Disorder in the Courts

Is it legal for college student newspapers to run alcohol advertising or isn’t it? The US Supreme Court’s recently announced refusal to hear a case brought by Virginia Tech’s The Collegiate Times and the University of Virginia’s The Cavalier Daily has served only to increase public confusion.

In 2006, the two newspapers sued Virginia’s Department of Alcoholic Beverage Control to overturn a regulatory prohibition against alcohol advertising in newspapers read by students under age 21, claiming that the restrictions violated their rights under the First Amendment of the Constitution. The federal judge who heard the suit found for the newspapers, but that ruling was overturned by the 4^th Circuit Court of Appeals. The Supreme Court, by not hearing the case, has left the ban in place, which is now binding in Maryland, North Carolina, South Carolina, Virginia, and West Virginia.

The 3^rd Circuit Court of Appeals heard a similar case in 2004, but in that case, the federal court ruled that a Pennsylvania state law banning paid alcohol ads in student media was unconstitutional. The suit had been filed by The Pitt News, the student newspaper for the University of Pittsburgh. The ruling still stands and remains binding in Delaware, New Jersey, Pennsylvania, and the US Virgin Islands.

Because the Constitution guarantees freedom of the press, a ban on alcohol advertising would be warranted only if there were strong, convincing evidence that such a ban would serve the public interest by reducing abusive drinking on college campuses. Two federal appeals courts have decided the question differently.

The fact is, however, that there is no convincing evidence that such a ban would serve to reduce drinking. We can assert that such advertising sends the wrong message to students, but the burden of proof here is to show that a ban would work. Given low alcohol excise taxes, poor enforcement of the minimum legal drinking age, and the blizzard of alcohol advertising that students are exposed to through television, the Internet, and other media, that is an unlikely prospect.

In my view, the key issue here is not advertising per se, but the need to eliminate ads that glorify abusive drinking and announce low-price promotions. What can be done? Student newspapers can work in concert with local merchants to develop and enforce guidelines for acceptable advertising. Absent leadership from the editorial staff, campus administrators can approach local retailers directly to work out voluntary agreements to eliminate irresponsible advertising. This has worked in Albany and Madison, and it can work elsewhere.

Are Displacement Effects a Myth?

For many years, college officials have hesitated to apply stricter policies and tougher enforcement of alcohol control policies, fearing that students might respond by pregaming, driving elsewhere to drink, or using other drugs. In the criminal justice field, there is a similar concern about displacement effects, when efforts to battle street crime in one district might only push it into neighboring areas. Underlying this pessimistic view about college drinking is the conviction that students are intent on getting intoxicated and that nothing can deter them. Given that reality, the thinking goes, tougher policies might actually put students at even greater risk of harm.

Two new studies suggest that fear of displacement effects might be unwarranted. Robert Saltz and his colleagues randomly assigned seven public universities to participate in a prevention initiative and assigned seven similar institutions to a no-intervention control group. The intervention focused on decoy operations to enforce the age 21 drinking age at local alcohol outlets, special patrols to deal with nuisance parties off campus, DUI checkpoints, and new social host ordinances. Campus and local media were used to increase the program’s visibility. The study showed that students were less likely to drink to intoxication in the settings targeted in the intervention. Importantly, students were not more likely to drink to intoxication in other settings. In short, there were no displacement effects.

In Massachusetts, public universities were directed to impose a new set of policies that included restricting alcohol to specific, supervised locations; requiring advance registration of social events involving alcohol; restricting possession of alcohol to separate residence halls for of-age students; greater penalties for violations; and parental notification of all alcohol policy violations by underage students. Subsequent enforcement levels varied, according to reports from the deans of students. Institutions that had consistently high enforcement levels showed the greatest declines in student drinking. There was no increase in marijuana use during that time.

It is too soon to say that displacement effects are a myth. As the refrain goes, we need more research. At this point, however, the burden of proof now rests with those who would oppose stricter alcohol policies and enforcement, not their proponents.

Harris, S. K., Sherritt, L., Van Hook, S., Wechsler, H., and Knight, J. R. (2010. Alcohol policy enforcement and changes in student drinking rates in a statewide public college system: A follow-up study. Substance Abuse Treatment, Prevention, and Policy, 5: 18.

Saltz, R. F., Paschall, M. J., McGaffigan, R. P., Nygaard, P. M. (2010). Alcohol risk management in college settings: The Safer California Universities Randomized Trial. American Journal of Preventive Medicine, 39(6), forthcoming in December.

FDA Ban Won't End the Problem of Caffeinated Alcoholic Drinks

On November 17, the Food and Drug Administration (FDA) sent a warning letter to four companies that produce caffeinated alcohol energy drinks, stating that the government could begin seizing the products if the caffeine were not removed within 15 days. The FDA had never approved the addition of caffeine to alcoholic beverages, nor could the agency state that the combination was “generally recognized as safe,” as specified by FDA regulations.

Phusion Projects, the makers of Four Loko, announced that they would comply with the FDA’s demand. The other notified companies include Charge Beverages (makers of Core High Gravity HG, Core High Gravity HG Orange, and Lemon Lime Core Spiked), New Century Brewing (makers of Moonshot), and United Brands Company (makers of Joose and Max).

Massachusetts, Michigan, Oklahoma, Utah, and Washington also banned these products, and other states may follow suit.

College-based prevention advocates may applaud these steps, but we should not think that this solves the problem. After all, with easy access to both energy drinks and alcohol, college students can still stir up their own witch’s brew of alcohol and caffeine or other stimulants.

Unfortunately, many college students now believe that mixing high doses of caffeine with alcohol helps counter the cognitive and motor impairments associated with alcohol intoxication. Outside The Classroom’s research shows that many college freshmen have unrealistic beliefs about combining alcohol and caffeine. They see many positive benefits, but grossly underestimate the dangers. Ironically, they hold these beliefs despite reporting that they experience more negative social, academic, and physiological consequences after consuming alcohol with energy drinks.

Clearly, we cannot let up in our efforts to warn college students—often—that drinking alcohol with energy drinks is a dangerous practice.

An overview of Outside The Classroom’s research on alcohol and energy drinks can be found on its website at: http://www.outsidetheclassroom.com/community/tools-resources/alcohol-and-energy-drinks.aspx

To Ban or Not to Ban: That Is the Question

The Michigan Liquor Control Commission acted recently to ban 55 caffeinated alcoholic beverages, including Four Loko, which gained notoriety in late October when nine Central Washington University students attending an off-campus party were rushed to the hospital with apparent alcohol poisoning. Other states are considering whether to follow Michigan’s lead.

The alarm over Four Loko is understandable. This malt concoction contains 12 percent alcohol, and just one can, according to the producer, Phusion Projects, has about the same amount of caffeine as a tall Starbucks coffee. The drink’s fruity flavor masks the alcohol’s taste, and the caffeine appears to mask the alcohol’s intoxicating and depressant effects, enticing young people to consume far more than they can safely drink. Four Loko has rightfully earned the sobriquet “Blackout in a Can.”

Phusion Projects, which announced that it will fight the Michigan ban, argues that caffeinated alcoholic beverages are as old as rum and Coke. It’s true that banning premixed beverages will not prevent young people from mixing vodka with Red Bull, Amp, or any of the other super-caffeinated energy drinks that are on the market. Even so, just because people might choose to stir up a toxic brew doesn’t mean that government regulators should allow the mixture to be packaged and sold.

I’m no fan of Four Loko, but I worry that the Michigan ban and the attendant publicity will drive even more young people to give the product a try. We’ve seen this happen before with illicit drugs. A new drug hits the streets, and a mickle of news stories, each intended to warn about the drug’s dangers, also convey the idea that its use is growing exponentially. Likewise, I’ve seen several news stories describing Four Loko as “popular,” and one even said it was “wildly popular.” If college students didn’t know about Four Loko before, they certainly do now.

Whether or not alcohol energy drinks are banned, it’s clear that college officials need to educate their students, without delay, about the dangers posed by these beverages. New research that Outside The Classroom’s Todd Wyatt and I have conducted may help us figure out how to best approach this task. I’ll have more to say about that next week.

To sign up for Todd Wyatt’s free webinar on college freshmen’s use of alcohol energy drinks, please go to http://www.outsidetheclassroom.com/news-events/conferences/web-conferences.aspx

The Problem is Cheap Alcohol

Would increasing alcohol excise taxes save lives? Yes, according to epidemiologist Alex Wagenaar, a professor at the University of Florida. Based on his analysis of dozens of studies that have looked at the relationship between alcohol taxes and health, a 50 percent tax increase would lower alcohol-related mortality by 35 percent, while also reducing crime, violence, and sexually transmitted disease. The research shows that even modest tax increases would suppress alcohol consumption enough to reduce alcohol-related problems, especially among price-sensitive groups such as teens and college students. 

Doubling the tax rate would be a big hike, but it would still be low by historical standards. According to the Marin Institute, if alcohol excise taxes on beer had been indexed to the inflation rate for the past 40 years, today’s $18 per-barrel federal tax would be near $62, or about $1.05 per six-pack. That means that, relative to other consumer goods, alcohol has become cheaper and cheaper with each passing year.

The alcohol industry’s resistance to any kind of tax increase is formidable. When states legislatures increase state excise taxes, and that does happen every so often, the purpose is not to enhance public health, but the state treasury. Even then, the industry will fight to undo those tax increases.

Consider what just occurred in Massachusetts. For many years, alcohol was exempt from the state’s sales tax, along with food, clothing, and prescription medicines. Needing revenue, in 2009 the state legislature increased the sales tax from 5.00% to 6.25% and removed the alcohol exemption. The new tax on alcohol was the main source of funding for the states alcohol and drug abuse programs. This November, with strong support from the alcohol industry, the voters approved Proposition 1 to eliminate the sales tax on alcohol.

For college officials worrying about student drinking, having low alcohol excise taxes makes the job of prevention that much harder. A former colleague once said to me, “The problem is cheap alcohol.” He had it right.

Wagenaar, A., Tobler, A. L., and Komro, K. A. (2010). Effects of alcohol tax and price policies on morbidity and mortality: A systematic review. American Journal of Public Health.

Available at http://ajph.aphapublications.org/cgi/content/abstract/AJPH.2009.186007v1.

Marin Institute (2010). Alcohol policy: Alcohol excise taxes.

Available at http://www.marininstitute.org/alcohol_policy/alcohol_taxes.htm

Happy (Hour) Halloween

A colleague told me this week that one of her students was especially excited about Halloween this year. Why? It’s four nights, Thursday through Sunday: four parties, four costumes.

October 31 has become a party night for adults and one of the biggest drinking nights of the year, second only to New Year’s Eve. This wasn’t always the case, of course. Why did this change? We have the beer industry to thank for that.

Many of you may not remember Elvira, Mistress of the Dark. In the mid-1980’s, the Coors Beer Company hired Elvira to be their spokesperson, and the link between Halloween and beer drinking was forged. Every Halloween, Coors saw a huge boost in sales thanks to Elvira.

Now, 25 years later, an adult-oriented Halloween seems fully accepted as part of the cultural fabric. Business executives dress up like Tarzan and Jane, and bars, taverns, and liquor stores run huge specials to get the booze flowing.

But there’s another lens through which we can look at the problem of college Halloween parties: environmental management.

Why can that student look forward to a blow-out party on Thursday night? She has no Friday classes, which is the case for the vast majority of the nation’s college undergraduates. Why Sunday night? I suspect because she has no tests or papers due on Monday.

Many campus-based prevention experts understand that the absence of Friday classes has institutionalized the three-day weekend and have pushed for that to change. Unfortunately, faculty resistance is unmovable: their day to work at home or do outside consulting is sacrosanct. Equally unfortunate is the fact that many faculty members will not schedule quizzes or have papers due on Mondays as a “favor” to students who party on the weekends.

And so it goes. Happy Halloween. Oh, and watch out for all the drunk drivers.

Academic Reform: An Alcohol Prevention Strategy

In nine years of teaching at the Boston University School of Public Health, I have given only one student a “failing grade” (C+), and that was because he never turned in one of the assignments.

Grade inflation is built into our grading system. For master’s and doctoral students, a grade below B- means that they have to take the course again, and given the steep tuition bills they face, I’m loathe to make anyone do that. And I think I know how BU would respond if I got tougher. Give too many B’s and I’ll have some explaining to do—or at least that’s what I heard happened to a junior faculty member in my department. I guess if we make it too “hard” to get A’s, then word might get around—and who knows what would happen then, right? Maybe…gasp…enrollment would drop off!

BU’s hardly unique. Recently, a tenured biology professor at a large state university started each class by giving students a brief quiz on the readings. She didn’t grade on a curve, and as a result a lot of students were flunking the quizzes. A top administrator heard the students’ complaints and stepped in mid-semester to remove her from the course.

What does this have to do with alcohol prevention?

According to data provided by UCLA’s Higher Education Research Institute, a typical freshman reports spending only 8.4 hours per week studying. Do the math: if students sleep eight hours per night (a generous assumption), then they are awake 112 hours per week. Students have a great deal of unstructured time, and too much of it is spent drinking.

Students do this, in part, because they can get by with relatively little academic work. Most have little faculty contact, especially in their first year. Most campuses have few or no Friday classes. And grade inflation is rampant everywhere, including (and maybe especially) at our most elite institutions.

We need to combat the forces at work that promote student disengagement and contribute to a lax academic environment that enables high-risk drinking. Academic reform has the potential to help students become better integrated into the intellectual life of the campus, shift perceptions of social norms, and make it easier to identify students in trouble with alcohol.

Academic Reforms for Better Prevention

1. Revise the Academic Calendar

• Hold Friday classes
• Schedule more early-morning classes

2. Promote faculty relationships with students

• Put greater weight on faculty mentoring
• Train faculty to identify and refer students in need

3. Increase Academic Standards

• Tackle grade inflation
• Put greater weight on teaching
  • Demand better quality work
  • Give more feedback
• Increase the number of small seminars
• Require students to do community service

When Will Student Affairs Officials Take a Tougher Stand?

Would college academic departments ever invite students to decide which textbook should be used by faculty who teach introductory physics, or to decide on a reading list for a course on the modern American novel? I hope not.

I’m puzzled, then, as to why so many student affairs departments are eager to get student input on the online alcohol prevention course to be used for first-year students, and in some cases ask an undergraduate student panel to make the final decision. Why does student opinion matter so much? If the students had a public health background, knew the alcohol prevention literature, and understood the advantages and disadvantages of different pedagogical techniques, then maybe that would make sense, but let’s get real: they don’t have those qualifications.

Does it matter to a student panel if the course covers all of the essential content that the research says it should cover? Does it matter if there’s a test to ensure that students taking the course have learned the key content? Does it matter if there is rigorous research that demonstrates that the course is effective in changing drinking behavior? Not so much, but these students do know what they “like,” and that’s usually the shortest program available, to make taking the course as “painless” as possible.

Then there’s the issue of mandating a course. Most student affairs officials are shy about requiring first-year students to complete an online course. They might tell students that it’s required, but then not impose any sanctions if they fail to complete it. Why? Incoming students might not like the requirement, but so what? Some student affairs professionals have even told me that they don’t believe in mandating students to do anything related to prevention. Does this make sense? After all, getting a bachelor’s degree involves passing certain courses. Why can’t a mandated alcohol course be viewed as just another academic requirement?

Sometimes student affairs officials will balk at paying for an alcohol education program because of its cost. Okay, their departments often have an embarrassingly small budget, but couldn’t first-year students pay to take the course? And what about imposing a small student fee—say $20 per semester, or $5 per month—to support all of the college’s alcohol prevention work? Whenever I raise this possibility, most deans of student affairs will shake their head and say that it can’t be done because higher education is already expensive enough and the college’s leadership won’t support it. Is $5 per month really so much to ask? Students who drink heavily can drop $20 at a local bar in less than an hour.

Alcohol is the number one social problem on campus and a leading cause of academic failure. Why are student affairs officials so reticent to take a tougher stand?

Drink Responsibly—Whatever That Means

It’s pro forma for alcohol advertisers to remind their customers to “drink responsibly,” but what does that mean exactly? For years, Anheuser-Busch has told America to “Know When to Say When.” When is that? They never say, of course.      

This vagueness is deliberate. After all, problem drinkers often think that their level of alcohol use is normal and therefore “responsible,” and many drinkers believe they are being “responsible,” no matter how much they drink, if they use a designated driver or take a cab home. A clearer definition of “responsible drinking” might drive down sales.       

At best, telling people to “drink responsibly” is a throwaway line, delivered with no expectation of changing anyone’s drinking behavior. It is, however, an effective public relations tool: the fact that alcohol producers are willing to insert this “prosocial” message into their product advertising takes pressure off the industry to reform their advertising and marketing practices.     

As student health professionals, what can we say about responsible drinking to students who are of legal age? For guidance, we can turn to the US Department of Agriculture’s Dietary Guidelines for Americans.

Importantly, the USDA specifies who should not drink. This includes minors, but also women who are pregnant or trying to conceive, “individuals who cannot restrict their drinking to moderate levels,” “individuals who plan to drive or take part in activities that require attention or skill,” and “individuals using certain prescriptions or over-the-counter medications.”       

The USDA defines “moderate drinking” for women as not more than one drink per day, and for men as not more than two drinks per day. A drink is defined as 12 ounces of regular beer, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits.       

This simple definition of moderate drinking makes good sense, but will students accept it as guidance. Unfortunately, most students will reject the USDA definition as “unrealistic” or “too extreme.”      

Given that, many student health professionals have told students to have no more than one drink per hour. For many young adults, this is sound advice, but not for small women, who at one drink per hour would soon enough have a dangerously elevated blood alcohol concentration (BAC).      

The key, I think, is not to look for a simple, one-size-fits-all rule, but instead to teach students who choose to drink how to keep their BAC in a safer range, well below .04%. To know how to do this, students need to know what BAC is, the factors that affect it, the risk of harm associated with different BAC levels, and a list of strategies for modulating their BAC level.        

Note that I said “safer,” not “safe,” since any amount of alcohol use will elevate risk to some degree, and students need to know that, too. Students also need to be reminded that, as the USDA points out, there are times and circumstances when people should not drink at all.     

This is a complicated message, but that seems unavoidable. Student drinking is a complicated problem, and a simple slogan or advertising tagline won’t help us change student behavior.

Listservs Are Missing the Mark

There are several listservs used by health and wellness staff to pose questions and share ideas. For a while, I read each message that came along, eager to get a glimpse into what campus officials are focusing on and the kinds of technical assistance they need. I was disappointed by what I saw.

Here’s a sample:

A staff member based at a private college asked folks to chime in with examples of what students could say to refuse a drink. I had thought that “No, thank you” might suffice, but there was no end to the “creative” responses that were posted. Here’s one example: “I would, but today is opposite day, so you'll start getting uglier.” Did you like that one? Here’s another: “I'm donating a kidney to my 8-year old cousin tomorrow, and he's already a recovering alcoholic.” Sigh.

An alcohol and other drug (AOD) coordinator sought feedback on an idea for Alcohol Awareness Week: a pong tournament, not with beer, but with Gatorade. Each cup would have a question written on the bottom. After draining the drink, a player “would have to answer the question correctly before moving on to the next player (flip-cup) or removing a cup (pong).” How many objections can you come up with for that idea?

Here’s another posting: “I am curious. Do any other student health centers have a neon ‘open’ sign in the door and if so, how does it look?” I’m thinking that the sign would make a student health center look like a nail salon or a massage parlor. I didn’t bother to read any of the posts that responded to this query, so for all I know I may be alone in that opinion.

Here was a curious, but potentially helpful query: “What is the ‘recipe’ for the magic sore throat wash?” I thought this kind of medical practice had ended with the Enlightenment, but I was wrong. The response came almost immediately: “Pink Magic” has equal parts of liquid Benadryl, Mylanta or Maalox, and Viscous Lidocaine. And now you know.

Here’s my complaint about all this: I’m not seeing any queries that get to the heart of our concerns about student drinking or that focus on evidence-based prevention strategies. Just once, I’d like to see a query about how to get the local police chief to step up off-campus patrols on weekends. I want to read a dialogue about successful strategies for reducing alcohol availability in the community or for dealing with pregaming in residence hall rooms. I’d like to see a request for research that has examined the impact of Alcohol Awareness Week, rather than a request for feedback on a new gimmick to get students’ attention.

All of us face the temptation each work day to get bogged down in trivia that prevents us from doing our most important work. Right now, the listservs are more of a distraction than a help. It’s up to all of us to elevate the dialogue.