Associations of state-level alcohol policies and population use rates with alcohol use and binge drinking among U.S. 4-year college students, 2008-2019 (2026)

OBJECTIVE: The prevalence of binge drinking among U.S. college students has decreased over the last two decades but remains high. We examined the extent to which state-level alcohol policies and drinking environments are associated with excessive and underage alcohol use among college students.
METHOD: Repeated cross-sectional surveys were administered to 902,486 college students ages 18-24 years from 591 4-year institutions in 47 states biannually from 2008 to 2019. Time-varying, state-level Alcohol Policy Scale (APS) scores and population-level binge drinking and alcohol consumption rates were examined in relation to students' 30-day alcohol use (1+ days) and frequent use (20+ days), and 2-week binge drinking (5+ drinks in a sitting).
RESULTS: More restrictive state-level policy environments were associated with lower odds of students' alcohol use, frequent use, and binge drinking; for a 10-point increase in APS, odds ratios [95% confidence interval] were .92 [.88, .95], .91 [.87, .96], and .94 [.91, .98], respectively (p < .01). Associations were significant for underage students (ages 18-20 years) but significantly stronger for older students (ages 21-24 years). State population levels of binge drinking and alcohol consumption were only positively associated with drinking outcomes for students age 21 years and older.
CONCLUSIONS: Alcohol use and binge drinking were less prevalent among young adults attending college in states with more restrictive alcohol policies and among students age 21 and older in states with lower state rates of binge drinking and alcohol consumption. Lifelong patterns of alcohol use can begin in college, and findings indicate that state alcohol policies are a foundation on which community- and campus-level preventive efforts can build. [Author's abstract]