Among college students ages 18-24, from 1998 to 2001, alcohol-related unintentional injury deaths increased from nearly 1,575 to more than 1,700—an increase of 6% per college student population. From 1999 to 2002, the proportion of college students 18-24 who drank five or more drinks on at least one occasion increased from 41.7% to 43.7%, a non-significant increase.

However, the proportion who, in the previous year, reported driving under the influence of alcohol increased from 26.5% to 31.4%, a highly significant proportional increase of 18%, from 2,297,550 students to 2,792,716 students. In 2001, 599,000 (10.5%) were injured because of drinking; 474,000 (8%) had unprotected sex because of drinking; 690,000 (12%) were assaulted or hit by another drinking college student; and 97,000 (2%) experienced an alcohol-related sexual assault or date rape.

Because only 32% of the 8,894,000 18-24-year-olds in 2001 in the U.S. were enrolled in college, the total number of 18-24-year-olds nation-wide who died from alcohol-related unintentional injury deaths greatly exceeds the numbers among college students that age, 5,367 compared to 1,717.

Heavy drinking college students not only place their own health at risk, they jeopardize the well-being of others. As many as 46% of the 4,553 people killed in 2001 in crashes involving 18-24-year-old drinking drivers were persons other than the drinking driver, and in 2001, over 690,000 college students were hit or assaulted by another drinking college student, and 97,000 were the victim of a date rape or sexual assault perpetrated by a drinking college student.

Further, new research illustrates that persons who drink to excess even before they enter college were more likely to experience alcohol-related problems in high school and college. This underscores the need for both colleges and the communities in which they are located to implement interventions to reduce excessive drinking and related problems in these populations.

Traffic crashes are the leading cause of alcohol-related death among U.S. college students. I began studying legal and community interventions to reduce alcohol-related traffic deaths more than 25 years ago, with colleagues at the Boston University School of Public Health.

We have published research on the effects of raising the legal drinking age, zero-tolerance laws that make it illegal for persons under 21 to drive after any drinking, lowering legal blood alcohol limits from 0.10% to 0.08%, setting even lower legal limits for drivers convicted of driving while intoxicated, and comprehensive community interventions to reduce alcohol-impaired driving.

More recently, we undertook a series of analyses which found persons who began drinking at younger ages are more likely to experience alcohol dependence, develop alcohol dependence more rapidly and before age 25, and experience chronic relapsing dependence characterized by multiple episodes of longer duration and meeting more dependence diagnostic criteria.

Persons who began drinking at younger ages are also more likely to be injured in motor vehicle crashes after drinking, be in physical fights, and have unplanned and unprotected sex after drinking. We have reported that the younger people are when first intoxicated, the greater their likelihood while in college to be alcohol-dependent, drive after drinking, ride with drinking drivers, injured because of drinking, and have unplanned and unprotected sex after drinking.

In 1994, I was awarded a grant by the Robert Wood Johnson Foundation to review the scientific literature on interventions to reduce college drinking. Then, in 1998, NIAAA established a task force of college presidents and U.S. researchers to review the magnitude and dimensions of college drinking problems and interventions to reduce the problems. I chaired a task force subcommittee examining interventions, wrote a paper on comprehensive community interventions, and also a paper on the magnitude of mortality and morbidity associated with drinking among college students ages 18-24.

The greatest obstacles to making precise estimates of the annual number of deaths associated with college drinking is the absence of identifiers in the Fatality Analyses Reporting System of whether people killed in alcohol-related fatal traffic crashes were college students, and the absence of information on blood-alcohol levels of persons who die from non-traffic injury deaths in the CDC injury mortality files.

Because most fatally injured drivers in fatal crashes are tested for blood alcohol level, researchers can track trends in the incidence of alcohol-related fatal crashes and do quasi-experimental studies that evaluate the impact of alcohol and drinking during law changes and community programs to reduce impaired driving. We lack similar measures for injury deaths other than traffic injuries, e.g., homicides, suicides, falls, drowning, burns, etc.

Injuries are the leading cause of death among persons ages 1-44 in the United States, and alcohol is arguably the leading contributor to these deaths. A recent CDC report estimated that 40,000 injury deaths annually are attributable to alcohol, at least half among persons under 44. Because injury deaths are more likely to occur among young people, the 40,000 alcohol-attributable injury deaths account for twice as many years of preventable lost life as the 35,000 alcohol-attributable chronic disease deaths. Alcohol is the third leading contributor to years of preventable life lost in the United States.

Among college students ages 18-24 and same-age persons not in college, injuries are the leading cause of alcohol-related deaths, accounting for more than 5,000 deaths annually. This total includes people who may not themselves have been drinking, such as persons who die in motor vehicle crashes involving drinking by another person, or victims of assaults perpetrated by persons who were drinking.

Colleges and surrounding communities need to implement or expand initiatives to reduce excessive college drinking and the harms these drinkers inflict on themselves and others. Research is needed to expand our understanding of how to reduce these problems. The NIAAA, which supported me and my co-authors of this paper through a Research Center Grant to Prevent Alcohol Problems among Young People, currently funds more than 50 research projects totaling more than $18 million annually.

As noted in this article, several interventions have already been identified that can reduce college drinking and related harm. New interventions may also be identified through the currently funded research. As colleges and communities attempt to curb excessive drinking and related harms among college-age individuals, they should strive to implement programs and policies identified through rigorous empirical research to successfully address this important national public health problem.