest, to review the criteria, to determine their readiness, and to discuss the reporting and monitoring requirements. Based on these discussions, interested communities submitted an application to the PLCB. After reviewing the applications and conducting follow-up discussions, 4 rural communities were selected to participate in the project. SELECTION CRITERIA: The 4 rural communities selected for this project met mandatory criteria and the following specific characteristics and commitments related to Underage Drinking (UD): 1. They have conducted need assessments and document UD risk factors and issues. 2. They each have a broad-based coalition with a primary interest in UD. They have appointed a chairperson for the coalition. 3. The community is committed to the public policy and enforcement approach, 4. They have demonstrated broad-based community support, especially law enforcement, in the form of letters of support. 5. They have participated in statewide and/ or regional UD planning events. 6. They have youth actively involved in local and statewide UD events and activities. 7. Each community has initiated UD activities but has engaged in fewer than three of the five. The selected communities are committed to the Project as demonstrated by their previous activity and their enthusiasm for this proposal. The 4 communities are very diverse and include: Honesdale (population 4,874) in the far northeast; Lock Haven (pop 9,230) and Wellsboro (pop 3,328) in the north central; and Indiana (pop 14, 895) in the western part of the state. They are very different in their population, the nature and diversity of their population, their economy, the nature of their substance abuse problem, and their response to the problem. The PLCB has developed a science-based strategy to reduce underage drinking (UD) using a 3-pronged approach. The project goals and objectives (below) address each of these approaches. 1. Reduce access (e.g., Responsible Alcohol Management Program, owner/server training), 2. Change cultural and social norms (e.g., alcohol–free activities, youth involvement, community coalition building) and 3. Enforcement (e.g., compliance checks, sobriety check points).


The Project will be guided and focused by measurable goals and objectives for each site. The PLCB and Project Steering Committee members have identified goals and objectives that are clear, measurable, and establish a timeframe for completion. The following goals and objectives have been established to guide the Rural Underage Drinking Initiative. GOALS AND OBJECTIVES: Process Goal: A diverse broad-based consortium, including youth, from each rural site will actively and effectively identify and address UD problems in their community. 1. Each site will convene a strong, diverse coalition to address Project goals and objectives within 30 days of award. Note: The Coalition will include, at a minimum, representatives from law enforcement, the justice system, local schools, healthcare, and post-secondary education. 2. Each Coalition will have youth representation of at least 20%. Note: The PLCB is strongly encouraging the Coalition to have active youth representation to contribute to the plan, plan local youth projects and activities, and provide valuable youth insight into the local project. 3. Each site will update a needs assessment of UD issues and problems within 30 days 4. Each site will work with PLCB and OJJDP/ NIAAA contractor to develop a strategic plan that summarizes the issues and problems, identifies goals and objectives, and develops timetables and plans for their achievement within 120 days of a contract between the PLCB and the site. 5. Each community will facilitate the direct involvement in the Project of 20-50 students. 6. Develop an interdisciplinary evaluation committee to improve data collection and to continuously monitor and improve UD drinking strategies and activities. 7. Collaborate with the PLCB and OJJDP/NIAAA to implement the project evaluation. Outcome Goal: Rural youth will have the skills and support to resist drinking and related behaviors.


Note: The project encourages law enforcement, justice, school, and community participants to collect pre-project baseline data and project outcome data (see outcome objectives 8-26 below). It would be most helpful if the local schools participated in the bi-annual survey and gave the PCCD permission to provide local school data (numbers only) as opposed to regional data currently available. Outcome Objectives: Over the 3 years of the grant: 8. Reduce UD in the past month by 14-20 year olds by 10% as compared to other communities measured by the Pennsylvania bi-annual survey and NIAAA evaluation findings (federal requirement). 9. Reduce attempts to purchase alcohol in the past month by 14-20 year olds by 10% as compared to other communities measured by the Pennsylvania biannual survey and local sources and findings (federal requirement). 10. Implement 3 prioritized local institutional and public UD policies as identified in the strategic planning process (federal requirement). 11. Conduct at least 2 compliance check operations in at least 90% of the off-site outlets per year using official reports and NIAAA evaluation findings (federal requirement). 12. Reduce alcohol related traffic injuries and fatalities among youth by 30%. 13. Decrease incidence of alcohol poisoning by 20%. 14. Reduce unintentional injuries related to alcohol consumption by 20%. 15. Increase student retention at each school/ college by 10%. 16. Identify key related behaviors (fights, violence, vandalism, etc.) and reduce by 10% as measured by the bi-annual survey and/or police reports. 17. Increase 10 alcohol related arrests/citation of individuals by 10% (see Attachment 2). 18. Increase the identification and referral of students for alcohol and other substance abuse evaluations by 15%. 19. Facilitate student organization of at least 5 positive alcohol free activities. Law Enforcement Objectives: 20. Increase arrests for furnishing alcohol to minors by 10 per year. 21. Conduct 3-5 sobriety checkpoint operations in each pilot community. 22. Increase driving while-intoxicated (DWI) arrests of underage drinkers by 10% in the second year and 10% in the 3d year. 23. Increase arrests for consuming alcohol on or near school sites by 10% in the second year and 10% in the 3d year. Enforcements and Institutional Policy Changes: 24. Adopt a model school substance abuse policy at each site. 25. Identify and institute at least one priority UD policy (law/ordinance) and adopt in each community.


26. Reduce perceived availability of alcohol among youth by 10% (as measured by the 2005 bi-annual Pennsylvania Youth Survey. Why it was developed: The Office of Juvenile Justice and Delinquency (OJJDP) is very concerned regarding the complexity, scope, and consequences of underage drinking (UD) in rural communities. To address this concern, they solicited proposals from states to specifically address this issue. Pennsylvania was one of only four states selected to participate in this important 3-year project. Responsible Alcohol Management Program (R.A.M.P.) Audience: Licensed establishments serving beverage alcohol. Definition of the Problem: Licensees needed and were seeking guidance for responsible beverage service practices. Licensees were also seeking insurance coverage discounts for recognized and certifiable training for themselves and their staff. Definition of Response: R.A.M.P. was created by the Pennsylvania Liquor Control Board to help licensees and their employees to serve alcohol responsibly. R.A.M.P. offers practical advice for licensees operating restaurants, hotels, clubs, distributors, and even special occasion permit holders. R.A.M.P. explains how to:
• • • •

Detect signs of impairment and intoxication, and effectively cut off service to a customer who has had too much to drink Identify underage individuals, and deter minors from coming into your establishment in the first place Detect altered, counterfeit, and borrowed identification Avoid unnecessary liability

Help reduce alcohol-related problems (underage drinking, vehicle crashes, fights, etc) in your community Development of the Program: Legislation enacted June 18 of 2001 establishes a voluntary Responsible Alcohol Management Program certification that provides incentives for licensees who participate. In 2005 R.A.M.P. made 421 certification visits to licensees, trained 2,300 Owner Managers and offered server seller training to 10,150 trainees. Through November 2006 the R.A.M.P. program has made 545 certification visits, trained 2,364 Owner Managers and offered server seller training to 12,224 trainees. New legislation enacted in June of 2006 (Act 26 of 2006) requires mandatory compliance with RAMP for any Licensee found to have violated section 493(1) for the first time in regards to sales of alcohol to a Minor or a visibly intoxicated patron. To date there have been 180 licensees ordered to comply with RAMP and 66 of those have already completed the certification. Why it was developed: Completion of the program provides certification for two years. There are five parts to the program: 1. Owner/Manager Training - An owner and/or manager must attend a free training session offered by the Pennsylvania Liquor Control Board.


2. Alcohol Server/Seller Training - 50% of the licensee’s alcohol service employees must complete a PLCB certified alcohol server/seller education program. (This includes anyone who is in the position to serve alcoholic beverages and/or check IDs.) Upon completion of the program, employees are required to complete a course examination and must receive an 80% or better grade. 3. New Employee Orientation – New employee orientation must be provided on or before the first day of the employee’s employment as a member of the licensee’s alcohol service staff. The Board will provide the licensee with a checklist and appropriate learning methods and licensees must maintain these records. 4. Signage – Posting of signs regarding responsible alcohol service. Signage will be provided by the Board; however, the licensee may use other signage provided that it is equivalent in size, number and content to the Board’s. Signage must be prominently displayed so that it can be observed readily by patrons. Licensees shall be responsible for posting and maintaining the signage at all times. Signage shall minimally include the following information: a. Acceptable forms of ID. b. Refusal of alcohol service to minors and visibly intoxicated patrons. 5. Certification Compliance Appointment and Visit – The final component consists of a compliance visit from your Regional RAMP Representative. After successful completion of the 4 above listed requirements necessary to receive official PLCBRAMP Certification, you must contact your Regional RAMP Representative and arrange a time and date for a visit to your establishment to review and complete the necessary documentation. Benefits to the licensee include possible reduction in the fines and penalties issued by the Administrative Law Judge to the licensee for serving a minor or a visibly intoxicated patron, so long as the licensee was in compliance with all parts of ACT 141 at the time of the violation and had no citations in the previous 4 years. Knowledgeable, responsible, well trained alcohol service staff and management. Recognition as a responsible licensee in your community. PLCB Grant Program Audience: Municipalities, School Districts, Colleges and Universities and 501 C-3 Community Organizations. Definition of the Problem: Many entities in Pennsylvania agree with the prevention strategies supported by the PLCB but lacked the necessary funding to institute and/or maintain activities to prevent underage and high risk drinking. Definition of the Response: The purpose of the Grant program is to reduce underage and/or high-risk drinking activities. The PLCB recognizes that environmental change can be an especially effective strategy in preventing underage and high-risk drinking on college campuses and in municipalities and communities throughout the Commonwealth. The Bureau has placed an emphasis on environmental and cultural changes to reduce the occurrences of inappropriate use of alcohol and related behavior that is unacceptable. Facilitating partnerships and coalitions between educational institutions and community


groups to comprehensively address the issues and make the most effective use of existing resources has done this. Development of the Program: The Grant period is for a maximum of one (1) year. The Grant will be funded for up to eleven thousand five hundred dollars ($11,500.00). Up to a maximum of one thousand five hundred dollars ($1,500.00) of this Grant must be spent on evaluation of the Grant activities. The Grant is a cost-reimbursable grant. No funds are advanced to Grantee. The Grants are awarded on a competitive basis, subject to availability of funds. The Bureau has sole discretion to determine the award of the grant. Since 1998 over $2,000,000.00 dollars has been distributed in grants to schools and municipalities and community organizations. Why it was developed: In its continuing efforts to fulfill its public trust, the PLCB works with local community groups, schools, colleges and universities to reduce the deaths, injuries, health risks and property losses caused by excessive consumption of alcohol. As a part of these continuing efforts, the PLCB has a grant funding mechanism for those institutions, municipalities and organizations that want to develop and maintain effective and promising practices with the purpose of preventing underage and high-risk drinking. Responsible Retailing Project Audience: Licensees and Colleges and Universities Definition of the Problem: Licensees in college communities face more difficult tasks of insuring that they and their staff operate a responsible licensed premise and do not serve underage or visibly intoxicated individuals. Definition of the Response: This project seeks to address the gap in services that NIAAA Call to Action identified. The PLCB will develop and test an environmental strategy to a) reduce alcohol sales to underage and intoxicated customers and b) curtail “predatory” marketing practices in college environments. The Responsible Retailing programs are designed to change the drinking context or environment by changing the behavior of those selling and serving alcohol. This prevention strategy is an excellent example of environmental prevention, which seeks to change at-risk individual drinking behavior by changing the environment in which drinking takes place. Development of the Program: This is a pilot project being coordinated by the PLCB in cooperation with the Center for College Health and Safety and the communities of Gettysburg and Selinsgrove and Gettysburg College and Susquehanna University. Responsible Retailing programs have as their foundation a commitment to prevent alcohol sales to minors and obviously intoxicated persons, as stipulated in state laws. The Campus Community Responsible Retailing Forum will increase leaders’ knowledge of state and local policy issues; improve their skills in community organizing and communication with retailers; and provide an opportunity for coalitions to identify and develop action plans to address urgent alcohol retailing issues in their respective communities and states. In turn, we expect that successful efforts to limit alcohol availability, restrict/limit predatory marketing and promotion of alcohol, and enforce laws related to the responsible sales and service of alcohol will not only lead to reductions in


the consequences of high-risk alcohol use to college students but will improve the wellbeing of all community residents. Why it was developed: This project draws upon and adapts the innovations of a new systems model of responsible retailing detailed in the document prepared for Center for Substance Abuse Prevention (CSAP), Report on Best Practices for Responsible Retailing. The innovations of that CSAP Report are: 1) identification of constituents parts of a comprehensive RR program, 2) emphasis upon continuing systems to monitor store conduct, and 3) a pro-active role for public sector stakeholders not only to enforce laws but also to assist retailers in identifying and implementing effective practices to prevent underage sales of alcohol and other age-restricted, such as cigarettes. This model is currently being studied by the RR Forum in the Responsible Retailing Systems Project— a community-based intervention in which the state regulatory / enforcement agency, in cooperation with the state retailer association, is engaging retailers in 4 study communities (Birmingham, AL; Des Moines, IA; Springfield, MO; Santa Fe, NM) to employ a Planning Tool for Retailers (a quality improvement tool derived from the CSAP Report) and management information systems to improve age verification / sales refusal skills. The PLCB project would adapt the RR Systems model to the unique requirements and challenges of college environments. The services are as follows: Assessment and Evaluation Planning Center staff will develop a framework for RR assessment. Center staff will consult with PLCB staff to design and implement a plan to assess the status of RR efforts at the campus-community level. The Campus Community Responsible Retailing Forum The first component of this project will be to conduct two Campus-Community RR Forums. Modeled after the national RR Forum, the CCRR Forums would bring together diverse public and private stakeholders in preventing sales to underage and intoxicated customers, and reducing alcohol abuse, in college communities. The first forum will be as a kick-off event for the project and the second forum will serve as a wrap-up for the project highlighting evaluation and program outcomes. The PLCB, local law enforcement, retailers, distributors / producers, public health agents, advocates and college and community officials will be targeted as participants. The purpose of these sessions will be to identify and promote best practices to prevent underage sales of alcohol, including implementation models, and to examine responsible retailing practices and policies from the perspective of the above named diverse stakeholders. Program staff will then present plans for a pre-defined RR intervention or allow participants to define a subsequent intervention to implement during the project timeline. Intervention Implementation


Following the CCRRF, project staff will work with off-premise licensees to replicate the RR Systems project: use of the Planning Tool for (PA) Retailers to identify current practices for age verification / sales refusal and mystery shopper inspections (using ofage inspectors only) to provide feedback to licensees on clerk/server conduct. Project staff will also engage on-premise licensees in practices for age verification / sales refusal and mystery shopper inspections and also in a pilot project to reduce marketing practices that may encourage underage alcohol use and/or over-consumption. The mystery shopper inspections will be conducted by PLCB staff. Program staff and consultants will work with the PLCB to establish a set of guidelines for conducting the inspections. In an effort to get the support of the local retailers, the mystery shoppers will be of-age inspectors only and no legal sanctions will be imposed on those licensees who fail to pass the inspection. Staff will also work with the local campus-community members to build their capacity and understanding of responsible retailing, strategic planning, and the implementation of environmental strategies. Project Evaluation & Reporting Staff will evaluate the interventions by conducting qualitative data collection / analysis (rates of age verification, changes in store practice) and quantitative data collection / analysis (changes in knowledge / self-efficacy for servers/sellers; changes in relationships between public and private stakeholders). Upon review of evaluations of the project it is anticipated that Responsible Retailing will become an eligible activity for the PLCB Grant Program in coming Grant cycles. L.C.Bee and Lesson Plans Audience: Elementary students in Kindergarten through Grade 3, Teachers. Definition of the Problem: Appropriate age level information and materials for elementary students in Grades K – 3. Definition of Response: Utilizing highly visible materials and life size mascot to associate with the PLCB, L.C. Bee was created to visit and assist elementary teachers. Development of the Program: One of the first areas of prevention work that the Alcohol Education Bureau began to work on was prevention information and activities for elementary school students. Most students in grades Kindergarten through Grade 3 have a fascination with “characters” be they puppets or other individuals. To develop a relationship with students in this age group and to give the PLCB a recognized “face” L.C. Bee was created. Why it was developed: The PLCB’s mascot L.C. Bee visits schools to help children say “no” to underage drinking. Coloring books, bookmarks, puppets, and other materials featuring L.C. Bee reinforce the no-use message and other appropriate messages for children in grades Kindergarten to Grade Three. Because L.C. Bee cannot personally visit every school, a video and lesson plan is available to supplement a school’s existing alcohol education curriculum.


Alcohol Awareness Poster Contest Audience: Students in grades Kindergarten through Grade 12. Definition of the Problem: Appropriate slogans and visual art for peer influenced prevention information. Definition of the Response: This contest challenges students in grade Kindergarten to Grade Twelve to create a poster about the facts and consequences of underage drinking. The winning entries and students are honored in Harrisburg and their designs are reproduced by the PLCB throughout the year and disseminated to schools and the public. In 2006 the PLCB received 1,643 poster submissions for this contest. Development of the Program: Program was created by the PLCB Alcohol Education Bureau and has been in existence for over ten years. Why it was developed: Peer to peer influence regarding prevention education and information is a critical component to reducing high risk and underage drinking. Work by Hawkins and Catalano support this notion. Alcohol Education Website Audience: General Public and specialized groups (licensees, college, etc.) Definition of Problem: The timely and most cost effective way to distribute information and other resources to Pennsylvania residents. Definition of the Response: The Bureau of Alcohol Education’s website ( is dedicated solely to providing facts, statistics, local resources, laws, games, and materials to educate and prevent underage drinking. The web site also hosts the grant applications and notices about trainings and conferences sponsored by or supported by the PLCB. In 2006 the Alcohol Education Web site average over 6,700 “hits” per day with March, April and November the peak months. Development of the Program: With the advent of the Internet, the PLCB began to utilize this efficient and cost reducing way to distribute information and other data to Pennsylvania residents. Why it was developed: With the advent of the Internet and continual ease of use and availability to all Pennsylvania residents, the PLCB established the website. Prevention Materials Audience: All Pennsylvania residents (and to a limited degree – anyone worldwide) Definition of the Problem: PLCB needed an efficient and effective way to distribute information and other items to individuals requesting same. Definition of the Response: The PLCB has developed and disseminates alcohol education materials. Over 170 different items (including brochures, posters, stickers, pencils, etc.) are available. Most items are printed in house. Pennsylvania residents and organizations and groups can order as many of the materials as they need at no cost to them including free shipping. The following breakout demonstrates the number of pieces of materials that have been sent out to schools, municipalities and organizations and individuals across the Commonwealth since January 2005 through December 11, 2006.


1/1/05 to 6/30/05: 1,250,381 pieces 7/1/05 to 12/30/05: 1,333,594 pieces 1/1/06 to 6/30/06: 1,148.072 pieces 7/1/06 to 12/11/06: 1,129,246 pieces Development of the Program: The PLCB has an in house graphics art and printing operation. Development of specific informational pieces was needed for the various programs that the Alcohol Education Bureau was/is involved in. Why it was developed: With an in house graphic arts and printing operation, this was the most cost effective method to acquire the necessary informational pieces required by the Alcohol Education Bureau. Contractual Relationship with Center for College Health and Safety Audience: Colleges and Universities and their host Municipalities Definition of the Problem: Provision of expert technical assistance and resources not currently available through or by the Pennsylvania Liquor Control Board for Pennsylvania Institutions of Higher Education to reduce high risk college drinking. Definition of the Response: In 1999 the PLCB entered into a contractual arrangement with the Center for College Health and Safety, a national organization, with ties to the Higher Education Center and the United States Department of Education. The Center provides the PLCB with expert personnel in areas related to environmental management prevention strategies, NIAAA strategies of prevention, campus/community coalition development, statewide initiative development, focus group informational gathering, and problem identification and resolution (regarding high risk drinking by college students) and technical assistance/resources related to these issues. Development of the Program: The relationship between the PLCB and the Center has resulted in a myriad of programs, information and developed relationships with schools, municipalities and statewide agencies and organizations in relationship to reduce high risk drinking by college students. Some of these items include:


Research on the phenomenon known as “Pre-Gaming” by college students (drinking a quantity of alcohol prior to attending an event where alcohol may or may not be served). This research has led to the PLCB and the Center being invited to present at national conferences on the topic and receiving national press coverage on this issue. Assistance with the establishment of the Pennsylvania Collegiate Alcohol Initiative, the statewide prevention project to work collectively with colleges and universities in Pennsylvania to prevent underage and high risk drinking. Pennsylvania is held up by the Center as a model of how a statewide initiative should work.



• •


Assistance in development of brochures for use by institutions of higher education. These brochures include “Changing the Culture” (brochure for faculty and staff on how they can help change the culture on campus regarding drinking) and “Your Degree Doesn’t Matter” (brochure for students indicating various professions that not only require a degree but licensing and or certification that may not be issued should the person have an alcohol related misdemeanor or felony charge). Presentations at the annual statewide conference for colleges sponsored by the PLCB. On site consultations with colleges and universities regarding their prevention programming and activities to ensure the institution is utilizing state of the art and science based prevention strategies to reduce high risk drinking. Audio Conferences for colleges and universities on various subjects such as The Biennial Review, Responsible Retailing of Alcohol, Transitioning of Students from High School to College and Pre-Gaming.

Why it was developed: While the PLCB has an experienced staff person dedicated to this project full time, the PLCB also recognizes that national experts are needed from time to time for various projects and activities related to reducing high risk drinking by college students. The relationship with the Center gives the PLCB the necessary access to such experts and the resources of the Center. The following programs are coordinated within Pennsylvania by the Pennsylvania Liquor Control Board and have either scientific proof of effectiveness or are sound environmental management strategies to reduce high risk and underage drinking or are recognized by the National Institute of Alcoholism and Alcohol Abuse (NIAAA) and the federal Center for Substance Abuse Prevention (CSAP): • • • • • • • • • • • • • Geographic Information System (GIS) mapping for alcohol use profile of municipalities Court Watch Programs SAFE Homes Project Sticker Shock, College Alcohol Risk Assessment Guide (CARA) Project Northland Start Taking Alcohol Risks Seriously (STARS) Community Mobilizing for Change on Alcohol Community Trials Intervention to Reduce High Risk Drinking Across Ages Same P.A.G.E. Cops in Shops Media Literacy Program


Same P.A.G.E. The mission of Project Same P.A.G.E. is to provide a training manual and video for law enforcement, which facilitates and promotes legally sound and thorough investigations, as well as successful prosecutions of underage drinking and related offenses in the Commonwealth of Pennsylvania. The program is meant to encourage police officers and court officials to work together in achieving more consistency in successfully prosecuting underage drinking violations. Successful prosecutions will help to educate the community and create a general deterrence to the use of alcohol by minors. The training materials provide guidelines to be utilized during underage drinking investigations. Same P.A.G.E. is not meant to infringe upon the individual discretion or experience of law enforcement personnel; however, it is developed with the intent of encouraging communication between officers and court officials to establish acceptable expectations when prosecuting these cases. If expectations of the officer and the court are on the Same PAGE, rulings will be more consistent and the community will recognize that underage drinking is being taken seriously by local law enforcement. Cops in Shops Program Cops In Shops® is an underage drinking prevention program developed by The Century Council. It is designed to deter minors from attempting to buy alcohol, and to deter adults from purchasing alcohol for minors. During a Cops In Shops "operation", local police in plain-clothes work undercover both inside and outside licensed establishments, beer distributors, and Wine and Spirits Stores. In calendar year 2005, One hundred and three (103) Cops in Shops operations were done with over four thousand (4,000) identification checks completed during these operations. Cops in Shops is a joint program between the PLCB and the Pennsylvania Department of Transportation who provides grant money for officer’s overtime to do the operations. Media Literacy Project The Media Straight Up! Critical Thinking Skills for Pennsylvania’s Youth helps middle school students become better decision makers by developing the critical thinking skills necessary for making healthy, informed choices. Working with educators, this media literacy program uses a curriculum designed to teach students how to critically evaluate the drug and alcohol information they receive from today’s media. It helps students become media smart about pro-drug messages and advertising methods glamorizing drug use and promoting unhealthy choices. use and promoting unhealthy choices. Court Watch Program The purpose of Court Watch is to enhance prosecution efforts and gather necessary data. It is recognized the importance of successfully prosecuting all alcohol-fueled cases for project credibility as well as not lose the interest of the investigating officers.


Court watch was instituted for early identification of any investigative, prosecution, or case presentation issues at the Magisterial District Judge (MDJ) summary level so that appropriate adjustments could be made. The Court Watch concept was designed to address concerns regarding dispositions of alcohol-related incidents and the criteria applied by the MDJ to find an individual: ∗ not guilty ∗ guilty ∗ allow the defendant to enroll in a community service ∗ juvenile justice program. College Alcohol Risk Assessment Guide Despite general agreement among campus officials and students alike that alcohol use contributes to a range of problems confronting colleges and universities, prevention often does not command a high priority for students, faculty, and staff. This guide is designed to help college administrators identify factors within the campus environment that contribute to alcohol-related problems. These factors are examined within the context of the public health approach, which emphasizes how the environment shapes behavior. Methods for identifying problems include scanning, analysis, response, and assessment. The publication also contains scanning and analysis exercises and selected resources. Project Sticker Shock Sticker Shock is a statewide project, which has gained national recognition as a proactive educational effort to remind and inform people who purchase alcohol that Underage Drinking and Furnishing to Minors is against the law. By placing brightly colored stickers with reminders: “It’s Not Your Call, It’s the Law” on cases of beer, your organization can educate all those who purchase quantities of alcohol that they will be held responsible for the health and safety of the youth and the future of your community. Safe Homes SAFE HOMES is a positive prevention program, developed by parents to support parents. Parents sign a pledge agreeing to supervise all gatherings of youth in their homes, to not allow any alcohol, tobacco or other drug use by youth in their home, and to know where their children are, whom they are with, and when they will be home. The SAFE HOMES network is for parents and guardians of all children through twelfth grade. Parents are encouraged to talk to each other and to unite in a clear “No Use” message to their children—there will be “No Use” of alcohol, tobacco or other drugs by youth in their homes or on their property. While signing the pledge is not a legally binding contract, it is an agreement among parents in the SAFE HOMES network. The pledge provides a clear understanding among the SAFE HOMES members and sets clear expectations for youth. Parents are encouraged to discuss this important decision with their children, to explain why it is an


important commitment, and to implement clear family rules, with appropriate and consistent consequences. Geographic Information System Visual representations of mapped incidents of underage drinking, DUI, or any other crime data can be quickly absorbed by law enforcement personnel. A picture or graph is worth more than vast reports, lists, and spreadsheet data. By integrating criminal records management data with GIS using location, crime mapping depicts activity by: 1. 2. 3. 4. 5. incident type date, day of week, time alcohol fueled alcohol source location

In combination with liquor establishments, nuisance property, and fraternity spatial designations, use of GIS to analyze patterns, determine trends, and plan enforcement of problem locations. GIS is a decision-making tool which improves organizational integration. Start Taking Alcohol Risks Seriously (STARS) for Families Is a health promotion program for preventing alcohol use among at-risk middle and junior high school youth (11 to 14 years old). The goal of STARS for Families is to have all youth postpone alcohol use until adulthood. STARS for Families matches media related, interpersonal, and environmental prevention strategies to each child’s specific stages of alcohol initiation, stages of readiness for change, and specific risk and protective factors. This innovative program has been shown to result in avoidance of, or reductions in, alcohol use among participating youth. Across Ages Is a school- and community-based drug prevention program for youth 9 to 13 years that seeks to strengthen the bonds between adults and youth and provide opportunities for positive community involvement. The unique and highly effective feature of Across Ages is the pairing of older adult mentors (age 55 and above) with young adolescents, specifically youth making the transition to middle school. The program employs mentoring, community service, social competence training, and family activities to build youths' sense of personal responsibility for self and community. Specifically, the program aims to: • Increase knowledge of health and substance abuse and foster healthy attitudes, intentions, and behavior toward drug use among targeted youth • Improve school bonding, academic performance, school attendance, and behavior and attitudes toward school


Strengthen relationships with adults and peers Enhance problem-solving and decision-making skills The overall goal of the program is to increase the protective factors for high-risk students in order to prevent, reduce, or delay the use of alcohol, tobacco and other drugs and the problems associated with such use Communities Mobilizing for Change on Alcohol (CMCA) A community-organizing program designed to reduce adolescent (13 to 20 years old) access to alcohol by changing community policies and practices. Initiated in1991, CMCA has proven that effectively limiting the access to alcohol to people under the legal drinking age not only directly reduces teen drinking, but also communicates a clear message to the community that underage drinking is inappropriate and unacceptable. CMCA employs a range of social organizing techniques to address legal, institutional, and social and health issues in order to reduce youth alcohol use by eliminating illegal alcohol sales to youth by retailers and obstructing the provision of alcohol to youth by adults. Community Trials to Reduce High Risk Drinking (RHRD) is a multicomponent, community-based program developed to alter alcohol use patterns of people of all ages (e.g.) drinking and driving, underage drinking, acute (binge) drinking), and related problems. The program uses a set of environmental interventions including:
• • • • •

• •

Community awareness Responsible Beverage Service (RBS) Preventing underage alcohol access Enforcement Community mobilization

The program’s aim is to help communities reduce various types of alcohol-related accidents, violence and resulting injuries. Project Northland A multilevel, multiyear program proven to delay the age at which young people begin drinking, reduce alcohol use among those who have already tried drinking, and limit the number of alcohol-related problems of young drinkers. Designed for sixth, seventh, and eighth grade students (10 to 14 years old), Project Northland addresses both individual behavioral change and environmental change. Project Northland also strives to change how parents communicate with their children, how peers influence each other, and how communities respond to young adolescent alcohol use. Components include:
• • •

Parent involvement and education programs Behavioral curricula Peer participation



Community activities

Each intervention year has an overall theme and is tailored to the developmental level of the young adolescent. Alcohol is the focus of the Project Northland program because it is American teenagers' drug of choice and inflicts the greatest harm among youth.


Pennsylvania State Police Bureau of Liquor Control Enforcement The Bureau of Liquor Control Enforcement’s mission is to maintain or improve the quality of life for the citizens of the Commonwealth through education and ensuring compliance with the provisions of the Liquor Code, Title 40 and related statutes. The Bureau’s purpose is to enforce the Commonwealth’s Liquor Laws. To effectively achieve State Police goals and objectives, the Bureau must assist individual licensees, as well as the general community, in understanding the laws and regulations governing the proper and lawful operation of a licensed liquor establishment. In 2005 the Bureau investigated 15, 502 complaints, issuing 2,919 violation letters and arrested 1,820 minors for alcohol violations. From January 2006 thru September 2006 the Bureau has investigated 12,099 complaints and issued 2,324 violation letters and arrested 1,822 minors. The Bureau offers a number of programs to reduce and eliminate underage drinking. The programs include: Hotline number The hotline was established by the Pennsylvania State Police, Bureau of Liquor Control Enforcement as part of former Governor Ridge’s partnership with parents, students, community leaders, law enforcement officers and university officials to combat underage and high risk drinking across Pennsylvania. The information obtained from this line (1888-UNDER 21 [1-888-863-3721]) is directed to the Pennsylvania State Police Consolidated Dispatch Center (CDC) in Harrisburg and forwarded to the appropriate agency. Callers, who can be anonymous, are encouraged to provide tips about planned events involving underage drinkers or about parties already underway. The Pennsylvania State Police refer calls that require immediate attention directly to the proper agency for whatever action that agency deems appropriate. In 2005 the hotline received 248 calls about drinking parties and 39 calls regarding minors being served alcohol. Minor Patrols An assignment of more than one Enforcement Officer within a District Enforcement Office to randomly inspect licensed establishments for the illegal sales of alcoholic beverages to minors. Age Compliance Program The Pennsylvania State Police have been granted authority, under ACT 141, to work with Underage Buyer volunteers between the ages of 18 and 20 to purchase alcoholic beverages in a controlled environment. This program was developed over a two year period and was implemented in Pennsylvania starting in January 2005. Underage Buyers, interns from the various colleges/universities throughout Pennsylvania, work in


conjunction with Liquor Enforcement Officers to enter liquor-licensed establishments and attempt to purchase alcoholic beverages. If the establishment serves the Underage Buyer, a Liquor Enforcement Officer immediately notifies them about the Age Compliance check and administrative action is taken. In the 2006 year thru September 30, eight hundred fifty seven (857) compliance checks have been conducted and 494 licensees were found in compliance while 363 were found not in compliance with the age statute. Choices Program Choices is a culturally diverse alcohol awareness program, presented by the Pennsylvania State Police, Bureau of Liquor Control Enforcement, which addresses the consequences of underage drinking. This program acknowledges that alcohol and other drugs are part of school life for many students and encourages them to educate themselves regarding the effects of alcohol and other substances on their mental, physical and emotional well being. The program goals are to encourage students to make intelligent decisions and to consider a wide range of healthy alternatives. The program is presented to students at the middle and high school level, college and university level, throughout the Commonwealth’s seven Catholic Dioceses, at health fairs and during Camp Cadet weeks. Instructors are Pennsylvania State Police Liquor Enforcement Officers who discuss the law, penalties, peer pressure and the consequences of choosing to engage in underage drinking. Additionally, the Officers are well versed in alcoholic beverage consumption trends and issues related to educating youth. The Choices Program at the college level provides a valuable opportunity for the Bureau to participate in campus community alliances. The program not only tries to motivate the college age students to make good choices, but it also provides an opportunity for Bureau representatives to explain the laws and consequences in the event incorrect choices are made. From the year 2001 thru 2005 over 1900 programs in Choices were held reaching over 94,000 students. In 2006 thru September 215 presentations were made reaching over 9,000 students.


Pennsylvania Commission on Crime and Delinquency The Pennsylvania Commission on Crime and Delinquency (PCCD) promotes a collaborative approach to enhance the quality of justice through guidance, leadership and resources by empowering citizens and communities and influencing state policy. PCCD strives to be a state and national leader by providing innovative services and programs that promote justice for all citizens and communities of Pennsylvania. PCCD was statutorily created as an administrative commission within the Governor’s Executive Offices with a complement of 122 full time staff. The Commission serves as catalyst for the prevention and reduction of crime and delinquency within the Commonwealth. The Commission supports local efforts to improve the apprehension and prosecution of crimes and promotes the use of technology to enhance operational effectiveness in local criminal justice agencies. PCCD fosters community-based initiatives in the areas of crime prevention, drug abuse resistance education and juvenile delinquency prevention. PCCD utilizes federal and state monies to assist units of government and private organizations to prevent and reduce crime; enhance the quality of justice for all Pennsylvanians; and help alleviate financial burdens resulting from the commission of a crime. PCCD uses fourteen (14) funding authorizations and eight state funding authorizations.


Pennsylvania Department of Health Bureau of Drug and Alcohol Programs
Structure: In 1972, the General Assembly established a health, education, and rehabilitation program for the prevention and treatment of drug and alcohol abuse through the enactment of the Pennsylvania Drug and Alcohol Abuse Control Act, Act 1972-63, as amended, 71 P.S. §1690.101 et seq. This law established the Governor's Council on Drug and Alcohol Abuse, which was to be chaired by the Governor. The Council was subsequently reorganized through Reorganization Plan 1981-4, which transferred its responsibilities and its administrative authorities to the Department of Health (Department). The Council was designated as the advisory body to the Department on issues surrounding drug and alcohol programs. Act 1985-119 amended Act 1972-63, changing the name of the Council to the Pennsylvania Advisory Council on Drug and Alcohol Abuse and designated the Secretary of Health, or his designee, as the chairperson. . The Pennsylvania Drug and Alcohol Abuse Control Act requires the Department to develop a State Plan for the control, prevention, intervention, treatment, rehabilitation, research, education, and training aspects of drug and alcohol abuse and dependence problems. Since the Council's inception, the provision of publicly funded drug and alcohol treatment and prevention services has had a strong community orientation through a system of Single County Authorities (SCAs). Some of the Commonwealth's 67 counties have opted to share administrative costs by creating multicounty administrative units, referred to as joinders, resulting in the established SCAs, which currently number 49 As it is important to understand and address risk factors at the local level, the Bureau of Drug and Alcohol Program’s (BDAP’s) defines the parameters for a statewide system of SCAs that have the responsibility of assisting BDAP in planning for community based drug and alcohol services, to include assessing needs, managing and allocating resources, and evaluating the effectiveness of prevention, intervention, treatment, and case management services. BDAP oversees the network of SCAs and performs central planning, management, and monitoring duties, while the SCAs provide planning and administrative oversight for the provision of drug and alcohol services at the local level. Most SCAs contract with providers for treatment, prevention, intervention, and case management services, although some SCAs provide these services directly and are commonly referred to as "functional units". Planning and Delivery of Services by the SCAs It is the intent of BDAP to further the advancement and implementation of substance abuse prevention policies and practices throughout the Commonwealth based on proven methodologies. These methods are based on the latest research within the substance abuse field. This work is carried out in conjunction with SCAs and their contracted


prevention providers and allows SCAs the flexibility to tailor service delivery based on identified needs and risk factors. Accomplishing strategic goals and objectives and the attainment of measurable outcomes is done in collaboration with local and state partners. BDAP mandates that the SCAs use the Strategic Prevention Framework (SPF) to advance community-based programs, policies and practices for substance abuse prevention and mental health promotion, and align them with the U.S. Department of Health and Human Services Healthier US initiative. The idea is to use public health research findings and apply this knowledge, along with evidence-based prevention programs that promote mental health and prevent substance abuse, to create healthier communities. The Framework uses a five-step process know to promote youth development, reduce risktaking behaviors, build on assets, and prevent problem behaviors across the lifespan. The five-steps are: (1) profile needs and response capacity; (2) mobilize and build needed capacity; (3) develop a comprehensive strategic plan; (4) implement evidence-based prevention programs, policies and strategies; and (5) evaluate program effectiveness, sustaining what has worked well. Underage Drinking Services Delivered across the Commonwealth of Pennsylvania SCAs plan and deliver services by considering and addressing underage drinking risk and protective factors, youth attitudes towards use, youth perceived risk attitudes concerning consumption, and by tracking social indicator data. Following is a list [by type] of services delivered, by SCAs and SCAs service providers in Pennsylvania during the state fiscal year 2005-2006 that addressed underage drinking Type of Services Delivered Number of Services Delivered 214,836 6,056 18,350 22,604 1,053 193,222 97,428 844 1,168 75,485 1,244 22 9,888 30,310 1,660,466 17,803 24,274

ATOD Free Activities Community and Volunteer Training Services Community Drop-In Center Activities Community Services Employee Assistance Programs (One-time basis Health Fairs Health Promotion Individual Case Monitoring Individual Therapy Session Multi-Agency Coordination and Collaboration Preventing Underage Alcoholic Beverage Sales-Education Preventing Underage Sale of Tobacco & Tobacco Products - Tobacco Vendor Education Recognition Activities SAP Parent/Teacher Meeting Speaking Engagements Training Services Youth/Adult Leadership Functions (One-time basis)


Following is a list [by program name] of services delivered, by SCAs and SCAs service providers in Pennsylvania during the state fiscal year 2005-2006 that addressed underage drinking Name of Program Number of Services Provided 11 10 7 1 586 4,414 56 66 40,372 3,894 1,190 7,905 1,330 3,257 7,598 375 5,581 4,004 208 46 645 294 496 444 16

Start Taking Alcohol Risks Seriously (STARS) for Families Class Action Communities Mobilizing for Change on Alcohol (CMCA) Brief Alcohol Screening and Intervention for College Students Project Northland Too Good For Drugs (TGFD) Woodrock Youth Development Program Girl Power ATOD Education Program ATOD Intervention Program ATOD Abuse Support Program ATOD Information Dissemination Program Leadership/Mentoring Program Parenting Programs After School Program ATOD In-Service Training ATOD Alternative Activity Programs ATOD Community Prevention Partnerships Program DUI Education/Intervention Program Employee Assistance Programs ATOD Prevention Training Program ATOD Prevention Program Marketing and/or Development Underage Drinking Program AOD Environmental Prevention Program ATOD Community Events Program State Level Coordination of Services

While SCAs and SCA providers provide services at the local level, BDAP also provides state level coordination of services to address underage drinking. In 2006, BDAP served as the state coordinator of the National Town Hall Meetings project, part of a National project to curb underage drinking. This campaign was sponsored by the Federal Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD) composed of multiple Federal agencies. Thirty-eight (38) Town Hall Meetings were conducted in Pennsylvania. The Town Hall Meetings were intended to increase the understanding of underage drinking and its consequences, and to encourage individuals, families, and communities to address the problem. While the format and style of each meeting reflected that of the individual community, each town hall meeting adopted the same theme: “Start Talking before They Start Drinking”. Each meeting brought together public officials, parents and youth with community leaders and organizations in health, 54

education, law enforcement, highway safety, and alcohol control to learn more about the science and consequences of underage drinking, and to discuss how their community can best prevent underage alcohol use by reducing demand, availability and access. Each meeting offered parents and other concerned adults the knowledge and tools to connect with today’s youth about underage drinking. Two additional components to this campaign were “Reach Out Now Teach-Ins” which took place across the Nation in fifth and sixth grade classrooms in April of 2006 and public service campaigns to prevent and reduce underage drinking. The U.S. Department of Health and Human Services and the Ad Council developed a campaign aimed at parents of children ages 11 to 15 and features the slogan, “Start Talking Before They Start Drinking.” These PSAs reinforced the fact that children who drink before the age of 15 are more likely to develop alcohol problems. The campaign comprised of television, radio, magazine, newspaper, and Internet ads, which were distributed to more than 28,000 media outlets in November 2005 and aired in advertising time and space donated by the media until the fall of 2006. Recently, the Pennsylvania Department of Health partnered with the 2006 Super Bowl champions, the Pittsburgh Steelers, to conduct a 2006-2007 campaign designed to influence teens and parents about the dangers of being a passenger of an underage drunk driver. Members of the Steelers reinforced the messages conveyed on stadium signage, television, radio, print and internet which displayed the slogan, “Be defensive; STOP… Don’t ride with a friend that has been drinking.” Currently, BDAP is working in partnership with Drug Free Pennsylvania (DFPA) to develop a statewide public awareness campaign targeted at youth ages 15 to 18 that will utilize the media and other youth oriented approaches as a venue for addressing underage drinking and underage drinking and driving. Research has shown that media campaigns designed to cultivate knowledge of substance abuse have been effective in modifying youths’ perceptions and beliefs relating to this issue. BDAP is presently working with a public relations agency to develop a combination of qualitative and quantitative techniques through focus groups and intercept interviews that will be used to gather information from youth for the development of hard-hitting messages about teen drinking and teen drinking and driving. The purpose of the studies is to gather teenagers’ opinions and attitudes regarding alcohol use and to gain an understanding of what media campaign strategies would be the most effective in reaching Pennsylvania’s youth. DFPA and BDAP will utilize these focused findings to deliver the most effective public awareness campaign possible.


Pennsylvania Department of Transportation Cops in Shops Program Cops In Shops® is an underage drinking prevention program developed by The Century Council. It is designed to deter minors from attempting to buy alcohol, and to deter adults from purchasing alcohol for minors. During a Cops In Shops "operation", local police in plain-clothes work undercover both inside and outside licensed establishments, beer distributors, and Wine and Spirits Stores. In calendar year 2005, One hundred and three (103) Cops in Shops operations were done with over four thousand (4,000) identification checks completed during these operations. Cops in Shops is a joint program between the PLCB and the Pennsylvania Department of Transportation who provides grant money for officer’s overtime to do the operations. PennDOT also provides statistical information and data as requested by agencies such as the PLCB and the Bureau of Liquor Control Enforcement for grant proposals and reports. Relevant data is included in the appendices of this report.


Pennsylvania Department of Education In school year 2005-06 approximately 12.8 million dollars in federal funds from Title VI (Safe and Drug Free Schools and Communities Act) were available to schools for prevention and intervention services related to alcohol, tobacco and other drugs and violence issues. Many schools have S.A.D.D. groups (Students Against Drunk Driving or Students Against Destructive Decisions) utilizing peer influence to prevent alcohol usage by underage individuals. Schools also have curriculum related to health issues surrounding alcohol use by students and family members. One of the most important components of prevention/intervention that schools utilize is the Student Assistance Program. The Pennsylvania Department of Education has a long history with this successful program. The following report gives the history of this program in Pennsylvania. EARLY PROGRAM DEVELOPMENT: In 1984, the Pennsylvania Department of Health’s Office of Drug and Alcohol Programs provided a grant to pilot Student Assistance Programs throughout the Commonwealth under the auspices of the Pennsylvania Department of Education. The first SAP training sponsored by the Commonwealth of Pennsylvania was held in December 1984. Districts were required to send core teams to the training consisting of one central office representative, one building administrator, three other team members (teachers, counselors, nurses, etc.), and one county drug and alcohol liaison. At the conclusion of the training, the core teams returned to their districts and began implementing SAP in their schools. In 1985, the Statewide Student Assistance Program Advisory Committee was established to provide Department of Education staff with input on maintaining quality programming and efficient use of funding. The committee was restructured in 2003 and reconvened as the SAP Advisory Council. Consisting of twenty-six members, the Advisory Council represents schools, educational associations, districts, parents, agencies, and state departments. The Advisory Council’s mission is to assist the Commonwealth in linking and promoting quality mental health and substance abuse services within the school and community to promote student achievement. This is accomplished by providing leadership in an advisory capacity and promoting accountability of the student assistance program as well as serving as a work group to assist in program growth, expansion, and refinement. During the 1985-86 school year, the Pennsylvania Masonic Foundation for the Prevention of Drug and Alcohol Abuse Among Children (now the Pennsylvania Masonic Foundation for Children) approached the Department of Education with an interest in becoming involved in the Student Assistance Program.


Since that time, the Foundation has underwritten elementary and secondary SAP trainings, the Commonwealth SAP Training System, and supported local SAP efforts across the Commonwealth. In 1993, the PA Masonic Foundation for Children established the Carl W. Stenberg, Jr. SAP Post-Secondary Scholarship for students who have successfully completed the SAP process. To date, over forty students have received scholarships. In 1986-87 in response to the increasing adolescent suicide rate, the PA Department of Public Welfare, Office of Mental Health and Substance Abuse Services (OMHSAS), provided for the expansion of the SAP to include intervention strategies for students at risk of suicide. In 1988, the PA Departments of Education, Public Welfare, and Health formed the Commonwealth SAP Interagency Committee for the purpose of collaborating to seek funding, improving Student Assistance training, and meeting the programming needs in Pennsylvania. As core teams became increasingly functional, the publicly funded county drug and alcohol and mental health agencies which received SAP referred students for assessment found themselves financially strained as a result of the increased caseload. In addition, county agencies had been sending representatives to SAP training to develop relationships with the teams and provide the linkages for referring students to the various agencies. This procedure assisted in facilitating the relationship between the agencies and the schools, but at the same time it created a large number of referrals for agencies that were not equipped to deal with the influx of new clients. In response to this demand, the Pennsylvania Departments of Health and Public Welfare initiated a funding process in 1986-87 to assist those counties in which core teams were functioning. The amount allocated to each county was based on the number of teams and the number of students being served. By 1990-91, the funding was expanded to all counties. In order to provide consistent and quality training to all SAP team members, the Commonwealth SAP Interagency Committee established a system of Commonwealth Approved Training Providers in 1986. At that time, applications were accepted for agencies to become Commonwealth Approved SAP Training Providers. Standards for SAP Training were issued in May 1987. The training system expanded in 1996 and again in 1999 and several new training providers were approved. The training system was again reopened in 2004. DATA COLLECTION AND REPORTING In 1986, the Department of Education began collecting information on an annual basis from public and nonpublic schools regarding the students who received services through the Student Assistance Program. The process included data collection, scanning and compilation of all forms received from SAP teams. This process was accomplished at the Department of Education until 1998. At that time, the Commonwealth Student Assistance Program Online Reporting System was developed allowing SAP teams to report their


annual data electronically. The system was modified for the 2002-2003 school year to allow elementary teams to report their data. ACT 211 OF 1990 In 1990, Act 211 was enacted which required “…the Secretary of Education, shall recommend to the General Assembly a plan to require and assist each school district to establish and maintain a program to provide appropriate counseling and support services to students who experience problems related to the use of drugs, alcohol, and dangerous controlled substances.” On April 19, 1991, the Secretary of Education named the Commonwealth Student Assistance Program (K-12) to fulfill the requirement to “…identify high risk students who are having problems due to alcohol or drug use, depression, or other mental health problems; and intervene and refer these students to appropriate community services.” AMERICAN MEDICAL ASSOCIATION AWARD In 1990, the Commonwealth Student Assistance Program received the American Medical Association (AMA) National Congress on Adolescent Health’s Aware for Excellence in Intervention for Coordination of Adolescent Health Services within a State. JUVENILE PROBATION PARTNERSHIP Due to an increase in the number of dropouts, behavioral issues and drug use and abuse among its students, Allentown School District’s Student Assistance Program realized that it needed to coordinate its services and programs outside the school district. The SAP team realized that some of the SAP referred students were on probation and that both the school district and probation office were trying to accomplish the same goals for the same students in isolation. In 1990, the Lehigh County Juvenile Probation Department obtained a grant through the Pennsylvania Juvenile Court Judges’ Commission (JCJC) to initiate a school-based probation service program. One of the grant requirements was that the school-based probation officers must receive SAP training and participate as a member of the SAP team. Since 1992, the Pennsylvania Commission on Crime and Delinquency’s School-Based Probation Program has provided funding to fifty counties to implement, expand, or continue their projects. IMPLEMENTATION OF SAP COUNTY COORDINATION TEAMS In 1991, the Commonwealth SAP Interagency Committee also issued guidelines for the coordination of SAP services through local SAP county coordination teams. These teams brought together community service agencies and local schools to address issues that effected students in their county. The mission of the SAP County Coordination teams is to promote


quality services to all school districts and communities. Local county coordination teams are responsible for providing leadership, planning, management and implementation of SAP services at the county or county joinder level. In December 2000, the Commonwealth SAP Interagency Committee issued an updated version of the Guidelines based on local feedback for Coordination Teams to consider as they continue to develop and strengthen their mechanisms for coordinating SAP. SAP BASIC EDUCATION CIRCULAR In 1997, a Basic Education Circular (BEC) was issued by the Department of Education to address Act 211 of 1990 (P.S. §15-1547 of the PA School Code). The BEC clarifies the mandates for instruction for every student in alcohol, tobacco, and other drugs prevention K- 12 every year; in-service for all instructors whose teaching responsibilities include courses on tobacco, alcohol and other drug prevention; and drug and alcohol counseling and support services (SAP).” PARENT INVOLVEMENT TRAINING In order to enhance the core team’s role in providing support to students and families, Commonwealth-Approved Parent Involvement Training was developed in 1998. The Department of Education made Safe and Drug-Free Schools and Communities funds available through intermediate units to offer the training to their local SAP teams. Intermediate units contracted with Commonwealth Approved SAP Training Providers to deliver the trainings locally throughout the Commonwealth. EVALUATION OF SAP In 1998, the Pennsylvania Commission on Crime and Delinquency, through the Governors portion of the Safe and Drug-Free Schools and Communities state grant, funded an initiative to evaluate Student Assistance Programs (SAP) in Pennsylvania. This evaluation investigated six areas of student assistance programs and developed a framework to guide future evaluations. The six areas were: 1. SAP referral processes 2. Parent consent practices 3. Intervention services 4. Contract provider assessments 5 School-based probation officers’ SAP involvement 6. SAP improvement and satisfaction In September 2000, the evaluators issued the “Pennsylvania SAP Components and Indicators Handbook” highlighting the results of the SAP Evaluation


Project. Nine essential components for an effective student assistance program are defined in the handbook: 1. Policy and Procedures 2. Communications 3. Referral Mechanisms 4. Parent Participation 5. Team Planning 6. Intervention and Recommendations 7. Follow-Up and Support 8. Training 9. Outcome Indicators and Evaluation RISK AND PROTECTIVE FACTORS’ TRAINING In 2000-2001, the Department of Education made Safe and Drug-Free Schools and Communities funds available through intermediate units to offer Risk and Protective Factors’ (resiliency) Training to their local SAP teams. Intermediate units contracted with Commonwealth Approved SAP Training Providers to deliver the trainings locally and focused on incorporating risk and protective factors into the Pennsylvania Student Assistance Program model. History of Elementary Student Assistance Programs in Pennsylvania In 1988, after implementing secondary SAP for four years, the Pennsylvania Department of Education provided a pilot training for the Elementary Student Assistance Program (ESAP). Five school districts that had developed secondary Student Assistance Programs were selected as pilot districts. The first elementary SAP training sponsored by the Commonwealth was held in October and December 1988. Initial evaluative data (Monteith and Manning, 1990) suggested that the ESAP concept was worthy of expanding throughout the state. Data consisted of anecdotal information from school staff and year-end statistics on the number of students that received services through ESAP. Concurrently, the Department of Education’s Bureau of Special Education was working on a project that identified students that needed additional services but were not appropriate for Special Education. This program was called the Instructional Support Team (IST) Program. Because both ESAP and IST identified many of the same students in need of additional services and the identification process using a core team model was identical, the Commonwealth determined that these two initiatives would be combined and implemented as one program. Therefore, in 1990, the Department of Education instituted the Instructional Support Team (IST) process with Elementary SAP becoming one of the five components of the program. The core team model consisted of the school administrator, guidance counselor, Instructional Support Team teacher, the classroom teacher, and the student’s parent(s). All school districts were


required to implement the IST process by 1995. Department of Education staff conducted trainings in the five components of IST: collaborative consultation, curriculum-based assessment, instructional adaptation, behavior management, and elementary student assistance. The IST process consisted of assessment, goal setting, strategy selection, implementation and evaluation. Assessment of the referred child’s observable behaviors, academic performance, and life skills would be made. Since the parent(s) took an active role as part of the team, they could also help the team understand any stressors that might be affecting the child. In 1999, the Department of Education offered grants to intermediate units to work with a secondary SAP training provider to incorporate the secondary SAP Training Standards and Competencies into their elementary training models. Twenty-three intermediate units participated in the pilots. In 2003, the Commonwealth SAP Interagency Committee formed the Elementary SAP Task Force. The directive from the SAP Interagency Committee to the Task Force was to develop an Elementary Student Assistance Program that would produce a seamless K-12 model for the Commonwealth. The Task Force identified the following goals: • review the documentation from the 1999 pilots • revise the SAP Basic Education Circular to reflect SAP K-12 • develop an elementary model/process • develop a program evaluation • identify the training system and address training issues • develop a system for providing technical assistance to teams and training providers • explore funding issues In Spring 2004, the Task Force administered an Elementary SAP needs assessment to identify the behavioral health needs and barriers that exist at the elementary school level.


Current Science
National Institute on Alcoholism and Alcohol Abuse College Drinking Prevention Report 3-In-1 Framework The research strongly supports the use of comprehensive, integrated programs with multiple complementary components that target: (1) individuals, including at-risk or alcohol-dependent drinkers, (2) the student population as a whole, and (3) the college and the surrounding community (Hingson and Howland, 2002; DeJong et al., 1998; Institute of Medicine, 1989). The 3-in-1 Framework presented in the final report, A Call to Action: Changing the Culture of Drinking at U.S. Colleges focuses simultaneously on each of the three primary audiences. The Task Force members agreed that the 3-in-1 Framework is a useful introduction to encourage presidents, administrators, college prevention specialists, students, and community members to think in a broad and comprehensive fashion about college drinking. It is designed to encourage consideration simultaneously of multiple audiences on and off campus. The Task Force offers the 3-in-1 Framework as a starting point to develop effective and science-based prevention efforts. The brief descriptions that follow provide the rationale for emphasizing these three targets in prevention programs aimed at high-risk student drinking and identify alternative prevention strategies that address each group. (1) Individuals, Including At-Risk or Alcohol-Dependent Drinkers: The risk for alcohol problems exists along a continuum. Targeting only those with identified problems miss’s students who drink heavily or misuse alcohol occasionally (e.g., drinks and drives from time to time). In fact, nondependent, high-risk drinkers account for the majority of alcohol-related problems (Lemmens, 1995; Kreitman, 1986). It is crucial to support strategies that assist individual students identified as problem, atrisk, or alcohol-dependent drinkers. Strategies are clearly needed to engage these students as early as possible in appropriate screening and intervention services—whether provided on campus or through referral to specialized community-based services. One important effort to increase on-campus screening is National Alcohol Screening Day, an event that takes place in April each year. This program, supported by NIAAA and the Substance Abuse and Mental Health Services Administration, provides free, anonymous testing and health information at a growing number of colleges and universities. (2) Student Body as a Whole: The key to affecting the behavior of the general student population is to address the factors that encourage high-risk drinking (DeJong and Langenbahn, 1996; DeJong and Linkenbach, 1999; DeJong and Langford, 2002; Perkins, 2002; Toomey and Wagenaar, 2002; Toomey et al., 1993).


They include the:

Widespread availability of alcoholic beverages to underage and intoxicated students; Aggressive social and commercial promotion of alcohol; Large amounts of unstructured student time; Inconsistent publicity and enforcement of laws and campus policies; and Student perceptions of heavy alcohol use as the norm.

• • • •

Specific strategies useful in addressing these problem areas tend to vary by school. Examples of some of the most promising strategies appear in the "Recommended Strategies" section. (3) College and the Surrounding Community: Mutually reinforcing interventions between the college and surrounding community can change the broader environment and help reduce alcohol abuse and alcohol-related problems over the long term. When college drinking is reframed as a community as well as a college problem, campus and community leaders are more likely to come together to address it comprehensively. The joint activities that typically result help produce policy and enforcement reforms that, in turn, affect the total drinking environment. Campus and community alliances also improve relationships overall and enable key groups such as student affairs offices, residence life directors, local police, retail alcohol outlets, and the court system to work cooperatively in resolving issues involving students (Hingson and Howland, 2002; Holder et al., 1997a, 2000; Perry and Kelder, 1992). 4 Tiers The evidence supporting the substance abuse prevention strategies in the literature varies widely. These differences do not always mean that one strategy is intrinsically better than another. They may reflect the fact that some strategies have not been as thoroughly studied as others or have not been evaluated for application to college drinkers. To provide a useful list that accounts for the lack of research as well as negative findings, Task Force members placed prevention strategies in descending tiers on the basis of the evidence available to support or refute them. Tier 1: Evidence of Effectiveness Among College Students Strong research evidence (two or more favorable studies available) supports the strategies that follow. All strategies target individual problem, at-risk, or alcohol-dependent drinkers. Their efficacy as part of a campus-wide strategy has not been tested.


Strategy: Combining cognitive-behavioral skills with norms clarification and motivational enhancement interventions. Cognitive-behavioral skills training strives to change an individual's dysfunctional beliefs and thinking about the use of alcohol through activities such as altering expectancies about alcohol's effects, documenting daily alcohol consumption, and learning to manage stress. Norms or values clarification examines students' perceptions about the acceptability of abusive drinking behavior on campus and uses data to refute beliefs about the tolerance for this behavior as well as beliefs about the number of students who drink excessively and the amounts of alcohol they consume. As its name implies, motivational enhancement is designed to stimulate students' intrinsic desire or motivation to change their behavior. Motivational enhancement strategies are based on the theory that individuals alone are responsible for changing their drinking behavior and complying with that decision (Miller et al., 1992). In motivational enhancement interventions, interviewers assess student alcohol consumption using a formal screening instrument. Results are scored and students receive nonjudgmental feedback on their personal drinking behavior in comparison with that of others and its negative consequences. Students also receive suggestions to support their decisions to change. Research indicates that combining the three strategies is effective in reducing consumption (Larimer and Cronce, 2002). One example of such an approach is a program using motivational enhancement, developed by Marlatt. The program, the Alcohol Skills Training Program (ASTP), is a cognitive-behavioral alcohol prevention program that teaches students basic principles of moderate drinking and how to cope with high-risk situations for excessive alcohol consumption (Fromme et al., 1994). The ASTP is designed for group administration and includes an alcohol expectancy challenge component. Controlled outcome studies show that the ASTP significantly reduces drinking rates and associated problems for both 1-year (Kivlahan et al., 1990) and 2-year follow-up periods (Baer et al., 1992). Strategy: Offering brief motivational enhancement interventions. Students who receive brief (usually 45-minute), personalized motivational enhancement sessions, whether delivered individually or in small groups, reduce alcohol consumption. This strategy can also reduce negative consequences such as excessive drinking, driving after drinking, and riding with an intoxicated driver, citations for traffic violations, and injuries (D'Amico and Fromme, 2000; Larimer and Cronce, 2002; Marlatt et al., 1998; Monti et al., 1999). This approach has been used successfully in medical settings (Dimeff and McNeeley, 2000; Monti et al., 1999). An effective brief intervention has been developed at the University of Washington. This brief intervention for high-risk drinkers is based on the ASTP program and is known as the BASICS program: Brief Alcohol Screening and Intervention for College Students (Dimeff et al., 1999). BASICS is administered in the form of two individual sessions in which students are provided feedback about their drinking behavior and given the opportunity to negotiate a plan for change based on the principles of motivational interviewing. High-risk drinkers who participated in the


BASICS program significantly reduced both drinking problems and alcohol consumption rates, compared to control group participants, at both the 2-year follow-up (Marlatt et al., 1998) and 4-year outcome assessment periods (Baer et al., 2001). BASICS has also been found to be clinically significant in an analysis of individual student drinking changes over time (Roberts et al., 2000). Strategy: Challenging alcohol expectancies. This strategy works by using a combination of information and experiential learning to alter students' expectations about the effects of alcohol so they understand that drinking does not necessarily produce many of the effects they anticipate such as sociability and sexual attractiveness (Darkes and Goldman, 1993, 1998; Jones et al., 1995). The research conducted to date indicates that the positive effects of this strategy last for up to 6 weeks in men, but additional research is under way to verify and extend this approach to women and for longer time periods. Tier 2: Evidence of Success With General Populations That Could Be Applied to College Environments The Task Force recommends that college presidents, campus alcohol program planners, and student and community leaders explore the strategies listed below because they have been successful with similar populations, although they have not yet been comprehensively evaluated with college students (Hingson et al., 1996b; Holder et al., 2000; Saltz and Stangetta, 1997; Voas et al., 1997; Wagenaar et al., 2000). These environmental strategies are not guaranteed to alter the behavior of every college student, but they can help change those aspects of the campus and community culture that support excessive and underage alcohol use. Strategy: Increased enforcement of minimum drinking age laws (Toomey and Wagenaar, 2002; Wagenaar and Toomey, 2002). The minimum legal drinking age (MLDA) law is the most well-studied alcohol control policy. Compared to other programs aimed at youth in general, increasing the legal age for purchase and consumption of alcohol has been the most successful effort to date in reducing underage drinking and alcohol-related problems. Most studies suggest that higher legal drinking ages reduce alcohol consumption, and over half found that a higher legal drinking age is associated with decreased rates of traffic crashes. Studies also indicate that policies are less effective if they are not consistently enforced. Moreover, the certainty of consequences is more important than severity in deterring undesirable behavior. The benefits of the MLDA have occurred with minimal enforcement, yet studies of the effects of increased enforcement show that it is highly effective in reducing alcohol sales to minors (Wagenaar and Toomey, 2002). Increased enforcement—specifically compliance checks on retail alcohol outlets—typically cuts rates of sales to minors by at least half (Grube, 1997; Lewis et al., 1996; Preusser et al., 1994; Wagenaar et al., 2000). Efforts to reduce the use of false age identification and tighter restrictions on "home delivery" of alcohol may also help enhance the effectiveness of this law.


Strategy: Implementation, increased publicity, and enforcement of other laws to reduce alcohol-impaired driving. Injury and deaths caused by alcohol-impaired driving and related injuries and deaths can be reduced by lowering legal blood alcohol limits to .08 percent for adult drivers (Dee, 2001; Hingson et al., 1996a, 2000; Shults et al., 2001; Voas et al., 2000); setting legal blood alcohol content (BAC) for drivers under age 21 at .02 percent or lower (Hingson et al., 1994; Wagenaar et al., 2001); using sobriety check points (Castle et al., 1995; Lacey et al., 1999; Shults et al., 2001); providing server training intervention (Gliksman et al., 1993; Lang et al., 1998; Russ and Geller, 1987; Saltz, 1987; Shults et al., 2001); and instituting administrative license revocation laws (Klein, 1989; Voas et al., 2000; Zador et al., 1989). Safety belt laws, particularly primary enforcement belt laws, have been shown in numerous studies to reduce traffic deaths and injuries (Dinh-Zaar et al., 2001). When California changed from a secondary to a primary enforcement belt law that permits police to stop vehicles and give a citation simply because an occupant was not belted, safety belt use rates increased 39 percent among drivers with BAC of .10 percent or higher compared to 23 percent overall (Lange and Voas, 1998). This indicates that primary enforcement belt laws can prevent many alcohol-related traffic fatalities. Comprehensive community interventions have also shown that increased enforcement and publicity of laws to reduce alcohol-impaired driving have produced significant reductions in the types of motor vehicle crashes most likely to involve alcohol (Holder et al., 2000) and alcohol-related traffic deaths (Hingson et al., 1996b). Strategy: Restrictions on alcohol retail outlet density (Scribner et al., 1995; Gruenewald et al., 1993). Studies of the number of alcohol licenses or outlets per population size have found a relationship between the density of alcohol outlets, consumption, and related problems such as violence, other crime, and health problems (Toomey and Wagenaar, 2002). One study, targeting college students specifically, found higher levels of drinking and binge drinking among underage and older college students when a larger number of businesses sold alcohol within one mile of campus (Chaloupka and Wechsler, 1996). Numbers of outlets may be restricted directly or indirectly through policies that make licenses more difficult to obtain such as increasing the cost of a license. Strategy: Increased prices and excise taxes on alcoholic beverages. A substantial body of research has shown that higher alcoholic beverage prices or taxes are associated with lower levels of alcohol consumption and alcohol-related problems (Leung and Phelps, 1993; Kenkel and Manning, 1996; Chaloupka et al., 1998; Cook and Moore, 2002). However, estimates of the extent to which consumption or problems change in response to a given price or tax change cover a fairly wide range. Some studies have examined these effects among young people separately from the general population. Most such studies have found that young people exhibit significant responses to price or tax changes, in some cases larger than responses estimated for the general population (Grossman et al., 1987; Coate and Grossman, 1988; Kenkel, 1993; Sutton and Godfrey, 1995; Ruhm, 1996; Grossman et al., 1998). An exception is the recent study by Dee (1999), which found only small and statistically insignificant effects of beer taxes on teens' drinking behavior. In addition, Chaloupka and Wechsler (1996) found that higher


beer prices tend to decrease drinking and binge drinking among U.S. college students, but that price is a relatively weak tool for influencing these behaviors among college students, especially males. In a study of the population aged 17 and older, Manning et al. (1995) found that consumption was responsive to price for all but the 5 percent of drinkers with the heaviest consumption, who exhibited no significant price response. A number of studies have examined the effects of alcohol prices or taxes on traffic crash fatalities and other alcohol-related problems. Most such studies have reported that higher taxes or prices were associated with significant reductions in traffic crash fatalities or drunk driving, particularly among younger drivers and during nighttime hours (Saffer and Grossman, 1987; Chaloupka et al., 1993; Kenkel, 1993; Ruhm, 1996). A few recent studies have questioned these findings. Dee (1999) found some evidence that beer taxes tend to reduce teen traffic fatalities, but concluded that those results were not robust and should be viewed with skepticism. Young and Likens (2000) found no significant effects of beer taxes on traffic crash fatality rates, either for young drivers or the general population. Mast et al. (1999) found mixed results, with several analyses indicating significant but relatively small effects of beer taxation on traffic fatalities. Other research has found associations between higher alcoholic beverage taxes and lower rates of some types of violent crime (Cook and Moore, 1993a), reduced incidence of physical child abuse committed by women (Markowitz and Grossman, 2000), and lower rates of sexually transmitted diseases (Chesson et al., 2000), as well as with increases in college graduation rates (Cook and Moore, 1993b). Further research is needed to clarify the effects that alcoholic beverage prices or taxes have on different drinking behaviors, health-related outcomes, and population subgroups, and to reconcile conflicting findings that have appeared in the literature. To date, however, the weight of evidence clearly suggests that higher prices and taxes can help to reduce alcohol consumption and alcohol-related problems. Strategy: Responsible beverage service policies in social and commercial settings (Saltz and Stangetta, 1997; Holder et al., 1997b). Studies suggest that bartenders, waiters, and others in the hospitality industry would welcome written policies about responsible service of alcohol and training in how to implement them appropriately. Policies could include serving alcohol in standard sizes, limiting sales of pitchers, cutting off service of alcohol to intoxicated patrons, promoting alcohol-free drinks and food, and eliminating last-call announcements. Servers and other staff could receive training in skills such as slowing alcohol service, refusing service to intoxicated patrons, checking age identification, and detecting false identification. To prevent sales to underage patrons, it is important to back identification policies with penalties for noncompliance. Strategy: The formation of a campus and community coalition involving all major stakeholders may be critical to implement these strategies effectively. A number of comprehensive community efforts have been designed to reduce alcohol and other substance use and related negative consequences among underage youth, including college students, and among adults (Chou et al., 1998; Hingson et al., 1996b; Holder et al., 1997b; Pentz et al., 1989; Perry et al., 1996; Treno and Holder, 1997; Wagenaar et al.,


2000); and their outcomes demonstrate the potential effectiveness of this approach in college communities. For example, the Community Trials Program (Grube, 1997; Holder and Treno, 1997; Holder et al., 1997a, b; Holder and Reynolds, 1997; Holder et al., 2000; Treno and Holder, 1997; Reynolds et al., 1997; Saltz and Stangletta, 1997; Voas et al., 1997), which focused on alcohol trauma in the general population, resulted in a significant decline in emergency room admissions for alcohol-related assault. Both this program and Communities Mobilizing for Change (CMCA) (Wagenaar et al., 1999, 2000), which was designed specifically to reduce drinking among young people, resulted in reduced alcohol sales to minors. In the CMCA project young people ages 18 to 20 reduced their propensity to provide alcohol to other teens and were less likely to try to buy alcohol, drink in a bar, or consume alcohol. The Massachusetts Saving Lives Program (Hingson et al., 1996b), designed to reduce drunk driving and speeding in the general population, produced relative declines in alcohol-related fatal crashes involving drivers 15 to 25 years of age. This approach reframes the issue as a community problem, not simply a college problem, brings together the range of players needed to address it, and sets the stage for cooperative action. In addition to college presidents and campus administrators, stakeholders in campus-community coalitions include student groups, faculty, staff, community leaders, law enforcement, and representatives from hospitality and alcohol beverage industries (Hingson and Howland, 2002). Research shows that promoting community ownership of programs enhances success (Holder et al., 1997a). On that basis, active campus and community coalitions can be expected to build support for addressing underage and excessive college drinking; help assure that strategies used respond to genuine community needs; maintain and, ultimately, institutionalize effective strategies; and evaluate and disseminate the results of the coalition's activities to other college communities (Hingson and Howland, 2002). Tier 3: Evidence of Logical and Theoretical Promise, But Require More Comprehensive Evaluation The Task Force recognizes that a number of popular strategies and policy suggestions make sense intuitively or have strong theoretical support. Many also raise researchable questions that may be crucial in reducing the consequences of college student drinking. Although the Task Force is eager to see these strategies implemented and evaluated, it cautions interested schools to assemble a team of experienced researchers to assist them in the process. The Task Force recommends that schools considering any of these strategies incorporate a strong evaluation component to test their viability in actual practice. Every strategy that appears below targets the student population as a whole. Strategy: Adopting campus-based policies and practices that appear to be capable of reducing high-risk alcohol use. The following activities are particularly appealing because straightforward and relatively brief evaluations should indicate whether they would be successful in reducing high-risk drinking on a particular campus.



Reinstating Friday classes and exams to reduce Thursday night partying; possibly scheduling Saturday morning classes. Implementing alcohol-free, expanded late-night student activities. Eliminating keg parties on campus where underage drinking is prevalent. Establishing alcohol-free dormitories. Employing older, salaried resident assistants or hiring adults to fulfill that role. Further controlling or eliminating alcohol at sports events and prohibiting tailgating parties that model heavy alcohol use. Refusing sponsorship gifts from the alcohol industry to avoid any perception that underage drinking is acceptable. Banning alcohol on campus, including at faculty and alumni events.

• • • • •



Strategy: Increasing enforcement at campus-based events that promote excessive drinking (DeJong and Langenbahn, 1996; Gulland, 1994). Campus police can conduct random spot checks at events and parties on campus to ensure that alcohol service is monitored and that age identification is checked. It may be important for non-students to enforce these campus policies. Resident assistants and others charged with developing close supportive relationships with students might find it difficult to enforce alcoholrelated rules and regulations consistently and uniformly. Strategy: Increasing publicity about and enforcement of underage drinking laws on campus and eliminating "mixed messages." As indicated previously, active enforcement of minimum legal age drinking laws results in declines in sales to minors (Grube, 1997; Lewis et al., 1996; Preusser et al., 1994; Wagenaar et al., 2000). Lax enforcement of State laws and local regulations on campus may send a "mixed message" to students about compliance with legally imposed drinking restrictions. Creative approaches are needed to test the feasibility of this strategy (DeJong and Langford, 2002). Strategy: Consistently enforcing disciplinary actions associated with policy violations (DeJong and Langford, 2002). Inconsistent enforcement of alcohol-related rules may suggest to students that "rules are made to be broken." To test the effectiveness of this approach would likely require staff and faculty training, frequent communication with students, and the implementation of a research component. Strategy: Conducting marketing campaigns to correct student misperceptions about alcohol use (Berkowitz, 1997; Clapp and McDonnell, 2000; DeJong and Linkenbach, 1999; Johannessen et al., 1999; Page et al., 1999; Perkins, 1997, 2002; Perkins and Wechsler, 1996). On the basis of the premise that students overestimate the amount of


drinking that occurs among their peers and then fashion their own behavior to meet this perceived norm, many schools are now actively conducting "social norming" campaigns to correct many of these misperceptions. Strategy: Provision of "safe rides" programs (DeJong, 1995). Safe rides attempt to prevent drinking and driving by providing either free or low-cost transportation such as taxis or van shuttles from popular student venues or events to residence halls and other safe destinations. Safe rides are usually restricted to students, faculty, staff, and a limited number of "guests." Safe rides sponsors often include student government, Greek Councils, student health centers, campus police, Mothers Against Drunk Driving chapters, and other local community organizations, agencies, and businesses. They have been criticized as potentially encouraging high-risk drinking, and this possibly should be considered in design, promotion, and monitoring. Strategy: Regulation of happy hours and sales (Toomey and Wagenaar, 2002). Happy hours and price promotions—such as two drinks for the price of one or women drink for free—are associated with higher consumption among both light and heavy drinkers. Research shows that as the price of alcohol goes up, consumption rates go down, especially among younger drinkers. Because many bars surrounding campuses attract students by promoting drink specials, restrictions on happy hours have the potential to reduce excessive consumption off campus. If colleges and universities have a licensed establishment on campus, drink specials could be prohibited or promotion of alcohol-free drinks and food specials could be encouraged. In nonlicensed settings on campus that serve alcohol, event planners could opt to limit the amount of free alcohol that is available and eliminate all self-service. Schools could also limit alcohol use to weekends or after regular class hours in an effort to separate drinking from activities more closely aligned with the core academic mission. Strategy: Informing new students and their parents about alcohol policies and penalties before arrival and during orientation periods. There is some anecdotal evidence that experiences during the first 6 weeks of enrollment affect subsequent success during the freshman year. Because many students begin drinking heavily during this time, they may be unable to adapt appropriately to campus life. Alerting parents and students to this possibility early on (e.g., through preadmission letters to parents and inclusion of information in orientation sessions and in presidents' and student leaders' welcoming speeches) may help prevent the development of problems during this critical, high-risk period. Tier 4: Evidence of Ineffectiveness The Task Force recognizes that it is difficult or impossible to "prove" that a specific intervention approach is universally ineffective. Nevertheless, when there are consistent findings across a wide variety of well-designed studies, it is possible to conclude that an approach is not likely to be effective and that limited resources should be used in other ways. Additionally, if there is strong evidence that an intervention approach is actually


harmful or counterproductive, recommendations not to use it can be made based on fewer studies. The Task Force also notes that some interventions may be ineffective when used in isolation, but might make an important contribution as part of a multicomponent integrated set of programs and activities (Larimer and Cronce, 2002). However, until there is evidence of a complementary or synergistic effect resulting from inclusion with other strategies, college administrators are cautioned against making assumptions of effectiveness without scientific evidence. Strategy: Informational, knowledge-based, or values clarification interventions about alcohol and the problems related to its excessive use, when used alone (Larimer and Cronce, 2002; Maddock, 1999). This strategy is based on the assumption that college students excessively use alcohol because they lack knowledge or awareness of health risks and that an increase in knowledge would lead to a decrease in use. Although educational components are integral to some successful interventions, they do not appear to be effective in isolation. Despite this evidence, informational/educational strategies are the most commonly utilized techniques for individually focused prevention on college campuses (DeJong and Langford, 2002; Larimer and Cronce, 2002). Strategy: Providing blood alcohol content feedback to students. This strategy uses breath analysis tests to provide students accurate information on their BAC. It could be used as part of a research evaluation or to dissuade students from driving while under the influence or continuing to drink past intoxication. Providing this information to students who are drinking must be approached with caution. Some researchers have found that the presence of immediate breath analysis feedback can actually encourage excessive drinking when students make a contest of achieving high BACs (personal communications from Scott Geller, 2002 and Robert Voas, 2002). If BAC feedback is to be provided in naturalistic settings, the procedure should be carefully monitored for adverse effects and adjusted as necessary.


MAGNITUDE OF ALCOHOL-RELATED MORTALITY AND MORBIDITY AMONG U.S. COLLEGE STUDENTS AGES 18–24: Changes from 1998 to 2001 Ralph Hingson, 1 Timothy Heeren, 1 Michael Winter, 1 and Henry Wechsler2 Boston University School of Public Health, Center to Prevent Alcohol Problems Among Young People, Boston, Massachusetts 02118; email:,,
2 1

Harvard School of Public Health, Boston, Massachusetts 02115; email: Integrating data from the National Highway Traffic Safety Administration, the Centers for Disease Control and Prevention, national coroner studies, census and college enrollment data for 18–24-year-olds, the National Household Survey on Drug Abuse, and the Harvard College Alcohol Survey, we calculated the alcohol-related unintentional injury deaths and other health problems among college students ages 18–24 in 1998 and 2001. Among college students ages 18–24 from 1998 to 2001, alcohol-related unintentional injury deaths increased from nearly 1600 to more than 1700, an increase of 6% per college population. The proportion of 18–24-year-old college students who reported driving under the influence of alcohol increased from 26.5% to 31.4%, an increase from 2.3 million students to 2.8 million. During both years more than 500,000 students were unintentionally injured because of drinking and more than 600,000 were hit/assaulted by another drinking student. Greater enforcement of the legal drinking age of 21 and zero tolerance laws, increases in alcohol taxes, and wider implementation of screening and counseling programs and comprehensive community interventions can reduce college drinking and associated harm to students and others. National surveys have focused attention on the heavy drinking patterns of many college students. In 1993, 1997, and 1999, the Harvard School of Public Health College Alcohol Surveys (CAS) monitored among college students heavy or binge drinking, defined as five or more drinks in a single drinking session for males and four or more for females). In 1999, of 14,138 full-time students randomly selected at 128 4-year colleges and universities, 44% reported at least one heavy drinking episode in the previous year, the same percentage as in 1993. About one fourth (23%) frequently drank in this manner (3 or more times in the past 2 weeks), up from 20% in 1993. Similarly, the national Monitoring the Future study reported 40% of 1440 full-time 2- and 4-year college students surveyed in 1999 consumed 5 or more drinks on a single occasion at least once in the previous 2 weeks, a greater proportion than found among same-age noncollege peers (35%) and high school seniors (31%). In 1998 the National Advisory Council of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), one of the Institutes of the National Institutes of Health, created a task force to review the research on college drinking to advise administrators and the NIAAA on implementing and evaluating college programs and future research directions. This study resulted in a 2002 report: A Call to Action: Changing the Culture of Drinking on U.S. College Campuses. Background papers appeared in "College Drinking, What Is It


and What to Do About It? A Review of the State of the Science" in the Journal of Studies for Alcohol. One of the 24 articles commissioned for this panel estimated that in 1998 more than 1400 students ages 18–24 enrolled in 2- and 4-year colleges died from alcohol-related injuries including motor vehicle crashes. Further, of the 8 million college students in the United States more than 2 million drove under the influence of alcohol and over 3 million rode with a drinking driver. More than 500,000 full-time 4-year-college students were unintentionally injured under the influence of alcohol, and more than 600,000 were hit or assaulted by and more than 70,000 experienced a date rape caused by another student who had been drinking. The purpose of this review is to assess whether the magnitude of alcohol-related morbidity and mortality among U.S. college students ages 18–24 changed from 1998 to 2001. We also outline interventions, identified by rigorous research in the 2002 NIAAA report and the recent National Academy of Science Report to Congress Preventing Under Age Drinking: A Collective Responsibility, to reduce college drinking problems. This review compares the number of alcohol-related traffic and other unintentional injury deaths in 1998 and 2001 among 18–24-year-olds in the United States who are full- or part-time college students attending either 2- or 4-year colleges. Information was integrated from multiple data sets because the U.S. Department of Transportation Fatality Analysis Reporting System (FARS): NHTSA does not routinely record whether persons who die in motor vehicle crashes are college students. In addition, people who die from other types of unintentional injuries are not systematically tested for blood alcohol concentrations (BACs). The data sources consulted are described below. First, the Centers for Disease Control and Prevention (CDC) annually records the numbers and ages of unintentional injury deaths, but they do not record whether these deaths are alcohol related. Second, a recent meta-analysis of 331 medical examiner studies from 1975 to 1995 revealed that 84% of unintentional nontraffic fatalities were tested for BACs. Of those tested 38% had positive BACs and 31% had BACs of 0.10% or higher, exceeding legal limits for intoxication nationwide. This analysis provides the best available estimates for alcohol involvement in injury deaths (other than motor vehicle crash deaths), but it does not provide information on annual changes in the proportions of those deaths that are alcohol related. Third, the National Highway Traffic Safety Administration's (NHTSA) FARS records all motor vehicle crash deaths in the United States and the proportion that are alcohol related, defined as involving a driver or pedestrian with a positive BAC. The ages of decedents are recorded, as are their blood alcohol concentrations. Because BACs are not drawn on all motor vehicle crash deaths, an imputational formula projects the likelihood of alcohol involvement in those crashes for which test results are not available. Fourth, the Department of Education's National Center for Education Statistics reports the number of undergraduate college students in the United States. In 1998, of the


26,058,760 18–24-year-olds living in the United States, 8,670,000 (33%) were enrolled as full- or part-time students in either 2- or 4-year colleges: 24% (n = 6,106,000) in 4year colleges and 10% (n = 2,564,000) in 2-year colleges. Of students enrolled in 4-year colleges, 74% were ages 18–24, as were 60% of those enrolled in 2-year colleges. In 2001, of the 27,918,979 18–24-year-olds living in the United States, 8,894,000 (32%) were enrolled as either full- or part-time college students: 23% 6,381,000 (23%) in 4-year colleges and 9% 2,518,000 (9%) in 2-year colleges. Of students enrolled in 4-year colleges 74% were age 18–24, as were 61% of those enrolled in 2-year colleges. Fifth, the National Household Survey of Drug Abuse in 1999 and 2002 surveyed 18–24year-olds regardless of whether they were college students. In both surveys, college students were more likely than same-age noncollege respondents to report drinking five or more drinks on at least one occasion in the past month and driving under the influence in the past year. On the basis of those survey results, we projected that the proportions of traffic and other unintentional injury decedents testing positive for alcohol would be as high among college 18–24-year-olds as noncollege-year-olds same-age persons. Because college students comprised 33% of the 18–24-year-old population in 1998 and 32% in 2001, we estimated that in 1998 18–24-year-old college students accounted for 33% and in 2001 32% of traffic and other unintentional injury deaths experienced by the 18–24year-old U.S. population. Calculation of other Alcohol-Related Risks Two national surveys conducted in 1999 and 2002 asked students about their experiences with alcohol in the previous year. Using their responses and data on the numbers of college students in the United States during those years, we estimated the annual numbers of college students ages 18–24 who drive under the influence of alcohol, were injured because of drinking, and experienced other alcohol-related problems. The National Household Survey on Drug Abuse (NHSDA) is the primary source of statistical information on illegal drug use in the United States. Sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), computerassisted interviews are conducted with a representative sample of the United States: residents of households and noninstitutional group quarters (e.g., shelters, rooming houses, dormitories) and civilians living on military bases. The 1999 and 2002 NHSDA used an independent multistage area probability sample for each of the 50 states and the District of Columbia. Youth and young adults were over sampled so that each state's sample was approximately equally distributed among people ages 12–17, 18–25, and 26 and older. In 1999, 169,166 addresses across the United States were screened, and 66,706 persons were interviewed within screened addresses. Weighted response rates for households screened and interviewed were 89.6% and 68.6%, respectively. The sample included 19,438 respondents ages 18–24, of whom 6930 (36%) were enrolled in college, 5796 (30%) as full-time students and 1134 (6%) as part-time students.


In 2002, 68,126 persons were interviewed within the screened addresses. Weighted response rates for households screened and persons interviewed were 91% and 79%. In the survey 20,478 respondents were ages 18–24, of whom 8041 (39%) were enrolled in college. Respondents were asked how often they drank 5 or more alcoholic drinks on any one occasion in the past 30 days. They were also asked, reflecting on the previous 12 months, Has your use of alcohol caused you to have any health problems?, Have you driven a vehicle under the influence of alcohol only?, and Have you received treatment or counseling for your use of alcohol? The Harvard School of Public Health CAS began in 1993 with a sample of 140 colleges selected from a list of all accredited 4-year colleges provided by the American Council on Education, using probability sampling proportionate to the size of undergraduate enrollment at each institution. At each college, a random sample of 225 undergraduates was drawn from the total enrollment of full-time students. In 1999, another survey was conducted with 128 of the original 140 colleges. The inability of 10 colleges in 1997 and 2 colleges in 1999 to provide a random sample of students and their mailing addresses resulted in the attrition of those schools. In 1999, 12,317 full-time students, ages 18–24 and having come from 40 states, were surveyed; nearly half of these students lived in dormitories, college housing, fraternities, or sororities (response rate 60%). In 2001, 215 full-time students ages 18–24 were randomly selected for the survey from each of 119 colleges and universities that had been part of the 1999 sample, response rate 52%. Respondents were asked their frequency and usual quantity of drinking, whether during the current school year they experienced a variety of health and social problems because of their drinking, and whether the drinking of other college students posed any of a series of social and health problems for them. Statistical Analyses of Surveys For both surveys we present weighted results that consider their respective designs and nonresponse. All statistical estimates of percentages for the survey data were conducted using the SUDAAN statistical package to account for each survey's design. The SUDAAN package accounts for sampling weights in calculating both estimates and standard errors, using first-order Taylor series approximations to provide standard errors that approximately account for sampling design. Using the information above, we identified the percentage of 2- and 4-year college students ages 18–24 that responded affirmatively to the survey questions regarding alcohol problems and then calculated 95% confidence intervals for those responses. To estimate the numbers of 18–24-year-old college students who experienced those problems, we then multiplied those percentages and confidence intervals by the appropriate population count from the Department of Education of students 18–24 years enrolled in 2- and 4-year colleges in the United States. Data from the Department of Education are considered to be true population totals; therefore, our confidence intervals


reflect only the sampling variability in the percentage estimates. We also made projections from the CAS responses to the full-time 4-year college population using the same analytic strategy. Percentages of responses with 95% confidence intervals were calculated from survey data accounting for the sampling design. Changes in numbers of events and rates of events per 100,000 population were described through relative risks, and 95% confidence intervals were calculated using the Poisson model. These percentages and confidence intervals are available on request. Motor Vehicle Crash Deaths The NHSDA surveys in both 1999 and 2002 revealed that in the year prior to the survey, a significantly greater percentage of 18–24-year-old college students compared with same-age noncollege respondents drank 5 or more drinks on a single occasion in the past month (41.7% versus 36.5% in 1999 and 43.2% versus 39.8% in 2002) and drove under the influence of alcohol in the previous year (26.5% versus 19.8% in 1999 and 31.4% versus 23.7% in 2002). The percentage in both groups of 18–24-year-olds who drank 5 or more drinks in the past 30 days did not significantly increase from 1999 to 2002. However, the percentage of college students who drove under the influence in the past year increased significantly [RR = 1.18 (95% CI 1.13, 1.25)]. In 1998, in the United States, among persons ages 18–24, 3783 (51%) of 7452 traffic deaths were alcohol related. On the basis of a deliberately conservative assumption that college students (33% of the U.S. population ages 18–24 in 1998) experienced alcoholrelated fatalities at the same rate as the entire 18–24-year-old population, 1248 (33%) of the alcohol-related traffic deaths in that age group would have been college students. (Note this figure is somewhat higher than reported by Hingson et al. because the Census Bureau revised its estimate of college students in 1998 from 8 million to 8.67 million.) From 1998 to 2001 the U.S. population ages 18–24 increased 7%, whereas alcoholrelated traffic deaths increased 11%. Thus the increase in alcohol-related traffic deaths per 18–24-year-old population was 4%. The U.S. college population ages 18–24 increased 3%, but the number of alcohol-related traffic deaths among 18–24-year-old students increased 8%. The 5% increase in the rate of alcohol-related traffic deaths from 14.4 to 15.2 per 100,000 college students approached, but did not reach, statistical significance [RR = 1.05 (95% CI 0.98, 1.14)]. Unintentional Nontraffic Deaths In the NHSDA survey, 18–24-year-olds in college and not in college were equally likely to report alcohol-related health problems (1.9% versus 2.0% in 1999 and 2.1% versus 2.3% in 2002). According to the CDC there were 10,052 unintentional injury deaths among 18–24-year-olds in 1998 and 11,272 in 2001 (5). Subtracting 7444 traffic deaths in 1998 from the total unintentional injury deaths among 18–24-year-olds that year and 8242 from the total in 2001 yielded 2608 nontraffic injury unintentional deaths in 1998


and 3030 in 2001. If 38% were alcohol related, as reported in national analyses of coroner studies, then 991 persons ages 18–24 in 1998 and 1151 in 2001 died from alcohol-related nontraffic injuries. If 33% of those deaths were among college students in 1998 and 32% in 2001, then 327 students in 1998 and 368 in 2001 died from alcoholrelated nontraffic unintentional injuries. From 1998 to 2001, the rate of these deaths showed a non-significant 10% increase from 3.8 to 4.1 per 100,000 college students, RR = 1.10 (95% CI 0.95, 1.27). Among 18–24year-old college students, deaths from all alcohol-related unintentional injuries, including traffic and other unintentional injury deaths, increased from 1575 in 1998 to 1717 in 2001, corresponding to an increase in the rates of these deaths from 18.2 to 19.3 per 100,000 students, a 6% increase that approached statistical significance (RR = 1.06, 95% CI 0.99, 1.14). From 1998 to 2001 the total population of persons ages 18–24, including college students and others, increased 7%, and alcohol-related unintentional injury deaths increased 12% from 4771 to 5367, a significant 5% increase per population [RR = 1.05 (95% CI 1.01, 1.09)]. Heavy Episodic Drinking From 1999 to 2002, the proportion of college students ages 18–24 who drank 5 or more drinks on an occasion in the previous 30 days increased from 41.7% to 43.2%, a nonsignificant increase. The number of college students ages 18–24 who consumed at least 5 drinks on an occasion in the previous month increased from 3,615,550 to 3,842,208, a nonsignificant 4% increase per college student population. The increase in the proportion who reported a health problem related to alcohol, from 1.9% to 2.1%, was also not significant. However, the proportion of college students ages 18–24 who in the past year reported driving under the influence of alcohol increased significantly from 26.5% to 31.4%, RR = 1.18% (95% CI 1.13, 1.25); the proportion of students who were arrested for an alcohol-related offense or who were receiving treatment for an alcohol or drug problem increased from 1.4% to 2.2%, RR=1.37 (95% CI 1.22, 2.01). The number of students who drove under the influence of alcohol in the previous year increased from 2,297,550 to 2,792,716, a highly significant 18% increase per college student population. Other Alcohol-Related Health Problems From 1998 to 2001 the number of full-time 4-year college students ages 18–24 in the United States increased 4% from 5,496,000 to 5,709,000. Because the proportion of students who in the CAS reported being hurt or injured or having unprotected sex did not significantly change from 1999 to 2001, the projected number of students with these experiences increased at rates similar to the proportional population increase. In 2001, 599,000 (10.5%) were injured because of drinking and 474,000 (8%) had unprotected sexual intercourse as a result of their drinking. Although in 2001 slightly smaller proportions reported being assaulted or hit by another drinking college student, more than 696,000 (12%) experienced that problem in 2001, and 97,000 (2%) were alcohol-related sexual assault or date rape victims.


From 1998 to 2001 the nationwide number of alcohol-related deaths among 18–24-yearolds rose at a rate that significantly exceeded that age group's proportional population increase. Whereas the population increased 7% from 26,058,760 to 27,918,979, alcoholrelated unintentional injury deaths rose 12% from 4771 to 5367. Thus, alcohol-related deaths per population of 18–24-year-olds rose 5% from 1998 to 2001. From 1998 to 2001, among college students ages 18–24 the population increased 3% from 8,670,000 to 8,894,000, whereas unintentional alcohol-related injury deaths increased 9% from 1575 to 1717. Thus, similar to the overall 18–24-year-old group, among college students alcohol-related unintentional injury deaths per population rose 6%, an increase that approached statistical significance. In 2001, nearly 600,000 college students were injured because of drinking, and 696,000 were assaulted by another drinking college student. Although the numbers are disturbingly high, we believe our estimates of alcohol-related college deaths are conservative. First, we focused only on unintentional injury deaths, not homicides and suicides, many of which are also alcohol related. Second, the proportion of 18–24-year-olds who engage in heavy episodic drinking and driving under the influence of alcohol is higher among persons that age who are enrolled in college. Consequently, our projection that college and noncollege 18–24-year-olds experience traffic alcoholrelated injury deaths at the same rate per population in each group was intentionally conservative. Third, the meta-analysis of coroner studies did not provide age-specific estimates of alcohol involvement in nontraffic unintentional injury deaths. We estimated the proportion of nontraffic unintentional injury deaths was the same among 18–24-year-old college students as among adults all ages, even though persons 18–24 are known to drink more than other adults. A higher proportion of traffic fatalities are alcohol related in the 18–24-year-old population (51%) than among all age groups (38%). It is therefore possible, if not likely, that our estimates of the number of unintentional alcohol-related nontraffic injury deaths among 18–24-year-olds are also conservative. Fourth, if respondents underreport illegal behaviors like driving under the influence of alcohol, our estimate of the numbers of students who engage in those behaviors may be low. Fifth, response rates for the NHSDA and CAS were low. Thus, students may under- or over represent problems associated with alcohol. In 1999 a short form of the CAS was sent to nonresponding students, and there was no significant difference in rates of previous year alcohol use for those answering the short survey compared with the full questionnaire. Of note, the estimates of heavy episodic drinking reported by college students in the NHSDA and the CAS are very similar to those obtained by other major national surveys that include college students e.g., the Monitoring the Future Survey. Sixth, this analysis focused only on college students ages 18–24. In 1998 only 74% of 4year college students and 60% of students at 2- or 4-year colleges were ages 18–24. In


2001, 74% of 4-year college students and 61% at 2-year colleges were in that age group. We have calculated the overall numbers of college students all ages that drink heavily and experience alcohol-related health problems. These numbers are larger than those reported here and are available on request. The magnitude of problems posed by excessive drinking among college students should stimulate both improved measurement of these problems and efforts to reduce them. We believe every unnatural death in the United States should be tested for alcohol. The average cost of such testing would be approximately $50 per deceased person or an annual cost of $1.1 million if all injury deaths of those under 21 were tested or $7.2 million for 144,374 unintentional deaths, homicides, and legal intervention and suicide deaths of all ages recorded in 2001. In comparison, the National Academy of Sciences reports $71.1 million are spent annually to reduce underage drinking. Even though this review used cautious assumption to estimate the numbers of alcohol-related deaths among college students and other 18–24-year-olds, direct systematic alcohol test results would be preferable. Also, mortality data sets (e.g., the Department of Transportation's FARS and CDC's Vital Statistics Mortality File) should include occupation and student status categories so that the absolute number of annual college student deaths can be tabulated. Progress has been made over the past two decades to reduce alcohol-related crash deaths. This process has occurred in part because a sufficiently high and consistent level of fatally injured drivers in crashes are tested for alcohol that statistical models based on crash factors, vehicle factors, and person factors have been developed and used to estimate the annual numbers of alcohol-involved fatal crashes in all states. The data on the numbers of alcohol-related fatal crashes annually in each state has proven invaluable to researchers seeking to study the effects of state-level legislative interventions to reduce alcohol-related traffic deaths. Unfortunately, without comprehensive testing for alcohol and determination of college student status of all persons who die from unnatural deaths, we lack the most dependable yardstick by which to measure the magnitude of alcohol-related injury death among college students, and whether this figure is changing over time. The increase in the past 3 years in alcohol-related traffic and other unintentional injury deaths among 18–24-year-olds both in college and not in college underscores the need for colleges and their surrounding communities to expand and strengthen interventions demonstrated to reduce excessive drinking among college students and their same-age noncollege counterparts. Of note, heavy-drinking college students not only place their own health at risk, but also they jeopardize the well-being of others. As many as 46% of the 4553 people killed in 2001 in crashes involving 18–24-year-old drinking drivers are persons other than the drinking driver, and the total deceased has increased 33% from 3425 to 4553 between 1998 and 2001. Further, surveys both in 1999 and again in 2001 indicate annually over 600,000 college students nationwide were hit or assaulted by a drinking college student,


and in 2001 97,000 students were the victim of a date rape or assault perpetrated by a drinking college student. Colleges and surrounding communities have an obligation to protect people from potential harm contributed by excess college drinking. The recent report on college drinking and its background reports and the National Academy of Sciences Report on Underage Drinking identified numerous individually oriented counseling approaches, environmental interventions, and comprehensive community interventions that can reduce drinking and related problems among college students and the college age population. These documents summarize scientifically valid approaches for effective prevention, and some believe they establish a new legal standard by which the adequacy of any college or university's efforts can be judged Individually Oriented Interventions Larimer & Cronce reviewed individually oriented strategies to reduce problematic alcohol consumption by college students from 1984 to 1999. Studies were included in this review if they had a control or comparison group and had at least one change in drinking or alcohol consequences outcome. A total of 34 separate studies were identified. The reviewers found little evidence for the effectiveness of information-based and values-clarification programs. Several skills-based interventions resulted in decreases in alcohol consumption, including self-monitoring/self-assessment as well as expectancychallenge procedures involving alcohol/placebo administration. Brief motivational interventions had demonstrated effectiveness in a variety of contexts including selected high-risk freshmen, high school classrooms, fraternity organizations, outpatient counseling centers, and emergency rooms. Mailed graphic feedback alone in three studies resulted in reductions in alcohol consumption equivalent or superior to skills-based interventions with combined feedback. Environmental Interventions: Legal Drinking Age of 21 The most powerful environmental intervention to reduce drinking among college students is the minimum legal drinking age of 21. In 1984, when 25 states had a legal drinking age of 21, the U.S. Congress passed legislation that would withhold highway construction funds from states that did not make it illegal to sell alcohol to people younger than 21. By 1988, all states adopted this law. A review of more than 49 studies of legal drinking age changes revealed that in the 1970s and 1980s, when many states lowered the drinking age, alcohol-related traffic crashes increased 10%. In contrast, when states increased the legal drinking age to 21, alcohol-related crashes among people younger than 21 decreased an average of 16%. Wagenaar & Toomey reviewed more than 48 studies of the effects of drinking age changes on drinking and 57 studies on traffic crashes. They concluded that increases in the age of legal alcohol purchase and consumption have been the most successful intervention to date in reducing drinking- and alcohol-related crashes among persons under 21. One national study of laws raising the drinking age to 21 indicated that persons who grew up in states with a drinking age of 21 relative to those with lower legal drinking ages drank less not only when they were younger than 21, but also when they were ages 21–25. NHTSA estimates that a legal drinking age of 21 saves


700–1000 lives annually and that more than 21,000 traffic deaths have been prevented by such laws since 1976. Zero tolerance laws, which make it illegal in every state for persons under 21 to drive after any drinking, have also contributed to declines in alcohol-related traffic deaths among people younger than 21. A comparison of the first 8 states to adopt zero tolerance laws with nearby states without such laws revealed a 21% greater decline in zero tolerance law states in the proportion of fatal crashes among drivers younger than 21 that were of the type most likely to involve alcohol (i.e., single-vehicle fatal crashes at night. Wagenaar et al. found that in the first 30 states to adopt zero tolerance laws, relative to the rest of the nation, there was a 19% decline in the proportion of people younger than 21 who drove after any drinking and a 23% decline in the proportion who drove after 5 or more drinks. Unfortunately, despite their demonstrated benefits, legal drinking age and zero tolerance laws generally have not been vigorously enforced. Young drivers are substantially underrepresented in the driving while intoxicated (DWI) arrest population relative to their contributions to the alcohol crash problem. Younger drivers may be more likely to drink at locations where DWI enforcement resources are less likely to be deployed. Young drivers with high BACs also are more likely to be missed by police at sobriety checkpoints. Stepped-up enforcement of alcohol purchase laws aimed at sellers and buyers can be effective if resources are made available for this purpose. Enforcement of zero tolerance laws is hindered in some states because their implied consent laws require either an arrest for DWI or probable cause for a DWI arrest before the evidentiary test can be done to prove a zero tolerance violation. Thus in practice zero tolerance laws often are not enforced independently of DWI. In states such as New Mexico, where this situation exists, most teenagers are unaware that there is a zero tolerance law. Price of Alcohol The National Academy of Sciences reviewed the literature on price of alcohol and alcohol-related problems and recommended that Congress and state legislators raise excise taxes to reduce underage alcohol consumption and to raise additional revenues to reduce underage drinking problems. With rare exceptions research since the early 1980s generally has concluded that increases in the price of alcohol beverages lead to reductions in drinking and heavy drinking, as well as reductions in the adverse consequences of alcohol use and abuse. Higher alcohol prices have also been found to reduce alcohol-related problems such as motor vehicle fatalities, robberies, rapes, liver cirrhosis deaths, sexually transmitted diseases, and child abuse. Among moderate drinkers, investigators have estimated that a 1% price increase results in a 1.19% decrease in consumption. Younger, heavier drinkers tend to be more affected by price than older, heavier drinkers, perhaps because younger drinkers have less discretionary income. Laixuthai & Chaloupka, Grossman et al., and


Coate & Grossman all found increasing the price of alcohol reduces the percent of youths who drink infrequently and produces even greater percentage declines in youths who drink frequently. Research taking into account the addictive nature of alcohol shows that the long-term price elasticity is well above short-term elasticity. Kenkel reported a 10% increase in the price of alcohol would reduce DWI 7% among men and 8% among women, and among persons under 21 this action would produce a 13% decrease among men and a 21% decrease among women. If, as recommended by the National Academy of Sciences Report, revenues generated by alcohol tax increases to raise beverage prices are in turn earmarked for programs and enforcement of policies known to reduce underage drinking, reductions in underage drinking problems could exceed deductions associated with alcohol price increases alone. Other Environmental Interventions Alcohol outlet density has been associated with alcohol-related problems and reducing outlet density may in turn reduce drinking-related problems. Wechsler et al. found that students who attend colleges in states that have more restrictions on underage drinking, high volume consumption, and sales of alcohol beverages and which devote more resources to enforce drunk-driving laws, report less drinking and driving. Laws in these states included prohibitions against using a false identification, restrictions on attempting to buy or consume for those under the legal drinking age, enforcement of a clerk age minimum, and maintenance of minimum mandatory postings of warning signs in retailers to potential underage buyers. Laws pertaining to volume alcohol sales were keg registration, a statewide 0.08 g/dl per se BAC law, and restrictions on happy hours, open alcohol containers, beer sold in a pitcher, and billboards and advertising. The availability of large volumes of alcohol (24- and 30-can cases of beer, kegs, and party balls), low sale prices, and frequent promotions and advertisements at both on- and off-premise establishments were also associated with higher binge drinking rates on the college campuses. Shults also reviewed 19 studies of states lowering legal blood alcohol limits for persons above 21 to 0.08% and reported that this law cut alcohol-related fatalities on average by 7% and concluded that there is strong evidence in favor of such a change. Comprehensive Community Interventions Several carefully conducted community-based initiatives have had particular success in reducing drinking- and/or alcohol-related problems among young people. These programs typically coordinate efforts of city officials from multiple departments of city government, school, health, police, alcohol beverage control, etc.; concerned private citizens and their organizations; students; parents; and merchants who sell alcohol. Often multiple intervention strategies are incorporated into the programs, including schoolbased programs involving students, peer leaders, and parents; media advocacy;


community organizing and mobilization; environmental policy change to reduce alcohol availability to youth; and heightened enforcement of laws regulating sales and distribution of alcohol and laws to reduce alcohol-related traffic injuries and deaths. Three comprehensive community programs in particular have shown reduction in alcohol problems among college-age youth: the Communities Mobilizing for Change Program, the Community Trials Program, and the Saving Lives Program. Two programs concentrated program efforts on underage alcohol purchase attempt surveys with feedback to alcohol sales merchants and the community about the proportion of attempts that resulted in sales and penalties for continued violations. Two programs focused on publicized police enforcement of drinking driver laws and alcohol service laws, and one targeted risky motorist behaviors—such as speeding, running red lights, failing to wear safety belts, and yielding to pedestrians in crosswalks—engaged in disproportionably by drinking drivers. Relative to the comparison communities, the Communities Mobilizing for Change communities achieved a 17% increase in outlets checking the age identification of youthful-appearing alcohol purchasers, a 24% decline in sales by bars and restaurants to potential underage purchasers, a 25% decrease in the proportion of 18–20-year-olds seeking to buy alcohol, a 17% decline in the proportion of older teens who provided alcohol to younger teens, and a 7% decrease in the percentage of respondents younger than 21 who drank in the previous 30 days. Further, drinking and driving arrests declined significantly among 18–20-year-olds, and disorderly conduct violators declined among 15–17-year-olds. In the Community Trials Program, single-vehicle crashes at night, a measure of alcoholrelated crashes, declined 11% more in program than in comparison communities. Alcohol-related trauma visits to emergency departments declined 43%. In the Saving Lives Program the proportion of drivers younger than 20 who reported in telephone surveys driving after drinking declined from 19% to 9% over the course of the program. The proportion of vehicles observed speeding through use of radar was cut in half, and there was a 7% increase in safety belt use. Minimal change in these outcomes occurred in comparison areas. Fatal crashes declined from 178 during the 5 preprogram years to 120 during the 5 program years, a 25% greater reduction than in the rest of Massachusetts. Fatal crashes involving alcohol declined 42%, and the number of fatally injured drivers with positive BACs declined 47%, relative to the rest of Massachusetts. Visible injuries per 100 crashes declined 5% more in Saving Lives cities than in the rest of the state during the program period. The fatal crash declines were greater in all six program cities relative to comparison areas, particularly among drivers ages 15–25. Weitzman et al. recently evaluated the impact of college/community partnerships implementing environmentally based interventions to reduce drinking and related problems specifically among college students. Interventions included in the A Matter of Degree (AMOD) program included keg registration, mandatory responsible beverage service, increased enforcement of community police collaboration or wild party


enforcement, substance-free residence halls, and a variety of alcohol bars advertising environment with change. Of the ten AMOD programs, the five that most vigorously implemented these interventions achieved significant reductions in binge and frequent binge drinking, frequent intoxication, driving after drinking, alcohol-related injury, and a variety of other alcohol-related problems. Relative to control colleges, significant reductions were observed also in the proportion of students who reported being assaulted by another drinking college student. Binge drinking and particularly DWI among college students and others in the 18–24 age group has increased since 1998, and alcohol-related deaths have increased significantly more than the population totals for that age. Colleges and the communities in which they are located have an obligation to control the harms to others posed by college-age drinkers, regardless of whether these drinkers are college students. Although a high percentage of 18–24-year-old college students drink heavily and engage in behaviors, such as driving a motor vehicle after drinking, that pose risk to themselves and others, there are so many more 18–24-year-olds not in college that this population actually accounts for more heavy drinkers, drinking drivers, and alcohol-related deaths. In 2001, while 3.8 million college students ages 18–24 engaged in heavy (5+ drinks) drinking episodes, so too did 7.6 million 18–24-year-olds who were not in college. While 2.8 million college students this age drove under the influence of alcohol, so too did 4.5 million persons that age who were not in college. While in 2001 nearly 1349 18–24-yearold college students died in alcohol-related motor vehicle crashes, among all 18–24-yearolds, there were 4216 of these deaths in 2001. While more than 300 college students ages 18–24 died from other unintentional alcohol-related injuries, among all 18–24-year-olds, 1151 individuals died from alcohol-related nontraffic unintentional injuries in 2001. Moreover, while young adults ages 18–24 have the highest rates of binge drinking (5+ drinks at a time) than do other adults, persons over age 26 account for two thirds of all binge drinking episodes. Also, while the highest rates of alcohol-related traffic deaths are among 18–24-year-olds, they accounted for only 24% of alcohol-related traffic deaths and 9% of all other alcohol-related unintentional deaths in 2001; this fact suggests that efforts are needed to reduce alcohol-related traffic and unintentional injury deaths among persons of all ages, including college students. Further, new research indicates that persons who drink to excess even before they enter college are more likely to experience alcohol-related problems both in high school and in college. According to the CDC National Youth Risk Behavior Survey, in 2001 47% of high school students (over 7 million) drank alcohol in the previous 30 days and 34% (over 5 million) drank at least 5 drinks within a 2-hour period at least once in the previous 30 days. Thirteen percent or 1.9 million individuals drove after drinking in the previous 30 days, and 31% (4.6 million) rode with a drinking driver. Further, the average age of starting to drink is declining. In 2001, 29% of high school students reported that they began drinking before age 13. Analyses of the 1999 CAS among college students 19 and older revealed that the younger college students were when they first drank to intoxication (got drunk), the more likely they were to experience alcohol dependence in college, to engage in frequent heavy episodic drinking, to drive after drinking and heavy


(5+ drinks) drinking, to ride with drunk drivers, to be injured under the influence of alcohol, and to have unplanned and unprotected sex after drinking. Community alcohol policy enforcement targeting high school students may have carryover effects in college years. Because increased efforts to enforce underage drinking laws at the community level have reduced underage drinking, alcohol-related assault, emergency department visits, and alcohol-related fatal crashes involving people of college age, it is important that colleges and their surrounding communities collaborate in these efforts. These efforts can include individually oriented screening and counseling strategies of proven efficiency among college and adolescent populations as well as environmental interventions such as alcohol tax increases, heightened education, and enforcement of minimum legal drinking age and zero tolerance laws. College crackdowns on campus drinking absent community support may drive problematic drinking off campus. Community crackdowns without college support may similarly drive drinking problems back onto campus. Moreover, community efforts to reduce underage drinking are needed to prevent the development of unsafe underage drinking practices before they spill over into the college setting.


Office of Juvenile Justice and Delinquency Programs Drug, Alcohol Therapy/Education Science has made great progress in recent years with regard to the prevention and treatment of substance abuse. We still have much to learn about adapting interventions and treatments to effectively address specific risks by gender, ethnic identification and geographic settings. However, from universal prevention aimed at children to offender treatment for substance use disorders in institutions and communities, much has been learned in the past two decades about what works and what doesn't (BJA, 2003; Dusenbury and Falco, 1997; Ferrer-Wreder, et al., 2003; NIDA, 2003). PREVENTION Much of the research on preventing drug use among children and adolescents has focused on reducing risks and promoting factors that lead to use and abuse (Hawkins, Catalano, and Arthur, 2002). These interventions are designed and tested to help optimize the development of children. Scientists have found effective ways to work with families, schools, and communities in order to help young people develop skills and approaches to stopping problems related to substance use before they occur (NIDA, 2003). Mothers and Early Caregivers There can be no question that the best way to start out life is by having a substance free environment from conception (Olds and Henderson, 1994). Further, being cared for in a family with many protective factors and few risk factors is another key element in fostering a propensity toward being drug free (Olds, et al., 1998). Olds and colleagues' program, Nurse-Family Partnership, is aimed at just that, promoting a solid beginning in life. This program serves to promote emotional-, physical-, and behavioral health in atrisk, first time mothers and their children who live in communities of disorganization and marginalization. The program seeks to give new mothers the tools, knowledge and, most importantly, support needed to initiate and maintain healthy lifestyles that are free of substance use, full of positive parenting and armed with the understanding of developmentally appropriate child behaviors. To date, Olds program has shown both short- and long-term positive effects on both the children and the families that it serves (Olds, Kitzman, Cole, and Robinson, 1997). School Age Problem behaviors such as alcohol or drug use often begin during the school-age years. Many believe that implementing prevention programs in the school setting increases the chance of averting the problems associated with alcohol, tobacco, and other drug use and abuse. According to the National Institute on Drug Abuse, prevention programs should address all forms of drug abuse, alone or in combination. This means programs should include preventing the underage use of legal drugs such as tobacco or alcohol as well as the use of illegal drugs such as marijuana or heroin. Further, programs should address the inappropriate use of legally obtained substances such as inhalants, prescription medications or over-the-counter drugs (NIDA, 2003).


Drug prevention efforts the past two decades have largely relied on classroom curricula usually designed for primary and middle school children (Dusenbury and Falco, 1997). The nation's schools spend $125 million on drug abuse prevention curricula each year however many of these programs may not be effective in preventing substance abuse (Dusenbury and Falco, 1997). The reason for this is drug and alcohol abuse prevention curricula have traditionally been based on pure information dissemination. Previous evaluations show that this didactic approach may be effective at transmitting information regarding drug and alcohol abuse however, used alone, it is not effective at changing the underlying attitudes and behaviors (Sherman, 2000; Gottfredson, 1997; Botvin, Botvin, and Ruchlin, 1998; Miller, 2001; Mendel, 2000; Sherman, et al., 1998; Rosenbaum and Hanson, 1998; Wyrick, et al., 2001). However, a review of the literature in the drug abuse prevention field suggests certain types of school-based curricula can effectively reduce substance abuse in adolescence (Botvin and Botvin, 1992; Dusenbury and Falco, 1997; Perry et al., 1996; Tobler and Stratton, 1997). Efficacious prevention curricula consist of several key elements. Curricula delivered in an interactive format with smaller groups of young people have been shown to produce strong and lasting positive results (Tobler and Stratton, 1997). Effective curricula gives students the tools to recognize internal pressures like stress or anxiety and external pressures like peer attitudes and advertising that may influence them to use alcohol, tobacco and other drugs. Following this, another useful component is helping students develop and practice personal, social and refusal skills in order to resist these influences effectively (Dusenbury and Falco, 1997). Effective school-based programs include Life Skills Training. Family Drug prevention efforts focusing on the family have shown considerable progress over recent years (Ashery, Robertson, and Kumpfer, 1998; Dishion and Kavanagh, 2000; Dusenbury, 2000; Kumpfer and Alvarado, 1998; Sanders, 2000). Family training at the time of transition from childhood to adolescence may be particularly important for parents. Such programs prepare parents for the changes their child will experience and offer parents tools that can help them to steer their children away from early- and heightened drug involvement (Bry, et al., 1998; Ferrer-Wreder, 2003; Kumpfer and Alvarado, 1998). Evaluations of promising family training programs that work to prevent youth drug use have shown both short- and long-term promise particularly in terms of lowering alcohol initiation- and use-rates. Positive programmatic-related changes in alcohol and family variables have been found to persist between two- to three-and-half years post intervention (Kumfer, Molgard and Spoth,, Loveland-Cherry, et al., 1999; Park, et al., 2000). While research is continuing about the usefulness of particular intervention actions, (Dusenbury, 2000; Etz, Robertson, and Ashery, 1998), exemplar interventions of this type regularly include some key components. These effective features include giving parents accurate information about alcohol and drugs and encouraging parents to clarify


their own views about youth substance use. Other useful tools are to support the family in defining and enforcing a family policy on youth substance use, as well as involving young people and parents in social resistance training (Bry, Catalano, Kumpfer, Lochman, and Szapocznik, 1998; Dusenbury, 2000; Kumpfer and Alvarado, 1998). For a few examples of well-tested, effective programs see Preparing for the Drug Free Years and the Child and Parent Relations Project. Higher Risk Youth and Families In the case of higher risk youth with behavioral problems in general and those related to substance issues in particular, family therapies may be more effective (Ferrer-Wreder, et al., 2003; Hogue, Liddle, Becker and Johnson-Leckrone, 2002; Szapocznik and Williams, 2000). These interventions work with single families on a one-to-one basis. This approach helps to target specific strengths within the family and provide a setting for youth and parents to practice new, positive ways of interacting directly with each other (Etz, Robertson, and Ashery, 1998; Kumpfer and Alvarado, 1998). Exemplar family initiatives that have shown efficacy in reducing overall reoffending rates, violence-drug related crimes, and other institutional assignments include Functional Family Therapy, and Multisystemic Therapy. For youth whose problem behaviors and risk is largely associated with their parents' drug abuse, interventions seem to be most successful when explicit drug treatment for parents is combined with the previously mentioned effective family intervention components. These family-focused interventions expressly treat parental addiction and relapse, codependence issues, as well as youth knowledge, attitudes, and expectations regarding alcohol and other drugs (Dusenbury, 2000; Ferrer-Wreder, et al., 2003; Kumpfer, Alexander, McDonald, and Olds, 1998). While only a few rigorously tested therapies for substance-addicted parents exist (Bry, et al., 1998; Ferrer-Wreder, et al., 2003), one program stands out. In the Focus on Families efficacy trial, results indicated declines in parental drug use and improvements in related family variables with endurance up to one year after the intervention. The same level of success in reducing youth substance use among the offspring of these parents has been more difficult to achieve. There is evidence that points to a possible trickle down intervention effect for children whose parents have successfully undergone addiction treatment (O' Farrell and Feehan, 1999). Longer-term follow up of participating children will offer a more precise test of the potential benefits of these family therapies (Bry, et al., 1998; Dusenbury, 2000). Future work may also profit from a greater incorporation of youth-focused components that are tailored to the social and developmental changes taking place in childhood and adolescence (Ferrer-Wreder, et al., 2003). Community Awareness Policy and Norms limiting a young person's access to alcohol and tobacco through community initiatives and policy change and enforcement has taken on renewed efforts (Ferrer-Wreder, et al., 2003). Using policy as an instrument for prevention is largely based on the premise that


this approach has the potential to yield population level changes in youth problem behavior and adult conduct (Ferrer-Wreder, et al., 2003). Analyses of public policy related to alcohol- and tobacco- purchase and consumption offer evidence that policy change and enforcement can be an effective deterrent (Holder, et al., 1998; Holder and Wagenaar, 1994). Well-tested, efficacious community focused interventions include Project Northland, Midwestern Prevention Project, and Communities Motivated for Change on Alcohol (CMCA). CMCA has proven that effectively limiting the access to alcohol to people under the legal drinking age not only directly reduces teen drinking but also communicates a clear message to the community that underage drinking is inappropriate and unacceptable. CMCA employs a range of social organizing techniques to address legal, institutional, social, and health issues to reduce youth alcohol use by eliminating illegal alcohol sales to youths by retailers and obstructing the provision of alcohol to youths by adults. MORE INTENSIVE INITIATIVES While prevention efforts have made great strides in helping stem the risks that lead to substance abuse, there is still high prevalence of substance use and addiction among American youth. According to the Center for Substance Abuse Treatment, addicted people can be helped through comprehensive programs that specifically target the factors associated with substance abuse (U.S. Department of Health and Human Services, 2004). Whether treatment occurs in detention, prison, jail or community settings, evidence shows that effective treatment programming can empower addicted young people to overcome their substance abuse, lead crime-free lives, and become productive citizens. The key to success to many of these treatment initiatives has been promoting buy-in from all stakeholders, staffing with well-trained providers, and encouraging excellent communication between the interested parties (Castellano and Beck, 1991). Further, for treating juvenile offenders, providing adequate aftercare and involving participants' families in the transition is also critical. Wraparound Wraparound initiatives have produced promising results in providing support, guidance, and services to at-risk youth and juvenile offenders with substance-use related issues. Wraparound offers a highly structured, integrated services environment that, when well run and staffed by committed individuals, have the potential to offer positive benefits for all. Baltimore's Choice Program and San Francisco's Detention Diversion Advocacy Program are two examples of programs that have produced promising results by providing at-risk youth and juvenile offenders with intensive supervision and individualized treatment plans. This complex, multifaceted intervention strategy is designed to keep delinquent youth at home and out of institutions whenever possible. Rather than forcing these young people to enroll in pre-determined, inflexible treatment programs these initiatives involve "wrapping" a comprehensive array of individualized services and support networks "around" young people, (Bruns, et al., 2004). A care coordinator assembles and leads child and family teams consisting of family members, paid service providers, and


community members (such as teachers and mentors), who know the youth under treatment and are familiar with his or her changing needs. These teams work together to ensure that the individual child's needs are being met across all domains-in the home, the educational sphere, and the broader community at large. Treatment Centers: Therapeutic Communities and Residential Treatment Centers Recent studies have demonstrated that properly implemented treatment programs for juvenile offenders can have a significant impact on both the substance abuse and recidivism rates of incarcerated youth. A recent analysis of Maryland's CREST program indicates that the program significantly increases participants' likelihood of remaining drug free (Mello, 1997). Two analyses of Arizona's Amity TC program (which features an intensive aftercare component) have also found a marked decrease in both substance abuse and rearrest rates for up to 24 months after leaving prison (Mullen et al., 1991; Wexler, 1999). Subjects in the Wexler study had a rearrest rate of 26.9 percent versus a rate of 40.9 percent for nontreatment offenders. Results such as these suggest that TC programs, while challenging to implement in many correctional settings, are nevertheless worth further investigation and refinement. Juvenile Drug Courts Juvenile drug courts (JDC) are intensive treatment programs established within and supervised by juvenile courts to provide specialized services for eligible drug-involved youth and their families. Drug courts were developed in response to rising levels of drugrelated crime and implemented in order to address the complex issues underlying substance abuse. The goals of JDC are to use the law as a therapeutic agent in order to stem the tide of young drug offenders flowing into the system, rehabilitate those already in the system, and reduce recidivism among released offenders. JDC is a problem-solving partnership where courts work closely with a wide range of stakeholders. The team is comprised of representatives from treatment, juvenile justice, social services, school and vocational training programs, law enforcement, probation, the prosecution, and the defense. Together, the team determines how best to address the substance abuse and related problems of the youth and his or her family (BJA, 2003). Maine is one of the few States to successfully implement a statewide system of juvenile drug courts. Maine currently operates six juvenile drug courts serving seven counties. The program runs about 50 weeks and in four phases, each with distinct treatment goals and specified completion times. Participants are required to attend drug treatment, weekly court appearances, and meetings with a drug treatment court manager. To advance to the next phase, participants must have a specified number of weeks of clean alcohol and drug tests and no unexcused absences from treatment or court appearances. In addition to treatment for substance abuse, the program offers a variety of other services, such as educational programming, job training, mental health services, and recreational planning (Anspach, Ferguson, and Phillips, 2003). In a review of over 35 drug courts, results show short-term positive effects while the youth remain in the program; however, long-term results while encouraging are still yet to be seen (Belenko, 2001).














Pennsylvania Youth Survey Pennsylvania Department of Education School Safety Report Pennsylvania Liquor Control Board RAMP Statistics 2005/06 Pennsylvania Liquor Control Board Controlled Party Dispersal Trainings Pennsylvania State Police-Bureau of Liquor Control Enforcement Pennsylvania Crimes Code Substance Abuse and Mental Health Services Administration Cops in Shops Data Center on Alcohol Marketing and Youth Report