Problem: Institutes of higher learning are increasingly trying to address the issue of problem drinking. The purpose of this study was to determine how patterns in alcohol use and smoking by college students, as well as their illness patterns, have changed over 20 years. Methods: A cross-sectional serial survey design was used for this descriptive study. Data were collected during the 2011-2012 academic year from a convenience sample of students enrolled in a personal health course at a large Midwestern university. Data were compared to findings from the 1991-1992 academic year. Self-reported survey data regarding illness and alcohol and tobacco use were collected using the Student Health and Lifestyle Questionnaire Results: More males reported abstaining and fewer were classified as binge drinkers than 20 years ago. The opposite was true of women, who reported less abstention and trends towards heavier drinking. The choice of alcoholic beverage changed from beer to consuming more hard liquor. Smoking was significantly decreased along with self-reported upper respiratory infections and episodes of acute illness. Conclusions: Smoking prevention efforts appear to be having a positive effect on campus health, but more gender-specific efforts may be needed to reduce the risk behavior of drinking.