Off-Campus Strategies (Promising But Little or Mixed Evidence of Effectiveness)

Theory Behind the Strategy

Access to free alcohol, including samplings and tastings, increases the availability of alcohol, which contributes to increased use and related harms.

Evidence of Effectiveness

To our knowledge, no studies have assessed the impact of providing free alcohol, alcohol samplings, or tastings on alcohol use.

For persons under the MLDA of 21 in Maryland, the use of false identification (ID) to obtain alcohol is a criminal offense. Penalties may include a driver’s license suspension through a judicial procedure.¹⁹⁵

Theory Behind the Strategy

Owning a false ID is associated with likelihood of heavy drinking.^323,324 False IDs are obtained by tampering with one’s own ID, using one from someone of legal drinking age, or ordering false IDs through multiple internet sites and/or friends and peers Penalties for using false IDs are intended to prevent people under the MLDA from being able to access alcohol from commercial sources.

The use of false IDs is common among underage college students³²⁵ and the probability of having one increases over the course of freshman and sophomore year.³²³ The ability to successfully purchase alcohol with a false ID might vary across cities, and even at the neighborhood-level.³²⁶ Because false ID use can facilitate more frequent drinking, longitudinal research has found that it can increase the risk of developing an alcohol use disorder.³²⁷

Evidence of Effectiveness

The first known study to assess the effects of false ID laws on underage alcohol use found that false ID laws that incentivize bar owners and retailers to use electronic scanners to verify patron age significantly reduce underage drinking by as much as 0.22 drinks per day on average.³²⁸ Another recent study found that false ID laws that prohibit the manufacturing or selling of fake identification to underage youth were associated with significant decreases in underage drinking-driving crash fatalities.³²⁹

Tips for Implementation

In a national survey, more than half of college students supported stricter penalties for using false IDs to buy alcohol³³⁰ while another survey found less than 18% reported using a false ID.¹⁸⁰ However, in a survey of more than 1,000 underage college students who had used false IDs, fewer than 30% reported getting caught.³³¹ It can be assumed that the majority of false ID owners have used it more than one time so the chance of getting caught is substantially less than one in three. To this end, rather than making the penalties more severe, a more effective way to deter underage persons from using false IDs would be to increase their perceptions of the certainty of getting caught.

OJJDP offers further enforcement tips in the Law Enforcement Guide to False Identification and Illegal ID Use.

Theory Behind the Strategy

Shoulder tapping is a law enforcement campaign where underage individuals (under the supervision of law enforcement) ask patrons who are of legal age at off-premise alcohol outlets to purchase alcohol for them from grocery, convenience, or liquor stores. The adults who purchase for the youth are then cited for providing alcohol to a minor.

Evidence of Effectiveness

Student focus groups at the University of Minnesota suggested that shoulder tapping is not very common.³²⁵ A recent survey of local U.S. law enforcement found that fewer than half (42%) of local agencies conduct enforcement strategies that target adults who provide alcohol to underage youth.³³² In addition, at least one small study suggested that the majority of people who receive a request to buy alcohol for an underage stranger will not do so.³³³ Another survey of current or recent college students ages 22 to 26 who were approached at least once since turning 21 by minors seeking alcohol found that few young adults provide alcohol to acquaintances or strangers (21% and 4%, respectively).³³⁴

Tips for Implementation

Given the relatively small likelihood of underage college students obtaining alcohol through shoulder tapping, these campaigns, as an isolated strategy, have limited potential to effectively address underage access to alcohol.

Theory Behind the Strategy

Responsible Beverage Service (RBS) training programs are intended to teach owners, managers, and other servers at alcohol establishments how to serve responsibly and abide by legal codes, such as not selling to obviously intoxicated patrons or those under the MLDA, to reduce alcohol-related harms.

Maryland law requires a licensee or an employee designated by the licensee to be trained in a certified alcohol awareness class that includes RBS training. In a half-dozen counties, the licensee or a designated employee in a supervisory position must receive the training and be on premises when alcohol is being served. This training teaches servers to check for IDs in order to not sell to underage youth as well as not serve obviously intoxicated patrons. Serving alcohol to a minor is a misdemeanor offense and punishable by fines up to $1,000 and imprisonment of up to two years. It is up to the local law enforcement agency, often in consultation with the state’s attorney, to determine whether to charge the individual server, the licensee, or the manager for service to a minor.

Evidence of Effectiveness

Research has found that RBS programs do not consistently contribute to reductions in alcohol use and related harms; however, they might play an important role in the effectiveness of enforcement of other strategies to prevent excessive drinking.^247,335 There is great variation across RBS programs, with some aimed at servers and bartenders and others designed for managers and owners. Because there are no established standards for RBS, programs differ substantially in quality and likely impact.³³⁶ High turnover in alcohol service staff, combined with the challenges of scheduling regular training means service staff are often not trained, even in states that require training or incentivize training through insurance discounts.

Server and manager training might have some effect if it is not used as an isolated strategy. The potential for lack of enforcement of RBS training (e.g., managers might not actually require the training) offers an explanation for the lack of evidence of effectiveness.

Tips for Implementation

Servers can be required to have a license to serve alcohol. Being licensed, as well as completing training, should be combined with other strategies. Compliance checks by law enforcement officials can help to enforce more responsible alcohol service practices by both servers and managers. Servers, managers, and alcohol outlet license holders should be subject to fines and penalties for facilitating illegal alcohol sales.¹⁷⁵

For further tips on implementation, OJJDP has made available a Guide to Responsible Alcohol Sales.

The minimum age of sellers differs across states and localities for on- and off-premise locations and by beverage type, ranging from age 18 for beer and wine to age 21 for spirits (off premise and bartenders) and 18 for on-premise servers of spirits. Maryland explicitly allows for exceptions by specific localities for more or less restrictive laws on the age to sell or serve alcoholic beverages.¹⁹⁵

Theory Behind the Strategy

Research has found younger servers are more likely to sell to underage or already intoxicated patrons, due either to their inexperience or their propensity to sell to people of similar age.^337,338 Sellers and servers of alcohol are often under the MLDA. One study in the Midwest found that underage patrons are more successful at purchasing alcohol when the server looks young (e.g., under the age of 30).³³⁸ Similarly, servers who appeared young served pseudo-intoxicated patrons more frequently.³³⁹

Evidence of Effectiveness

To our knowledge, there are no published studies evaluating the impact of a minimum age of sellers’ law.

Tips for Implementation

As part of a more comprehensive RBS training, strategies can be developed to train sellers and servers about the risks of providing underage or intoxicated patrons with alcohol. However, such trainings are subject to the same limitations as RBS training in general, chiefly that the quality and depth of such training might vary widely.

More specific tips for implementation are available through the University of Minnesota Alcohol Epidemiology Program.

Theory Behind the Strategy

Restrictions on alcohol use in public would reduce the availability of alcohol, and thus, reduce alcohol use.

Evidence of Effectiveness

Public Places: No studies were identified that evaluated the evidence of effectiveness on alcohol restrictions in public places. However, these public settings might be associated with underage drinking that results in vandalism, violence, and littering,³⁴⁰ and it can be assumed that alcohol restrictions will reduce access to alcohol.

Public Events: Restrictions on alcohol use at public events can prevent alcohol from becoming the main focus of the event.¹⁷⁶ For instance, rates of sales to underage youth are high at community festivals,³⁴¹ so making alcohol available only in enclosed areas might reduce the prevalence of underage drinking. Toomey et al.³⁴² examined the effectiveness of enclosed alcohol areas at community festivals on reducing alcohol sales to minors. In combination with other strategies to reduce drinking at community festivals, they did not report an observed reduction in underage sales; however, the effect of an enclosed alcohol area was not assessed in isolation.

Tips for Implementation

Alcohol use can be prohibited through local ordinances banning alcohol use in public places, such as beaches and parks. Policies prohibiting the possession of open alcoholic beverage containers might also help to enforce restrictions of alcohol in public places.¹⁸⁹

At public events, alcohol service and use could be restricted to designated areas. Adults ages 21 or older could receive wristbands upon entrance to the event so that they are clearly distinguishable from those under the MLDA. More research is needed to determine whether this strategy has greater potential to be effective if used in conjunction with other strategies to prevent underage drinking (e.g., compliance checks and regulating alcohol outlet density) and with increased support from law enforcement officials.³⁴²

Social host policies aim to minimize the social availability of alcohol by targeting the environments in which underage youth drink, focusing primarily on parties. These policies can be enacted at the local level (social host ordinances) or at the state level (hosting laws). Additionally, these policies can hold civil or criminal penalties, ranging from administrative fines to jail time.

Hundreds of local governments across the U.S. have adopted local ordinances related to social host civil liability. Typically, the ordinances of these cities and counties will provide for both criminal and civil remedies that include possible jail time, fines, fees, and the costs of response (law enforcement and any emergency medical and/or fire services). Under the provisions for fee recovery, the locality will usually establish in its policy that the use of alcoholic beverages by underage persons is an immediate threat to the general public safety and welfare that diverts critical and essential law enforcement, and fire and other emergency responses from other service calls in the community. Consequently, the locality may impose fees sufficient to recoup the costs of dispatching resources to the site of the illegal activity.

Maryland has host party laws that make it a crime to allow underage guests to drink alcohol in one’s home. Hosts who know underage people unrelated to them are possessing or consuming alcohol in their home can be charged and fined.¹⁹⁵ Although there is no social host civil liability at the state-level in Maryland for serving alcohol to a minor or obviously intoxicated person,¹⁹⁵ in 2015 Baltimore City and in 2016 Baltimore County and the Town of Princess Anne all passed local social host ordinances. These ordinances establish civil penalties and fines for hosts of “loud and unruly” parties, including those that involve the illegal provision of alcohol to underage youth as well as public disturbances such as excessive noise and traffic, violence, and public displays of drunkenness. The ordinances also provide the option of civil penalties and fines for property owners of residences where those parties occur. Fact sheets on each of these social host ordinances can be found at the Maryland Collaborative website.

Theory Behind the Strategy

Social host ordinances make adults who provide alcohol in private settings to people under the MLDA or to those who are obviously intoxicated liable for the provision of alcohol as well as for subsequent alcohol-related harms, such as injury or death. There does not have to be an alcohol-related harm or event for hosts to be cited under social host policies—hosting the party is grounds for citation. Social host liability might deter adults from providing alcohol to underage youth.

At the state level, college student binge drinking rates are correlated with adult binge drinking rates. The correlation is substantially explained by the strictness and enforcement of the state’s alcohol policies.³⁴³ Underage people might be able to purchase alcohol themselves at alcohol outlets³⁴⁴ or they might be able to obtain it from social sources, such as adults. Underage college students have indicated that getting alcohol from friends or acquaintances who are at least 21 years of age is one of the easiest ways to obtain alcohol.^180,325

Evidence of Effectiveness

There is mixed evidence regarding the effectiveness of social host ordinances to reduce underage alcohol use. Wagoner et al.³⁴⁵ evaluated the impact of social host policies on drinking on 14- to 20-year-olds by comparing data collected in 2004, 2006, and 2007. They compared communities (not specific to college settings) in five states that passed the policies before the intervention, during the intervention, and did not have the policies. The findings indicated that the presence of social host policies was not associated with where young people drank, how much they engaged in heavy drinking, or non-violent consequences of that drinking. However, the policies did make it less likely that young people would drink in large peer groups.

Dills³⁴⁶ examined the relationship between changes in state-level social host ordinances and traffic fatalities among 18- to 20-year-olds in the general public using data from the 1975 to 2005 Fatality Analysis Reporting System. In 1975, seven states had social host laws and by 2005, 32 states had such laws. Dills found that state social host laws were associated with a 9% reduction in alcohol-impaired driving deaths among 18- to 20-year-olds, most likely due to a decline in drinking-driving rather than a drop in alcohol use.

Paschall et al.³⁴⁷ evaluated the effects of social host laws in 50 California cities in 2009 on past-year alcohol use, heavy drinking, and drinking at parties among a cohort of adolescents ages 13 to 16. The authors found that social host liability laws with stricter liability and civil penalties might be associated with less frequent underage drinking in private settings.

Since lenient state alcohol policies are associated with higher rates of binge drinking among college students and adults, and stronger state alcohol policies (even those not aimed at youth) are associated with reduced youth alcohol use, it can be assumed that greater restrictions on adults supplying alcohol to those under the MLDA would lead to reductions in college drinking.³⁴⁸ However, no studies were identified that specifically assessed this.

Tips for Implementation

If social host ordinances are enacted, media coverage of civil and criminal cases might help to clarify that it is illegal to provide alcohol to underage youth and that adults are liable, as well as increase the perceived risks associated with allowing or providing alcohol to youth under the MLDA.¹⁷⁵ Based on the increased perception of likelihood of consequences, adults might be dissuaded from actions that increase the social availability of alcohol to minors. Growing numbers of community coalitions across the country have been able to put in place new social host ordinances. These ordinances might offer an early “win” for these coalitions as they seek to bring about changes in alcohol environments.

Maryland’s law “allows furnishing of alcohol to minors by members of their immediate family when the alcoholic beverage is furnished and consumed in a

private residence or within the curtilage of [land immediately around] the residence,” where immediate family is in reference to parent/guardian/spouse.¹⁹⁵ Parents of other students, or other adults, are not allowed to provide alcohol to underage persons.

Theory Behind the Strategy

Adults who supply alcohol to underage persons increase its availability, thus increasing the risks for

excessive use and related harms. Since lenient state alcohol policies are associated with higher rates of binge drinking among college students and adults, it can be assumed that greater restrictions on adults supplying alcohol to those under the MLDA would lead to reductions in college drinking. However, no studies were identified that specifically assessed this.

Evidence of Effectiveness

Nelson et al.³⁴³ assessed the relationship between college student drinking, adult drinking, and state-level alcohol control policies. In their study, they included the following alcohol policies: keg registration, illegal to drive with a BAC of 0.08% or greater, “and restrictions on happy hours, open containers, beer sold in pitchers, and billboards and other advertising.” The researchers separated states into two categories based on the number of alcohol policies (those with four or more and those with fewer than four) to examine the effects of alcohol policies on college student and adult drinking.

In the study, they also took into account the level of enforcement, using grading criteria from Mothers Against Drunk Driving (MADD). They found that at the state level, college student binge drinking rates are correlated with adult binge drinking rates (see Figure 4). The correlation is substantially explained by the strictness and enforcement of the state’s alcohol policies.³⁴³

Underage youth might be able to purchase alcohol themselves at alcohol outlets³⁴⁴ or they might be able to obtain it from social sources, such as adults. Underage college students have indicated that getting alcohol from friends or acquaintances who are at least 21 years of age is one of the easiest ways to obtain alcohol,³²⁵ suggesting the potential effectiveness of restricting adults from supplying to minors as a strategy to reduce college drinking.

Tips for Implementation

Ordinances can be passed to help ensure that adults do not supply alcohol to people under the MLDA. For instance, the University of Minnesota Alcohol Epidemiology Program developed a model ordinance holding adults responsible for underage drinking at parties on their property or on premises under their control. The ordinance is available here. Increased enforcement of such ordinances to prevent adults from supplying alcohol to underage persons would reduce their access to alcohol.^180,

Theory Behind the Strategy

The presence of noise ordinances can assist police in legally entering parties in homes where they suspect underage drinking is occurring. Parties involving alcohol are often loud, so noise ordinances provide police with a reason to enter the party without first seeing underage people consuming alcohol. Then, once inside, police have the authority to issue citations for underage drinking.

Evidence of Effectiveness

To our knowledge, no research has been conducted to assess the effectiveness of noise ordinances.

Tips for Implementation

Noise conditions can be built into leases with landlords or passed as a local ordinance. The former was one strategy used by the Safer California Universities project. Noise conditions might also be an element of social host ordinances, such as those passed in Maryland in Baltimore City, Baltimore County, and the Town of Princess Anne. Fact sheets about each of these ordinances can be found here.

The University of Minnesota Alcohol Epidemiology Program has a proposed noisy assembly ordinance. Details are available here. More information on landlord leases can be found through Prevention by Design.

Theory Behind the Strategy

Direct sales/shipments of alcohol from producers to consumers are not permitted in Maryland¹⁹⁵; however, home deliveries from retailers increase the physical availability of alcohol to underage people, and mobile-based apps are proliferating to make this easier. Restrictions on alcohol deliveries to homes by local retailers might prevent underage people from readily obtaining alcohol as they might be able to order and accept delivery without showing necessary identification.

Evidence of Effectiveness

People younger than the MLDA can obtain alcohol from outlets through home delivery systems, suggesting that restricting home deliveries would reduce the availability of alcohol to underage college students. A study found that among 18- to 20-year-olds, high-risk drinking and more recent drinking were positively associated with purchasing alcohol for delivery. However, this method of obtaining alcohol is not used extensively and was practiced by less than 10% of the approximately 1,700 young adults.³⁴⁹

Researchers in another study had 100 18- to 20-year-olds attempt home deliveries; 45% were successful at receiving alcohol delivered to their home. More than half of the vendors had minimal to no age verification process,³⁵⁰ suggesting that restrictions on home deliveries would reduce sales to minors.

Tips for Implementation

Prohibiting home deliveries of alcohol is a strategy to reduce access to alcohol; this can be accomplished through ordinances, such as the example provided here by the University of Minnesota Alcohol Epidemiology Program. In short, restrictions could include banning alcohol deliveries to residential addresses or requiring the delivery person to record the transaction at a licensed liquor outlet.

Theory Behind the Strategy

Mass media campaigns to reduce drinking-driving help publicize enforcement activities, thereby increasing the perceived importance of drinking-driving as well as public support for actions to address it.¹⁹²

Evidence of Effectiveness

Maryland conducted an anti-drinking and driving campaign, Checkpoint Strikeforce, in six month increments, for three years, starting in 2002.³⁵³ The focus of the campaign was to publicize sobriety checkpoints with the goal of reducing alcohol-related motor-vehicle crashes. There were no improvements in alcohol-related crashes or fatalities, nor was there evidence of increased enforcement against alcohol-impaired driving. Additionally, public perceptions of being stopped by the police for alcohol-impaired driving actually declined.

The failure of the Checkpoint Strikeforce campaign is a cautionary tale: if such campaigns are to be effective, they need to occur at the same time as actual increased enforcement, and they need sufficient funding to break through a cluttered media environment.³⁵³

Tips for Implementation

To execute an effective mass media campaign to reduce drinking-driving, implementers should consider the following. First, it is important to consider the message content, including how the motivation for preventing alcohol-impaired driving is instilled and how the optimal level of fear of apprehension is produced. Second, the delivery of the message needs to reach the target audience, which can be achieved through paid campaigns. Campaigns should be of high quality or the target audience might dismiss them. Third, implementers should pre-test the campaign message and make revisions to improve its effectiveness if necessary.¹⁹² Finally, such campaigns need to occur at the same time as actual, visible enforcement efforts are taking place.