State Alcohol Policies Most Strongly Associated With College Students' Drinking, Driving Risks, and Alcohol-Related Harm.

Abstract

State-level alcohol policies reduce excessive drinking and related harms in the general population, but their effectiveness may vary by policy type and age group. This study examined associations that mutually exclusive policy subgroups of the Alcohol Policy Scale (APS) had with alcohol use and alcohol-related negative consequences among U.S. college students. Data were from repeated cross-sectional surveys of 902,486 college students ages 18-24 years from 591 four-year institutions in 47 states during 2008-2019. Outcomes were past 2-week binge drinking, 30-day frequent alcohol use, 30-day driving after drinking, 12-month use of designated drivers, and a series of 12-month negative consequences following drinking. Three sets of mutually-exclusive APS policy subgroups were used to evaluate their independent effects: consumption-oriented vs. impaired driving-oriented policies, general population vs. youth-specific policies, and tax vs. non-tax policies. Multilevel logistic and negative binomial models adjusted for individual- and institution-level covariates and time trends. Data analyses were conducted in 2025. Stronger general population-oriented, consumption-oriented, and tax and non-tax policies were associated with lower odds of negative alcohol-caused consequences, binge drinking and frequent alcohol use. More restrictive youth-specific policies were associated with lower odds of binge drinking among students aged 21-24, but not among those aged 18-20 (i.e., underage students). Effects of impaired-driving policies were specific to lower odds of driving after drinking, whereas effects of consumption-oriented policies were specific to lower alcohol use and alcohol-related negative consequences. Population-based alcohol policies, including taxation, appear to protect against risky drinking patterns and alcohol-related harms among college students.