135 university presidents and chancellors have opened a debate on the minimum legal drinking age in the U.S. Should it be lowered? Researchers say decades of data make the answer clear as gin.

Story by Mat Edelson
Illustrations by Joe Cepeda

When scores of college and university presidents and chancellors agree on any one issue, it’s bound to garner notice. But when the subject is college binge drinking, and the thing they agree upon is to sign a Web pledge created by a group that encourages debate about lowering the minimum drinking age, the media firestorm that follows is almost a fait accompli. Such is the case with the Amethyst Initiative, a concept created by John M. McCardell, Jr., president emeritus of Middlebury College in Vermont.

On its website, the Amethyst Initiative boldly proclaims, “Twenty-one is not working.” The Amethyst pledge argues that since Congress pressured states to raise the minimum drinking age to 21 in 1984, a culture of offcampus “clandestine ‘binge drinking’” has developed and students have not significantly changed their behavior. (Public health researchers dispute both points.)

It is a startling argument, one that caught the attention of The New York Times, The Wall Street Journal, and more than 100 newspapers and media outlets. It also moved 135 college and university presidents—including former Hopkins President William R. Brody— to sign the pledge. And though some presidents, including Brody, signed to pledge to raise issues and seek solutions outside of changing the drinking age, as McCardell notes, “I would say many of the signatories of Amethyst do, in fact, support lowering the drinking age.” But, would lowering the drinking age help cure or only exacerbate the problem?

There’s no doubt that binge drinking is a huge problem on college campuses. According to a 2008 National Institute on Drug Abuse (NIDA) survey, 41 percent of college students said that in the two weeks prior to their interview they had engaged in binge drinking, defined as having consumed five or more drinks within two hours.

But it’s not just binge drinkers who are creating problems. Alcohol use in general by students has created a crisis. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) figures show that alcohol consumption annually plays a role in the deaths of 1,700 college students, 599,000 unintentional nonfatal injuries, 696,000 assaults and 97,000 sexual assaults, including date rape. Given those horrifying numbers, one can understand why college administrators are anxiously looking at new strategies to attack these issues. But is lowering the minimum legal drinking age (MLDA) the answer? Bloomberg School faculty who’ve studied the problem are unanimous in their response:

No.

“I’ve not seen one shred of evidence that allowing an earlier onset of legal drinking in 18- to 20-year-olds will have any positive impact on them,” says Debra Furr-Holden, PhD, an assistant professor of Mental Health who specializes in drug and alcohol dependence epidemiology. Furr- Holden’s comments echo those of her colleagues: The data show that raising the drinking age from 18 to 21 has had numerous public health benefits, which investigators fear will greatly erode if the drinking age is lowered.

The National Highway Traffic Safety Administration (NHTSA), for example, has estimated that 900 lives are saved annually due to MLDA laws, with more than 25,000 lives saved since 1975.

Researchers have confidence in their arguments because the move has been so well studied. In the 1970s, partially in response to the lowering of the voting age to 18 in 1971, 29 states dropped their MLDA below 21 between 1970 and 1975. Studies done in the immediate aftermath showed a significant jump in teenage auto accidents. Pressure came from citizen groups to push the MLDA back to 21. That happened under the Uniform Drinking Age Act of 1984, which was a great research opportunity,” says David Jernigan, PhD, associate professor of Health, Behavior and Society, and one of the country’s foremost experts on alcohol public policy.

The reason the Act was an epidemiological goldmine is that it wasn’t implemented all at once. In fact, Congress left it up to the states whether to change their laws or not. The cutlass the feds held over their heads was slashing 10 percent of a state’s annual federal highway funding if it didn’t comply. The resulting variations between states—some such as Washington and Pennsylvania had age 21 minimums on the books since the 1930s, some moved from 18 to 21 in 1984, while others such as Wyoming and South Dakota didn’t fully go to 21 until 1988—allowed “so many natural experiments, easy comparisons that public health researchers could make,” says Jernigan.The resulting sophisticated, quantitative analysis has continued for decades. “There have been literally hundreds of studies that have looked at the law,” he says. “The preponderance of the evidence is clear: These laws have saved thousands of young people’s lives.”

College administrators are, understandably, concerned with those they’re paid to protect, namely the nation’s roughly 18 million college students. They look at the devastation alcohol is creating on and off their campuses, and think there has to be a better way, especially because so many of their students started drinking in high school. NIDA statistics show that 72 percent high school seniors have consumed alcohol at some point in their lives. “But the law says ‘don’t drink,’” notes John McCardell. “How can we say this law has been effective?” Public health researchers tend to look at the larger picture, including the rest of the age 18 to 20 population who never go to college but would also be affected by any national change in the drinking age (see sidebar next page). These young adults make up, by some estimates, nearly half of the entire demographic.

Looking at the overall group, Susan Baker, MPH ’68, says it is impossible to ignore the effect of raising the MLDA to 21. “The decrease in alcohol-related crashes involving drivers [under 21] was far greater than in any other age group. It dropped fatal crashes,” notes Baker, a Health Policy and Management professor and co-director of the NIAAA’s Training Program in Alcohol, Injury and Violence. Conversely, she predicts, “If you lower the drinking age, young people are going to drink and drive more and crash more and kill more people and not just themselves.”

The numbers bear out Baker’s assessment. According to the NHTSA, between 1984 and 1998, fatal crashes involving drunken youth dropped 61 percent. Driving after binge drinking dropped 45 percent, while binge drinking itself fell 22 percent.

That last statistic is of particular interest to researchers. The claim that binge drinking suddenly showed up on campus when the MLDA was raised is, in David Jernigan’s opinion, patently false. “Show me the evidence that that’s something new,” demands Jernigan, adding that in more than 25 years of research, no such data has ever crossed his desk. Quite the opposite. “Binge drinking has always been there,” he adds. “That’s what we battle here, that’s true. But 21 didn’t create that.” In fact, Jernigan says it may help combat it.

It’s hard to argue that, nation- wide, increasing the MLDA to 21 didn’t alter behavior patterns. In the first seven years after the new drinking age was rolled out, Jernigan notes, the number of 18- to 20-year-olds who said they were currently drinking dropped from 59 percent to 40 percent. Though that decline reversed itself a bit by the turn of the millennium, it was still significantly below pre-MLDA 21 levels. Similarly, there was an on-campus impact, especially with regard to drinking and driving. From 1982 to 1991, covering the transition period, students who reported driving after consuming several drinks dropped by 27 percent.

Given all this data, Jernigan is asked how he feels about Amethyst’s claim that “Twentyone is not working” on college campuses.

His answer is surprising. “I would agree. Twenty-one isn’t working.”

He goes on to explain, “The reason it isn’t working is because the rest of the environment completely undercuts it. We set that law out there by itself as if it’s supposed to do the whole job. Of course, it’s not.”

Jernigan points to the drinking stats on campus as an example of where MLDA 21 needs help. The law didn’t do much to significantly change the overall prevalence of drinking. In 1991, 74.7 percent of all college students reported having a drink in the previous month. In 2007, it was 66.6 percent, still a vast majority. And binge drinking numbers have hardly changed in 25 years.

But Jernigan insists that lowering the MLDA isn’t the answer. Nor is alcohol education per se. “There’s a naïve belief among educators that you can educate your way out of anything. What the research has shown over and over again in my field is that alcohol education all by itself doesn’t work,” says Jernigan.

Though many question why adults under 21 can vote and join the military, but can’t drink a beer, injury prevention pioneer Susan Baker says, “I just don’t get that ‘if you’re old enough to fight for your country, you’re old enough to put a harmful substance into your body.’”

The disconnect between education and the surrounding physical environment is often too hard for college students to resist. “If you tell a person in a school room ‘don’t drink’ and they walk outside to a neighborhood that’s surrounded by bars, restaurants and convenience stores with posters telling them how wonderful [drinking] is, what educational program is going to be able to balance that level of ‘positive’ messaging?”

Even freshman orientations that include alcohol awareness components have limited effects. “The follow-up shows there’s no difference in behavior,” notes Jernigan. “That is what alcohol education finds over and over again. You get a difference in knowledge, but not a difference in behavior.”

BETWEEN ACCESS AND CONSUMPTION Debra Furr-Holden, PhD, has made a career out of studying populations vulnerable to public policy. That’s why she’s concerned by talk about lowering the drinking age. So while college presidents are debating such a proposal, Furr-Holden is considering a group that’s so far been left out of the discussion: Those in the affected age group who are neither in college nor employed. Among those in this population—often poor and minorities—she notes, “this will be 100 percent to their detriment.” “We know for a fact that there’s a relationship between access and consumption,” says Furr-Holden, an assistant professor in Mental Health at the Bloomberg School. “When we remove the access barrier for these 18- to20-year-olds who are not in college and are unemployed, these kids will have increased access with no interventions or services. And many of these kids are uninsured.” Furr-Holden, who received a five-year, $3 million Presidential Early Career Award for Scientists and Engineers in 2006 for her work studying how alcohol and drugs contribute to youth violence, has combed alcohol access points in Baltimore, Washington, D.C, and the San Francisco Bay Area to observe and survey youth behavior. Her findings are disturbing. “Forty percent of kids who frequent nightclubs and bars are not employed, not in college, and already have the beginning of pathology in the use of alcohol and drugs,” she says. In Furr-Holden’s opinion, restricting access until 21 is crucial for protecting the young people who fall into this group. On one hand, she notes that most young drivers can’t handle alcohol at all. “Kids who are 18 to 20 are 10 times more likely, with any blood alcohol content, to be involved in a crash. Even if they’ve had one drink,” she says. Then there’s the fact that this is a population long primed by advertising and pop culture to think highly of drinking. A report by Dartmouth and University of Oregon researchers in the March issue of Archives of Pediatrics & Adolescent Medicine— which includes an accompanying editorial by Bloomberg School associate professor David Jernigan—noted a link between adolescents who wear alcohol-branded merchandise and the onset of a positive mindset regarding the use of alcohol. “This study presents some of the strongest evidence to date that ownership of alcohol-branded merchandise is a powerful predictor of kids initiating drinking,” Jernigan says. “Selfregulation doesn’t work.” “It’s interesting,” says Furr-Holden, of the effect of alcoholrelated media on youth. “Very young kids—9, 10, 11 years old—report a very high level of harm from alcohol use. So if you ask those kids ‘How harmful is it if you have five drinks?’ they’ll say ‘Oh, that’s bad, you’ll be drunk.’ Ask that same kid when they’re 14 and they’ll say, ‘It’s not harmful. It’s fun.’” Add in evidence that those who delay drinking or drug use until their 20s are far less likely to fall into the cycle of use, dependency, treatment and relapse, and it’s easy to understand why Furr-Holden is greatly concerned about any attempt to lower the MDLA. “The kids who most need the protection will get nothing but increased access,” she says.

So is the situation hopeless? Not exactly. Jernigan says there are a few examples of universities and their communities who’ve joined forces to impact drinking, often spurred on by student alcohol-related tragedies. Frostburg State University was one such community. In November 1996, a freshman there died after consuming a minimum of six beers and 12 shots of vodka at a frat party. In 2005, alcoholladen hazing by teammates nearly killed a field hockey player. And in February 2006, an intoxicated student reportedly vomited and choked to death in his offcampus home.

In response, Frostburg’s leadership phased in a zero tolerance policy for illegal alcohol consumption both on and off campus, including parent notification of student violators. Offcampus alcohol violators also had to face a university judicial board. Outside the university’s borders, the school and the bars took aggressive action to enforce existing laws and curb policies that encouraged excessive drinking. The goal, according to Frostburg President Jonathan Gibralter, who arrived on campus in August 2006, was to alter the “culture of alcohol abuse.” It appears to have worked; according to The Washington Times, Frostburg officials claimed that second offenders of the school’s alcohol policies dropped by 89 percent the year after the new policies began on-campus, and offcampus citations fell 39 percent after Gibralter brought those offenders before Frostburg’s judicial board.

Jernigan says Frostburg and the University of Delaware have worked with businesses surrounding their campuses to create the kind of controlled environment that can be effective. The key, he insists, is limiting access to alcohol through legal, economic and social constraints. “You create a town gown coalition,” he says. “You go into the bars that predictably ring a college campus and you do things like getting rid of drink specials, pitchers of alcohol and any kind of unlimited serving. You get rid of drinking games. You make the on-premise service safe. You support strong enforcement of checking ID.”

Jernigan admits that such efforts are time consuming and go against the grain of many college administrators who don’t like the idea of playing cop and who hope that lowering the MLDA would eliminate excessive drinking and its associated health consequences. “This problem on college campuses is unpleasant. It’s incredibly unpleasant to have to notify a parent that their kid has suffered an alcohol related injury. It is incredibly unpleasant to have to be in the position of enforcing the age 21 drinking laws. Apparently some college presidents do not like being in that business.”

Asked if what they really might be objecting to is the cost of such enforcement, Jernigan is blunt.

“I would argue that it will cost them more if they don’t have these laws.”

If there is to be a debate over the MLDA, researchers interviewed for this story say it has to be an honest one, with all the cards laid on the table. In the case of the Amethyst Initiative, that means questioning some of the group’s assertions and pointing out areas of impact the initiative has yet to address.

Of the former, perhaps most notable is Amethyst’s notion that lowering the drinking age is essentially an act of fairness and equity. “Adults under 21 are deemed capable of voting, signing contracts, serving on juries and enlisting in the military,” reads the statement signed by the 135 administrators, “but they are told they are not mature enough to have a beer.”

“I don’t buy that argument,” counters Sue Baker. “At a certain age, you go from junior high to senior high. So, if you’re old enough to go to senior high, you’re old enough to do drugs? I just don’t get that ‘if you’re old enough to fight for your country, you’re old enough to put a harmful substance into your body.’”

Jernigan, who is also a sociologist, points out that American society has consistently decreed that the passing of time allows the assumption of different responsibilities. Eighteen-year-olds “can’t run for Congress, for president, and in a lot of states can’t rent a hotel room,” he notes. “We have lots of different ages of majority. For sex crimes it’s 16. Smoking is 18. Alcohol is 21. They speak to our consensus as a society around what is going to protect our children and permit their development.”

Advocates for lowering the MLDA also contend that legalizing drinking for all college age students will create a less clandestine, more controlled atmosphere where students stay or come on campus to consume alcohol as opposed to going to off-campus frat parties and bars. But Debra Furr-Holden, who has interviewed numerous young adults on their drinking habits, says that’s an unproven assertion. “We have no data to support that. I don’t think most of the on-campus opportunities for drinking are going to appeal to the population we most want to impact, which are heavy binge drinkers. They want to drink in ad-lib locations; bars where excessive drinking is allowed, clubs, fraternity and private parties … it’s just not going to appeal to the most problematic of the group.”

Phil Leaf, PhD, a Mental Health professor and director of the Bloomberg School’s Center for the Prevention of Youth Violence, is also skeptical. “If you’re not living on campus, why would you come on campus just to get alcohol? Unless it’s amazingly cheaper on campus, in which case you’re going to get some heat from the local bars.” Left unaddressed by any effort to lower the drinking age are two major areas of concern. The first is the 25 percent of college students who, according to the NIAAA, report that their academics are suffering because of alcohol use. The second is the potential impact that lowering the MDLA to 18 would have on high schoolers and their underage friends. “You tend to know people closer to your age than not,” says Leaf. “Some of the people in high school will be 18 in their senior year. It increases access just because of relationships with people who will legally be able to purchase.”

And that access, says Jernigan, could guarantee that some kids will never get to college, or at least not to the college of their choice. “Human brains, as it turns out, are not mature until the early 20s. The research that’s been done on 16- and 17-year-olds [shows that] heavy drinking in that period leads to demonstrably lower test scores. And when they do MRI imaging of these kids, you see less activity in the brain than in nondrinking kids of the same age.”

Despite all these reasons for rejecting a lower MLDA, Jernigan says that the Amethyst Initiative can be the beginning of an important dialogue. He says it all depends whether college administrators truly want to solve the problem as opposed to getting off the hook for enforcing the existing law on their campuses.

If it’s the former, he just wants them to be armed with public health facts.

“I’m really glad they care about the problem,” he says. “If this debate they’re calling for can lead to more widespread use of solutions that are based in science, then I’m all for the debate. But if it leads us down the road to increasing access to alcohol for a group that is hugely at risk of adverse consequences from drinking, then I think it’s all a big mistake.”

Reprinted with kind permission of Johns Hopkins Public Health (http://magazine.jhsph.edu/), Summer 2009