The combined impact of campus and state alcohol policies on college drinking and harms.

Introduction: Little is known about what policies and practices may prevent alcohol-related harms to others (AHTOs). This study tested whether campus alcohol policies were associated with alcohol use and AHTOs among college students and whether these associations differ in states with weak vs. strong alcohol policies.

Methods: This cross-sectional study used data from a 2021 probability-based survey of United States college students. The main predictor was a campus alcohol policy score (CAPS) that combined 33 policies. Alcohol use outcomes included past 30-day volume and binge drinking frequency, and analyses with alcohol use outcomes included 968 students who drink. In 2024, models with AHTO outcomes used data from 1,737 students (comprising abstainers and those who drink alcohol) and three AHTOs: verbal, physical and sexual. Models also assessed interactions between campus and state alcohol policy scores.

Results: Stronger CAPSs were associated with lower alcohol volumes (IRR = 0.91, 95% CI = 0.86, 0.97, p=0.003) and lower odds of verbal AHTOs (aOR = 0.86, 95% CI = 0.75, 0.98, p = 0.022). Associations between CAPSs and binge frequency, verbal AHTOs, and sexual AHTOS were only significant in states with weak policies, while the association between CAPSs and alcohol volumes held across state policy environments.

Conclusions: Student drinking and rates of AHTOs were lower on campuses with stronger alcohol policies. CAPSs were associated with lower volume overall, and with reduced binge drinking and verbal and sexual AHTOs in states with weaker policies. Findings highlight the importance of campus alcohol policies in such states.