Drinking and Driving Among College Students The Influence of Alcohol-Control Policies Henry Wechsler, PhD, Jae Eun Lee, DrPH, Toben F. Nelson, MS, Hang Lee, PhD Background: Studies have reported high rates of heavy episodic drinking and alcohol-related problems, including drinking and driving, among college students. However, most studies have been conducted in single colleges or states. This study used a national sample to examine policy factors associated with alcohol-involved driving. Methods: A random sample of full-time students (N=10,904) attending a nationally representative sample of 4-year colleges in 39 states (n=119) completed self-administered questionnaires. The questionnaire examined driving after consuming any alcohol, driving after 5 drinks, and riding with a high or drunk driver. Individual level data about driving after 5 drinks were linked to information on the policy environment at both local and state levels and to ratings of enforcements for drunk driving laws. Results: Drinking and driving behaviors are prevalent among a minority of college students and differ significantly among student subgroups. Students who attend colleges in states that have more restrictions on underaged drinking, high volume consumption, and sales of alcoholic beverages, and devote more resources to enforcing drunk driving laws, report less drinking and driving. Conclusion: The occurrence of drinking and driving among college students differs significantly according to the policy environment at local and state levels and the enforcement of those policies. Comprehensive policies and their strong enforcement are promising interven- tions to reduce drinking and driving among college students. (Am J Prev Med 2003;25(3):000) © 2003 American Journal of Preventive Medicine Introduction D uring the year 2001, over 16,000 motor vehicle fatalities and 310,000 injuries in the United States involved alcohol, 1 and a high proportion of these events involved adolescents and young adults. Although the percentage of alcohol-related motor ve- hicle fatalities decreased from the early 1970s through the 1980s, the downward trend stabilized in the past decade, and recent evidence suggests that it may be reversing. 1,2 Despite the relative stability in the national rate of alcohol-involved traffic fatalities, significant vari- ability exists in the rate of alcohol-involved traffic fatalities across states. 3–5 Significant variations also exist in the levels of binge drinking in the general U.S. population 6 and in the policy environment regarding alcohol consumption and sales as well as the resources available for enforcing those policies in each state. 7 Stronger drinking and driving countermeasures at the state policy level are associated with lower rates of alcohol-impaired driving. 8 College students are particularly susceptible to alco- hol-impaired driving. Higher rates of heavy drinking occur in this population compared with same-aged peers who do not attend college. 9,10 Heavy episodic alcohol use or “binge drinking” among college students is a nationally recognized health problem, 11,12 occur- ring among two in five students nationally. 13–16 More than half of the students who engage in frequent binge drinking experience five or more different alcohol- related problems during the school year, a rate of problems significantly greater than that for those who drink but do not binge. 13–16 Perhaps the most danger- ous of these problems is drinking and driving. The number of college students that sustained fatal injuries in alcohol-related traffic crashes for the calendar year 1998 is estimated to be approximately 1100. 17 Studies of college students’ drinking habits have often been limited to single schools or a few schools from the same state, 18 a design limitation that has been documented in epidemiology. 19 There is also an ab- sence of work on the impact of alcohol control policies From Harvard School of Public Health, Department of Health and Social Behavior (Wechsler, Jae Lee, Nelson), Boston, Massachusetts, and Massachusetts General Hospital (Hang Lee), Boston, Massachu- setts. Address correspondence and reprint requests to: Henry Wechsler, PhD, Department of Health and Social Behavior, Harvard School of Public Health, 677 Huntington Avenue, Boston MA 02115. E-mail: hwechsle@hsph.harvard.edu. The full text of this article is available via AJPM Online at www.ajpm-online.net. 1 Am J Prev Med 2003;25(3) 0749-3797/03/$–see front matter © 2003 American Journal of Preventive Medicine • Published by Elsevier Inc. doi:10.1016/S0749-3797(03)00199-5