This study examined the extent to which program comprehensiveness, programmatic outcomes, program integration, and environmental factors are being addressed by 336 urban and rural United States college and university drug use prevention programs. College-based prevention programs employed a range of programmatic goals, prevention communication channels, and prevention strategies within a centralized department for drug use prevention. Most program coordinators reported no perceived change in alcohol, tobacco and other drug use, alcohol/drug-related problems, faculty/staff drug use, and alcohol and drug-related crime resulting from prevention efforts on campus. The level of prevention activity differed across institutional type.