TOPICS > Health

Extended Interview: Binge Drinking on Campus

April 1, 2002 at 12:00 AM EDT

TRANSCRIPT

SUSAN DENTZER: Dr. Kington, tell me a bit about why the institute empanelled this task force in the first place.

DR. RAYNARD KINGTON: This task force was formed in response to the recognition both within the research community and within the community of college and university presidents. There was a strong need to bring the best science that we can to understand both the scope and the consequences of college drinking, as well as to assess the effectiveness of interventions to prevent and treat the problem.

SUSAN DENTZER: And so how did the group decide to do that?

DR. RAYNARD KINGTON: The task force was formed in 1998. It was a unique task force in that it was a coalition of university and college presidents, researchers and students, who met over the course of three years. We empaneled them to review the scientific evidence and to really bring that evidence to bear on what we can say to university and college presidents, to parents, to students, about what works in addressing the problem, and we have been extraordinarily pleased with the result. We think this will be a ground-breaking report.

SUSAN DENTZER: The task force has used the word “crisis.” Is this in fact a crisis, excessive college drinking?

DR. RAYNARD KINGTON: We’ve known for many years that there was a problem, and we have evidence really dating back for decades that there’s been a problem with drinking on college campuses, but we’ve never been able the really describe the parameters of the problem, how big of a problem it is.

I think that that’s the great advantage of doing this type of research. Every college might have one problem here or there, and one tragedy every several years or so, but what we wanted to do was step back and look at the big picture. And in doing that, we recognized that the problem was truly enormous.

And I think that even the researchers who were involved from the very beginning were surprised by some of the conclusions, just the magnitude of the problem is really enormous.

SUSAN DENTZER: We’ll talk in a moment with Dr. Hingson about some of the specifics of that, but I want to zero in on one fundamental point that the task force has made, which is that this is all about a culture. In fact the word “culture” appears in the actual title of the task force’s report. What do you all mean when you say “culture?” What did the task force mean when it said “culture?”

DR. RAYNARD KINGTON: Well, that word was chosen very carefully to really convey the idea that students and colleges don’t exist in isolation, they exist in communities; that really in order to address the problem you have to intervene at multiple levels, both at the individual level, counseling when appropriate, and targeted interventions geared towards specific students at the university level, looking at an entire body of students with regulations and involvement of university administrators.

But also looking at the broader societal context, because students don’t just appear at college. They come to college having had experiences in high school, having a certain understanding of how the culture perceives drinking. And one of the real forces that we’re up against is a sense of complacency, that this is inevitable, that there’s nothing that we can do, when in fact there’s a great deal that we can do. We have shown that there are effective interventions that can address the problem, and that we can provide tools that are based on the best available science on what works.

So the sense of complacency is a real problem, and that’s why we particularly see this both as a crisis, and we think it’s important that we recognize that this issue must be seen from the context of the broader society.

SUSAN DENTZER: One of the points that the task force has made is that much more research needs to be done on evaluating treatments that have applied other contexts, and testing out how well they could be applied to the college student and college community.

What from the agenda of the institute are the most important things that ought to be done going forward?

DR. RAYNARD KINGTON: Probably the area of research where we most need better information is how to in change–change the broader culture, how to change the environment. We have pretty good information on some interventions that work at the individual level.

But really pulling together communities and colleges, and in a rigorous way assessing interventions that span this whole spectrum is the big challenge, and we plan to fund initiatives specifically targeting interventions that really require a coalition–coalitions formed among administrators, students and communities to try to intervene at all 3 levels, and that’s the area of research where we know the least and where we think that there is great potential for really having strong interventions that are very effective.

SUSAN DENTZER: I know that efforts like that have been under way over the last couple years at places like Penn State, where President Graham Spanier has been vocal on the need for these approaches. Has much of that gone on, or are you basically envisioning a situation where you’ll create more opportunities to study that as this goes forward?

DR. RAYNARD KINGTON: Well, we know that universities and colleges have been trying at all different levels to try to address this problem. What is missing though is the rigorous evaluation of what’s being done, and that’s the part, that that’s extraordinarily important so that if something works in a particular setting, that we can understand why it works, and then we can understand whether it might work in another setting, and how we might adapt it to another setting.

So they are definitely having efforts that have crossed these 3 different levels, but what’s been missing is rigorous science, looking at critical evaluations of what works and why certain interventions work in certain settings and not in other settings, so that we can give a tool kit, if you will, to university administrators, and students and parents, and communities, about what works at all 3 levels.

SUSAN DENTZER: And how much do you think the institute will expend on this effort going forward in terms of funding more research and so on?

DR. RAYNARD KINGTON: We’ve already committed several million dollars to this effort, and both in fiscal year 2002 and 2003 we’ve committed to issuing requests for applications on this specific topic, again, in particular focusing on interventions that span these levels, particularly the interventions that require involvement of communities, and focus on changing the environment.

SUSAN DENTZER: Would you elaborate on what the task force meant when it called for “3-in-1″ types of interventions?

DR. RAYNARD KINGTON: The 3-in-1 framework means that you can’t just work at one level to address this type of problem. You need to work at multiple levels, at the level of the individual student, at the level of the university or college, and at the level of a broader community, and that we’ve learned repeatedly in public health that working at just one level doesn’t work very well when you’re trying to change behaviors, particularly behaviors that have strong cultural reinforcements.

And so we need to really intervene at multiple levels. We have this 3-in-1 approach because we’ve learned over and over again that if you intervene at just one level, you just aren’t as effective as if you–compared to when you interview at multiple levels.

SUSAN DENTZER: Dr. Hingson, we’ve known for years, by virtue of the College Alcohol Survey and other things, that there was a lot of heavy episodic drinking going on on campus. What are the conventional assumptions that we’ve made on the basis of these about how heavy the rates of binge drinking or heavy episodic drinking are on campus?

DR. RALPH HINGSON: The national surveys that had been done by Dr. Henry Wechsler at the Harvard School of Public Health, College Alcohol Surveys, and other surveys as well, indicate that over 40 percent of college students engage in binge drinking. He defines binge drinking as 5 drinks on an occasion for a man, and 4 drinks on an occasion for a woman.

And he’s found that these very heavy episodic drinking rates have remained relatively constant over the last decade. One of the things that we’ve tried to do is to find out, well, how many people really is that? How many are we talking about? And then also learn more about what proportion of unnatural deaths, unintentional injury deaths college students involve alcohol.

Part of the issue that Dr. Kington raised about needing rigorous research to find out what types of environmental and campus community interventions will make the most difference, part of the reason that we have not had that information to date is that there has not been systematic testing of all unnatural deaths in the United States for alcohol, and that’s something that is very important to establish a baseline to understand the magnitude of the problem, and also to be able to measure change over time to see whether or not if states or communities adopt certain programs and policies, whether or not they can bring those numbers down relative to areas that don’t adopt those policies.

So establishing a good solid measurement base, testing all fatally injured drivers and all people who die and other unintentional injuries for alcohol is very important to do, and then identifying ones that are not the people who die in these instances are college students or not. Most of the data sources, fatality analysis reporting system and the mortality data indicate the age of individuals, but they don’t indicate whether or not they’re in college or not. And until we have that information, it will be very difficult for us to get the most precise estimates of what the magnitude of the problem is and what impact our interventions are having in trying to reduce the deaths associated with excessive alcohol consumption.

SUSAN DENTZER: We were given a statistic several years ago about there being, roughly speaking, 30 deaths on campuses every year due to excessive alcohol use. Tell me what that statistic meant.

DR. RALPH HINGSON: That statistic probably focuses on alcohol overdose deaths, but actually that’s only a very small part of the mortality toll that was taken by alcohol among young people.

In the United States last year, among 18 through 24-year-olds, there were 3,900 alcohol-related traffic deaths, so a much larger problem. About a third of people that age are enrolled in college. We found through national surveys, a national household survey on drug abuse, interviewed nearly 7,000 18 to 24-year-olds, and found both in college and outside of college that the college students were engaging in heavy episodic drinking, a larger proportion were than the non-college respondents the same age, 42 percent versus 38 percent. And more of the 18 to 24-year-olds who were in college were driving under the influence of alcohol in a given year than the non-college, a greater proportion, 27 percent versus 20 percent. So–

SUSAN DENTZER: Let’s stop right there. In effect, it looks as if being in college is a separate risk factor for heavier drinking; is that right?

DR. RALPH HINGSON: I think it’s fair to say that college students, a greater proportion of college students are drinking more than same age non-college students, so, yes, I think that that’s a reason why–one of the many reasons why we’re concerned about college drinking and want to involve colleges with the communities that they reside in, in intervention efforts to reduce these problems.

SUSAN DENTZER: You said that the survey data showed that college students are also driving under the influence of alcohol more than non-college students in the same age bracket do.

DR. RALPH HINGSON: Yes, a greater proportion of college students report driving under the influence of alcohol in a given year than same-age non-college students.

SUSAN DENTZER: To come up with the estimates in your study, you had to assemble a number of different data sources. Which data sources did you pull together for the first time?

DR. RALPH HINGSON: We looked at the U.S. Department of Transportation Fatality Analysis Reporting System. This is the reporting system that looks at all fatal traffic crashes and traffic crash deaths in the United States. We looked at the Centers for Disease Control mortality statistics for unnatural deaths, unintentional injury deaths. We looked at the U.S. Census Bureau data on how many 18 to 24-year-olds there are in the United States.

We looked at the Department of Education data on how many college students there are full time and part time in 2-year and 4-year colleges.

And we also looked at a analysis published by Gordon Smith in “Annals of Emergency Medicine” that examined 20 years of medical examiner studies published in the scientific literature, looking at the proportion of unintentional injury deaths that were alcohol related.

Then we looked at several–3 national surveys that had been conducted, the Centers for Disease Control 1995 College Youth Risk Behavior Survey, the Harvard School of Public Health College Alcohol Survey in 1999, and then the 1999 National Household Survey on Drug Abuse.

Combining data from all of those different sources, we derived estimates of how many unintentional injury deaths and traffic deaths each year among college students are alcohol related, and then we also made projections, based on the survey results, about how many people were driving under the influence, how many people were injured because of their drinking. We made projections of how many students that really amounted to.

SUSAN DENTZER: And let’s begin to break all that down. How many unintentional deaths did you project were occurring in a year?

DR. RALPH HINGSON: We estimate that there are 1,400 unintentional injury deaths among college students 18 to 24 each year in the United States. Probably about 1,100 of those deaths are traffic deaths. The others are drownings, falls, burns, overdoses and so on.

We estimated, based on the survey results, that there are over 2 million college students each year who are driving under the influence of alcohol, 3 million who are riding with a drinking driver. Half a million are unintentionally injured because of drinking. 600,000 are assaulted by another college student who had been drinking. 400,000 are having unprotected sexual intercourse because of their drinking. 100,000 having intercourse when they were so intoxicated that they couldn’t consent. And 70,000 victims of date rape or assault.

So the magnitude of these problems among the college population is really very high, and it should be a clarion call for us to try and develop interventions to try to reduce these problems. And one of the–I think one of the important points of the task force that was put together is that there are interventions at the individual level and also at the environmental level that can–and the community level, that can address these problems.

At the environmental level, for example, enforcing the age 21 law will clearly make a difference. Adopting or lowering legal blood alcohol limits down to .08 can make a difference. Having primary enforcement safety belt laws can reduce alcohol-related traffic deaths. Administrative license revocation; increasing the price of alcohol; reducing outlet density; the numbers of stores and bars and restaurants that sell alcohol in a given geographic area or per population.

All of those interventions can make a difference. And there have been a number of comprehensive community programs that involve multiple departments of city government, the health department, the police department, the school department, parks and recreation, working with private citizens, have been found to reduce alcohol-related problems among college-age youth.

There have been studies that have shown remarkable reductions in the proportions of outlets that will sell to young people, alcohol to young people under 21, the proportion of young people who will attempt to purchase alcohol under 21. The one study by Alex Wagner in “Journal Studies on Alcohol 2000″, 25 percent reduction in the proportion of 18 to 20-year-olds attempting to purchase alcohol, and a 7 percent reduction in consumption.

They’ve also, these type of community interventions have also produced reductions in admissions to emergency departments for alcohol-related assaults. Hal Holder’s Community Trials program out in California produced a 42 percent reduction in alcohol-related assaults, admissions to emergency departments. A program we were involved in in Massachusetts produced a 42 percent reduction over a 5-year period in alcohol-related traffic deaths, again, a comprehensive community intervention program. So one of the things that we hope will come from the task force is a recognition that communities can work together with campuses to address these problems.

If the colleges try to do this alone, it’s simply going to drive the problems out into the community. Conversely, if the communities address the problem and the campuses don’t, it will drive the problem back onto the campus.

What we really need to test out and to try to implement are comprehensive campus community interventions, where both groups are working together with parents and with concerned citizens to try to reduce these problems.

SUSAN DENTZER: Were you surprised at the numbers your own study unearthed on this?

DR. RALPH HINGSON: Quite frankly, it was a wake-up call to me too, that really the magnitude of this problem is very large. It’s not only college students. Even though college students are more likely than same-age respondents to report these behaviors, people 18 to 24 are disproportionately at risk for unintentional injury deaths.

Among the college students 18 to 24 we estimated that there were 1,400, but if we look at all individuals that age, there probably are 3,200 alcohol-related unintentional injury deaths, which is yet another reason why we need to involve the communities to address this. It’s not just college students, but it’s young people at large.

Unintentional injuries are the leading cause of death in the United States from ages 1 through 34, and traffic crash is the leading cause of death from ages 1 through 24. These are the leading causes of death among young people in the United States.

Last year there were over 90,000 unintentional injury deaths in the United States, 16,000 alcohol-related traffic deaths, or alcohol related, approximately 50,000 injury deaths are alcohol-related each year in the United States.

So these are problems that affect college and affect the community and the nation at large.

SUSAN DENTZER: I was struck by the projection that there are 2 million college students driving around under the influence every year.

DR. RALPH HINGSON: We derive that estimate, 27 percent of college students 18 to 24 in our National Household Survey on Drug Abuse reported driving under the influence in the past year. There are 8 million college students at 2 and 4-year colleges in the United States. You multiply–or 27 percent of 8 million is the 2 million that we’re talking about.

SUSAN DENTZER: And the projection that 600,000 students a year report being assaulted by other students who are drinking – how did you derive that?

DR. RALPH HINGSON: That estimate was derived from the College Alcohol Survey that was of full-time 4-year college students. And those students said that they had been hit or assaulted by another student who had been drinking at the time. So it was 600,000 students saying that another drinking student had hit, pushed or assaulted them since the beginning of the school year.

SUSAN DENTZER: What do we know about the degree to which all of this affects the academic experience of students, even of students who are not drinking so heavily?

DR. RALPH HINGSON: Well, if one looks at the college alcohol survey, and others as well, many students say that their study is interrupted, that they fall behind in school work as a result of their drinking, and there have been some of the surveys that have found a relationship between the amount of consumption and lower grade point averages, the [so-called] CORE survey done at the University of Illinois, for example. So there’s every reason to believe that these behaviors are undermining the very purpose of our higher institutions of education.

And we want to make sure that young people, who have this wonderful opportunity to go to college and go to universities, will be able to take full advantage of that, and we’re concerned that alcohol consumption, the problems that it causes the individuals who are consuming the alcohol, and also the problems that those not necessarily consuming the alcohol but who have to live in an environment with those who are, are experiencing that may pose a detriment to their education.

SUSAN DENTZER: I mentioned that we had interviewed the father of the young man who died recently here at the University of Maryland, whose father told us that the young man’s blood alcohol level taken in the hospital after he was taken to the hospital unconscious, was .5.

Walk me through this business about blood alcohol content, and give me a general sense of how much the young man would have had to have drunk to have a blood alcohol content that high.

DR. RALPH HINGSON: An enormous amount of alcohol needs to be consumed to reach a blood alcohol level that high. The legal blood alcohol limit in most states in the United States now is .08 percent.

I would have to consume 4 drinks in an hour on an empty stomach in order to reach a blood alcohol level of .08, and I weigh about 160 pounds. A 135-pound woman would have to consume 3 drinks in an hour to reach a blood alcohol level of .08. We’re talking about 6 or 7 times that level of alcohol. We know that at .08 virtually all drivers are impaired. There is an 11-fold increased risk of single vehicle fatal crash involvement at a blood alcohol level of .08 among all age and gender groups. Among young people, 16 through 20, particularly males, it’s a 53-fold increased risk.

So you could imagine what the risk would be, for example, just of fatal crash involvement on a blood alcohol level that’s 7 times the legal level of intoxication.

SUSAN DENTZER: Let’s go back and talk a little bit more about some of the interventions that have been shown to work. What is one that you think could serve as a very good model for this kind of multi-pronged 3-in-1 approach that the task force says is necessary.

DR. RALPH HINGSON: Well, there are several types, and what I’d like to do is to talk about, a little bit about each type.

First there are individually oriented interventions, counseling people who are identified to be at high risk because of their drinking problems. The most effective of those interventions have been in emergency department and trauma center things.

Larry Gentilillo (ph) did a study at the Harborview Trauma Center, where they screened all of the people admitted to that trauma center for alcohol. They found that 46 percent had been injured under the influence of alcohol. They then did an experimental study where they randomly allocated half of them to receive a brief 30-minute intervention, where they were told how their drinking compared to people of the same age and gender nationally, what their increased risk of injury and medical problem was if they continued to drink at the level that they were when they came into the trauma center, and then where they could obtain help.

A year later those in the intervention group, relative to the control group, were averaging 3 drinks less per day, over a 3-year period had 23 percent reduction in drunk driving arrests, and over a 3-year period had a 47 percent reduction in emergency department admissions for injury, and a 48 percent reduction in admissions to the trauma centers for injuries.

So catching people at a teachable moment, when they’ve just been injured because of their drinking, has great promise, and there have been a number of brief intervention studies, not only done with the general adult population, but with adolescent populations.

Peter Monte (ph) at Rhode Island Hospital found very similar results. And there have been a number of brief intervention studies focusing on high-risk college students. Allen Marlot (ph), Mary Wearmer (ph), John Baer (ph), just to name a few. Mark Goldman (ph), one of the task force members who was co-chair had been involved in this research that consistently shows in rigorous experimental studies that brief intervention and counseling approaches of various types have an effect focusing on individuals.

At the environmental level, there are interventions such as lowering the legal blood alcohol limit from .10 to .08. Primary enforcement safety belt legislation, those are laws that permit the police to stop a vehicle simply because somebody in the vehicle is not belted. Studies of–in California when that legislation was adopted, showed that it increased safety belt use, not only among the general population, but also among people who were driving after drinking, and heavy drinking, actually even greater increases in the proportion of occupants that were wearing belts among the heavy drinking population and the youthful population. So that can save a lot of alcohol-related deaths.

Mandatory treatment for people who have been convicted of drunk driving is another example. Increasing the price of alcohol may have a particular impact on young people because they have less discretionary income, both in returns of reducing drinking and reducing alcohol-related traffic deaths.

SUSAN DENTZER: Let’s talk about any evidence that raising the prices of drinks around college campuses, or other interventions to raise the price of alcohol, makes a difference.

DR. RALPH HINGSON: There have been a number of econometric studies that have shown that the higher the price of alcohol, the less consumption there is, and the most pronounced effects are among young people who have less discretionary income.

Another intervention that I think is very important to talk about is raising the legal drinking age to 21. Back in the 1970s, when a lot of states lowered the legal limit, there was about a 10 percent increase in traffic–alcohol-related traffic crashes among young people. This is according to a review of over 50 studies that the Centers for Disease Control just published this past year. When states reversed that and started to raise the drinking age to 21, there was a 16 percent reduction in alcohol-related crashes among young people.

The National Highway Traffic Safety Administration estimates that 700 to 1,000 young people each year or deaths are prevented as a result of the drinking age being raised to 21. Nearly 20,000 traffic deaths have been prevented. I think that’s an underestimate actually of the overall lifesaving benefit of this legislation, because it doesn’t take into account other unintentional injuries, homicides and suicides that are often alcohol-related.

That’s not to say that alcohol is the sole cause of these problems. It’s much like the Titanic. 10 things had to go wrong for that ship to sink. There’s a multiple web of causation, but if one can break the web at any given point, for example, by taking alcohol out of the equation, then one can prevent these injury deaths from happening.

Another reason why I think that’s an underestimate is we’ve learned from a study sponsored by the National Institute on Alcohol Abuse and Alcoholism that the earlier young people begin to drink, the more likely they are to develop alcohol dependence, even after controlling for whether or not they’re alcohol dependent, in other words, looking at people who don’t development dependence or don’t drink heavily frequently. Those who start drinking at a younger age are much more likely to engage in other behaviors that pose risk of injury and death.

For example, based on the National Longitudinal Alcohol Epidemiology Study of over 40,000 people nationwide, those who began to drink at age 14 or younger, relative to those who wait until they’re 21 or older, are 12 times more likely to be unintentionally injured under the influence of alcohol, are nearly 11 times more likely to be involved in physical fights after drinking, and are 7 times more likely to be in motor vehicle crashes because of drinking.

And this is true not only when they’re adolescents, but it’s true when they’re adults. The survey asked did any of these things happening the past year. The average age of the respondent in the survey was 44, and they found the same pattern or relationship.

So it appears that raising the drinking age and efforts to reduce underage drinking may have benefits, not only reducing injuries and deaths among people when they’re under the age of 21, but there may be carryover benefits into adult life.

SUSAN DENTZER: So when students say–and I should emphasize not just students, because you frequently hear this from others as well — that the problem is the drinking age of 21, how do you respond?

DR. RALPH HINGSON: Well, clearly the data in the United States indicate that that’s incorrect, that when the drinking ages were raised, there were reductions in drinking and reductions in alcohol related traffic deaths and other unintentional injury deaths.

People often cite the European example as they have a belief that European young people learn to drink more safely than young people in the United States. There is a very interesting multi-country study done in Europe in 1995, over 20 countries young people were surveyed, using the same questions as are used in the United States in our National Monitoring the Future Study of high school seniors.

They found that in those 20 European countries more young people, again, a greater proportion of young people began to drink at younger ages. But they also found that at least half of those countries, more of them drink to intoxication than young people in the United States.

So the European approach has not necessarily gotten it figured out. It’s not true that young people in Europe don’t have drinking problems, and in fact, the most recent multi-country study completed by the same group in Europe, published a month or so ago–the survey was done in 1999–revealed that in half of the European countries, drinking rates and drinking to intoxication among young people increased even beyond the 1995 study.

So the notion that people can learn to drink at younger ages is–is simply not correct. Raising the drinking age to 21 saves lives. It prevents unintentional injuries and a myriad of health problems among young people. And those are the leading cause of death among young people in the United States.

I certainly want to make sure that people understand that these are things we can be doing to reduce the problem. In 1984 Congress passed legislation that would withhold highway funds from states if they didn’t adopt age 21 as the legal drinking age. By 1988 all states had adopted that law.

In 1982 the National Highway Traffic Safety Administration first started recording alcohol involvement in fatal traffic crashes. Since 1982, among 15 through 20-year-olds, there has been a 59 percent reduction in alcohol-related traffic deaths, from 5,300 in 1982 to just over 2,000 this last year. The greatest decline in alcohol-related traffic deaths in any age group has been among those 15 through 20.

Back in 1982 that was the group with the highest proportion of fatal crashes that were alcohol related. Now it’s the age group in the country with the lowest proportion of fatal crashes that are alcohol related.

SUSAN DENTZER: To what degree have colleges and universities inherited this problem from high schools? You mentioned earlier that the predisposition, the higher predisposition of students to have problems later in life with alcohol, they started sooner. To what degree are colleges and universities just stuck with problems that begin at the high school level if not sooner?

DR. RALPH HINGSON: I think there’s good evidence that many of the students who come to college had developed heavy drinking patterns even before they enrolled in college. And so I think that underscores the need for the communities and the states in which these colleges reside to engage in programs and activities to reduce underage drinking. Otherwise, it just percolates up into the colleges, and the colleges by themselves can’t alone address this and correct these problems. Really, I think one of the underlying conclusions and central themes of the task force report is that this is going to require campus and community cooperation if we’re really going to most effectively address these issues.

SUSAN DENTZER: And now let me come back to Dr. Kington. Are college presidents, are the leaderships of colleges and universities, taking this problem seriously enough?

DR. RAYNARD KINGTON: I think most college presidents know that there’s a problem. They didn’t know how big of a problem, and we helped inform them about how big the problem is.

But they need tools. They need to understand what to do, and I think most college presidents want to do the right thing.

This task force report really can be thought of as a tool kit that we can give to college presidents so that we make it easy for them to do whatever can be done that’s effective to problems on this–along this–with this particular problem.

So college presidents I think are–are interested. They are engaged, and we hope to provide them with the tools so they can make the best decisions about what to do, and make the decisions about interventions that are likely to have the most effect.

DR. RALPH HINGSON: With regard to the estimates of fatalities, I think I would like to emphasize that when we were making these estimates, we had some assumptions, but every assumption that we used, we tried to produce the most cautious or conservative estimate. For example, when we assumed that college students are involved in about a third of the alcohol-related traffic deaths among 17 to 24-year-olds, we made that assumption even though they’re a third of the 18 to 24-year-old population, even though college students report driving under the influence, a greater proportion report driving under the influence of alcohol in a given year than non-college students.

When we made estimates about other unintentional injury deaths, we assumed that the proportion of unintentional injury deaths that were–involved alcohol, alcohol was present, was the same among 18 to 24-year-old college students as it was among–the coroner studies tell us among adults of all ages. That’s probably a conservative estimate because you know that 18 to 24-year-old college students are much more likely to drink and drink heavily than the general adult population.

To illustrate, 38 percent of the unintentional injury deaths involve–among all ages, involve alcohol, and that’s the proportion of college unintentional injury deaths that we assumed involve alcohol. Yet when we look at the fatal crash, traffic crash data among 18 to 24-year-olds, actually it’s 49 percent that are alcohol related. So we used the 38 percent figure which is–and 38 percent of traffic deaths among all ages are alcohol related. So the 38 percent figure that we used in our assumption or in our projection is probably quite conservative.

So if anything, we feel that our estimates have been conservative, and the numbers may even be larger than the 1,400 unintentional injury deaths among 18 to 24-year-old college students that we projected in our analysis.

SUSAN DENTZER: How much larger?

DR. RALPH HINGSON: It’s a good question and I can give you one response to it.

I should point out that we looked only at college students who are 18 to 24. If we had included all-aged college students, then our estimate of the numbers of deaths would have increased from 1,400 to over 2,000 unintentional and traffic deaths involving college students.

If we looked at all young people, age 18 through 24, not just the college students, again, the numbers of unintentional injury deaths would rise from 1,400 to 3,200.

The number is so large that it ought to be of great concern to college administrators, to parents and to the communities in which they reside.

SUSAN DENTZER: What if anything do you think are the weaknesses of your study?

DR. RALPH HINGSON: Well, I think that even though we tried to make conservative assumptions, use conservative assumptions in making our projections, that what this country really needs to do is to test every motor vehicle crash death and every unintentional injury death to find out if alcohol is present.

Until we do that, we won’t have a–we won’t be able to have the most accurate estimates of the problem, and we won’t be able to monitor change and monitor whether or not program and policy interventions that are adopted by some colleges or some communities, not adopted by others, make a difference, and produce greater reductions in alcohol-related traffic deaths and other unintentional injury deaths than would be done in areas where these interventions are not being applied.

SUSAN DENTZER: And roughly speaking now, how many motor vehicle deaths a year do include a test to determine blood alcohol content?

DR. RALPH HINGSON: The testing is most comprehensive with fatally-injured drivers. They can’t refuse. The–so about 70 to 80 percent of fatally-injured drivers are tested each year. The surviving drivers, the percentage is more around 25 percent. It’s high enough that the National Highway Traffic Safety Administration has developed estimate–estimation procedures.

They look at the characteristics of fatal crashes where they know alcohol is involved, and then they look at those characteristics, the type of driver, the time of day, day of the week, whether safety belts were being used and so on. And they can project the proportion of other fatal crashes that are alcohol related with a high degree of accuracy.

They go to states that have a high comprehensive level of testing, use this algorithm that they’ve developed, and then project onto some other states where there’s also high testing, and try and estimate–not by the test result, but by the other characteristics–and then look at the actual test results, they come within a percentage point or two in each given state.

That particular methodology has been invaluable in helping us to understand what legal interventions make a difference in reducing alcohol-related traffic deaths. We need to do the same sort of thing with other injury deaths, homicides, suicides and other unintentional injury deaths, the falls, the drowning, the burns and so on. When we start to do that, then we can–will be in a much better position to understand what types of interventions colleges and communities can implement to reduce those totals.

DR. RAYNARD KINGTON: The National Institute on Alcohol Abuse and Alcoholism has been funding research in this area for some time, but our research is of limited value if it doesn’t affect what happens in the real world. And we see efforts such as this task force report as being essential and part of our obligation to make sure that people in real world settings, trying to solve problems related to alcohol, have access to the best available scientific evidence.

And we see this as part of our responsibility at the institute.

SUSAN DENTZER: Thank you both very much.