21st Birthday Cards

Cost$5,045
Impact Score11.1
Students Impacted22%

There is no question that 21st birthday drinking is often excessive and dangerous. The level of drinking that often occurs on these occasions is especially dangerous for those consuming alcohol for the first time and others attempting to consume large amounts of alcohol, as with the “power hour” practice. However, research has demonstrated that students tend to think more alcohol is consumed on 21st birthdays than is the case, and that such misperceptions are associated with higher levels of high-risk drinking on birthdays.

What are 21st birthday cards?

Many alcohol prevention practitioners have sought to promote safe birthday celebrations by sending birthday cards to students prior to their 21st birthdays. Often signed by a senior university administrator, the card may include strategies to protect oneself against the risks of alcohol use and information on the risks of consuming large amounts of alcohol, such as information on blood alcohol concentration and the signs of alcohol poisoning. It may also encourage students to develop a plan for safe alcohol use like setting a drinking limit for their birthday.

21st Birthday cards can also include normative information about typical 21st birthday consumption and associated negative consequences. By adjusting students’ misperceptions, these cards are intended to reduce students’ alcohol consumption and negative consequences. Some cards personalize this normative feedback, pointing out when a student intends to consume more drinks than typical students on their birthday.

A card distributed at many institutions is the B.R.A.D. Birthday Card Initiative, first launched on the Michigan State University campus. Created by the B.R.A.D. Foundation, the card tells the story of the alcohol poisoning death of Brad McCue on his 21st birthday. Signed by McCue’s parents, the card encourages recipients to celebrate their birthday responsibly. A credit card-sized insert is also included outlining the signs, symptoms, and steps to address alcohol poisoning (“B.R.A.D.”, 2009)

Research findings

While research demonstrates that cards can adjust student misperceptions regarding 21st birthday drinking, there is limited evidence that the cards impact drinking behaviors or associated negative consequences. Even when personalized normative feedback is incorporated into a card, this approach has not been found to reduce drinking or negative consequences (Lewis et al., 2008). It is likely that the effectiveness of 21st birthday cards may increase when used in conjunction with other environmental strategies.

Issues and considerations

Given that the research indicates limited effects of 21st birthday cards, consider whether this is a strategy you want to expend effort on and invest in. If so, use a best practices approach to designing and delivering health education and social marketing messages and consider some cost-saving strategies, such as using peer educators to manage the initiative. As with any health education or social marketing materials, birthday card messages should be tailored to the specific audience, and cards should be focus-group tested prior to distribution. Including students in the design of 21st birthday cards can help ensure that cards engage students. As with any alcohol prevention initiative, campuses must evaluate the impact of 21st birthday cards on behavior change, to ensure that messages remain credible and relevant to the campus culture. In order to reduce costs, some campuses employ peer educators to run a 21st birthday initiative.

As the research demonstrates that 21st birthday cards alone may not be a sufficient means for addressing this high-risk event, campuses should consider employing other prevention strategies surrounding 21st birthdays. As much of the high-risk drinking takes place in on-site establishments, some campuses have attempted to engage bar owners in the effort to drive down this behavior. For example, North Dakota State University launched a campaign with local bars to ban “power hours” (drinking 21 shots at the stroke of midnight on your 21st birthday). Other proven strategies such as the promotion of responsible beverage service (RBS) can deter this behavior, giving alcohol servers skills and knowledge to support their identification of visibly intoxicated patrons and their denial of alcohol to them. Campuses have also collaborated with non-alcohol-serving establishments to offer students alternative activities or incentives not to drink on their birthdays. For example, establishments may provide free coupons for food or movie tickets to students on their birthdays.


B.R.A.D. Be Responsible about Drinking (2009). Retrieved June 17, 2009 from http://www.brad21.org/index.html.

Lewis, Melissa A.; Neighbors, Clayton; Lee, Christine M.; and Oster-Aaland, Laura. (2008). 21st Birthday Celebratory Drinking: Evaluation of a Personalized Normative Feedback Card Intervention. Psychology of Addictive Behaviors, 22(2), 176-185.