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2010.6 The National Institute on Alcoholism and Alcohol Abuse (NIAAA) formed a special task force to make recommendations to address the problem.7 Binge drinking has even received global attention from the World Health Organization, which convened a conference to address the topic.8 Several prominent organizations and key leaders have accepted this call to action. Mothers Against Drunk Driving developed a new initiative to address college binge drinking and is campaigning to open new chapters on college campuses.9 The Robert Wood Johnson Foundation funded a multimillion-dollar grant program in 10 college communities to work on the problem.10 In addition, The National Association of State Universities and Land-Grant Colleges sponsored a national media campaign to draw attention to the issue,11 and many local and regional coalitions have formed to develop interventions to reduce heavy drinking among college students. During the 1990s, the increased national attention paid to college binge drinking prompted colleges and universities to initiate or increase their prevention efforts.2,12 The actions taken to date, however, have focused on educating or changing the perceptions of the drinkers themselves, providing counseling or short-term treatment, and imposing sanctions for the most severe offenses.13 Features of the environment that promote heavy alcohol use, such as college drinking traditions, lax college or community policies and enforcement, easy accessibility to cheap alcohol in high volume, and gaps in service networks have received far less attention than other prevention efforts.13–15 Several other studies that measure college student binge drinking have shown that little or no change in students’ heavy-drinking patterns has occurred. The Monitoring the Future: National Survey Results on Drug Use, 1975–2000 reported that the rate of consuming 5 or more drinks in a row in the past 2 weeks for college students who are 1 to 4 All of the authors are with the Department of Health and Social Behavior at the Harvard School of Public Health in Boston. Hang Lee is also with the Massachusetts General Hospital in Boston. Abstract. The 2001 Harvard School of Public Health College Alcohol Study surveyed students at 119 4-year colleges that participated in the 1993, 1997, and 1999 studies. Responses in the 4 survey years were compared to determine trends in heavy alcohol use, alcohol-related problems, and encounters with college and community prevention efforts. In 2001, approximately 2 in 5 (44.4%) college students reported binge drinking, a rate almost identical to rates in the previous 3 surveys. Very little change in overall binge drinking occurred at the individual college level. The percentages of abstainers and frequent binge drinkers increased, a polarization of drinking behavior first noted in 1997. A sharp rise in frequent binge drinking was noted among students attending all-women’s colleges. Other significant changes included increases in immoderate drinking and harm among drinkers. More students lived in substance-free housing and encountered college educational efforts and sanctions resulting from their alcohol use.