College binge drinking in the 1990s: a continuing problem. Results of the Harvard School of Public Health 1999 College Alcohol Study

Guns and gun threats at college

A random sample of more than 10,000 undergraduate students, selected from 119 4-year colleges, answered a mailed questionnaire about gun possession and gun threats. Approximately 4.3% of the students reported that they had a working firearm at college, and 1.6% of them have been threatened with a gun while at school. Students are more likely to have a firearm at college and to be threatened with a gun while at college if they are male, live off campus, binge drink, engage in risky and aggressive behavior after drinking, and attend institutions in regions of the United States where household firearm prevalence is high. Having a firearm for protection is also strongly associated with being threatened with a gun while at college. Students who reported having firearms at college disproportionately reported that they engaged in behaviors that put themselves and others at risk for injury.

South of the border: a legal haven for underage drinking

AIMS

The research describes the characteristics and motivations of youthful San Diego County residents who patronize the bars and nightclubs in Tijuana, Mexico.

DESIGN

Two random-digit-dial surveys of San Diego County residents-one group aged 18-20 years and one aged 21-30 years-was conducted during a 2-year period. Those who reported having visited the bars in Tijuana in the last year were compared with those who had not.

SETTING

All respondents were residents of San Diego County, California, USA.

PARTICIPANTS

The study comprised 2200 youths between 18 and 30 years of age.

MEASUREMENTS

The interview protocol included questions covering demographic characteristics, drinking and drug-use history, experience with Tijuana bars, and ratings of bar features in San Diego and Tijuana.

FINDINGS

About half of the 18-20-year-olds and a third of the 21-30-year-olds reported visiting bars in Tijuana at least once in the past 12 months. Race, age, gender, heavy drinking and drug-use history were significantly associated with visits to Tijuana bars. The price of alcohol and the perceived freedom to get drunk in Tijuana bars were considered attractive features leading to cross-border drinking.

CONCLUSIONS

The features of the alcohol service in Mexican bars that attract youthful drinkers (low cost and liberal availability of alcohol, lack of formal controls, and presence of heavy drinkers) are similar to those present in other drinking locales that lead to drunkenness. Thus, a better understanding of the characteristics and motivations of the US youths patronizing bars in Tijuana can lead to improved interventions to reduce heavy, risky drinking.

Multilevel analysis of situational drinking among Canadian undergraduates

Using a multi-level approach, we examined the contribution of drinking setting characteristics and of individual characteristics on the alcohol intake per drinking occasion. The data are drawn from the Canadian Campus Survey, a national mail survey conducted in 1998 with a random sample of 8,864 students in 18 universities. For each student, up to five drinking occasions were investigated, resulting in 26,348 drinking occasions among 6,850 drinkers. At the individual level this study focused on the university life experience. At the situational level, information about alcohol intake was recorded relative to why, when, where and with whom drinking occurred. Our results show that drinking setting is as important as the individual characteristics in explaining the alcohol intake per occasion. Policies aimed at reducing students alcohol intake may be more beneficial if they address both situational and individual factors.

Secondhand effects of student alcohol use reported by neighbors of colleges: the role of alcohol outlets

This is a study of the secondhand effects of student alcohol use experienced by residents of neighborhoods near college campuses. We examined the relationship of a college's level of binge drinking and the number of alcohol outlets in the immediate area, to lowered quality of neighborhood life through such secondhand effects. Adults from 4661 households in the United States were interviewed through a stratified list-assisted random digit dialing telephone survey. The interview schedule included questions about residents' experiences of secondhand effects of alcohol use such as noise, vandalism or public disturbances. Reports about the quality of neighborhood life provided by respondents residing near colleges were compared with those of respondents who did not live near colleges; and reports of neighbors of colleges with high rates of binge drinking were compared with those of neighbors of colleges with lower rates. The presence of alcohol outlets in these areas was also compared. Residents near colleges and particularly near colleges with heavy episodic drinking reported the presence of more alcohol outlets within a mile. Those neighborhoods were characterized by lower socioeconomic status. Neighbors living near college campuses were more likely to report a lowered quality of neighborhood life through such secondhand effects of heavy alcohol use as noise and disturbances, vandalism, drunkenness, vomiting and urination. A path analysis indicated that the number of nearby alcohol outlets was an important factor mediating the relationship between colleges, especially those with high rates of binge drinking, and such secondhand effects. The results suggest that neighborhood disruptions around colleges due to heavy alcohol use may be reduced by limiting the presence of alcohol outlets in those areas, and the marketing practices that this engenders.

Preparing adolescent patients for college

Adolescents making the transition to college should have a thorough medical evaluation during the year prior to matriculation. In addition to required and recommended immunizations and tests, a comprehensive history and physical examination is important. Screening for substance abuse, sexual activity, depression, and suicidality is needed with appropriate anticipatory guidance, examinations, and treatment, if indicated. The teen should also be counseled on stress, sleep, and self-care, with information on when to seek medical care. The adolescent should be encouraged to continue communications with the primary care clinician during college. While respecting the adolescent's confidentiality, it is important that the physician communicate all significant medical and psychiatric health information to the college health center before the adolescent arrives on campus.

Social norms marketing: a prevention strategy to decrease high-risk drinking among college students

We describe a social-norms marketing approach to moderating college student drinking behaviors and correcting student misperceptions about campus drinking. The intervention has the potential to be applied to other health behaviors where misperceptions abound, such as those related to cigarette smoking, eating disorders, sexual health, and sexual assault. Even though nurses are actively working on alcohol and other drug (AOD) prevention efforts on college campuses, little data based research have been published. Collaborative efforts between faculty from different disciplines, including nursing and nurse health educators, can be an effective combination for preventing alcohol abuse and for initiating sound research-based campus prevention programs.

Cognitive deficits and CNS damage after a 4-day binge ethanol exposure in rats

Impairments of learning and memory are common neuropsychological sequelae of chronic alcohol abuse. Alcoholics often have impairments of anterograde memory, including spatial memory dysfunction, and a tendency toward response perseveration. This study was designed to assess the effects of binge ethanol exposure on neurodegeneration and cognitive function. Rats were given ethanol three times daily for 4 days. Silver staining revealed neurodegeneration in the olfactory bulb, piriform cortex, perirhinal cortex, entorhinal cortex, and dentate gyrus. After withdrawal, behavioral testing in the Morris water maze revealed significant differences in reversal learning between treatment groups. Ethanol-treated animals required more trials to learn the reversal task, entered the previously trained quadrant more often, and spent more time there than controls. [3H]PK-11195 binding, an index of CNS damage, was elevated in the piriform cortex of ethanol-treated animals. Thus, binge ethanol exposure resulted in neurodegeneration of a corticolimbic circuit with common excitatory inputs from the olfactory bulb and was associated with perseverative responding on a spatial learning task. These studies suggest that a single binge drinking episode could cause neurodegeneration and cognitive dysfunction in humans. The perseverative nature of the behavioral deficit could be related to both cognitive dysfunction and the behavioral components of the addiction process.

Peer influences on college drinking: a review of the research

Peer pressure is consistently implicated in the excessive drinking of college students. However, both theory and empirical findings suggest that peer pressure is a combination of three distinct influences: overt offers of alcohol, modeling, and social norms. Overt offers of alcohol can range from polite gestures to intense goading or commands to drink. Modeling occurs when the student's behavior corresponds to another student's concurrent drinking behavior. Perceived social norms can serve to make excessive alcohol use appear common and acceptable to the student. This review critically examines the literature on each form of peer influence and provides suggestions for future research.

Sexual assault and alcohol use: exploring the self-medication hypothesis

Though a link between sexual victimization and alcohol use has been well documented, the mechanisms underlying this relationship remain unclear. The current study used path analysis to examine the role of self-reported levels of psychological distress and the function of alcohol use as indirect pathways between adult sexual assault and alcohol use. Participants were 318 undergraduate female victims and nonvictims of adult sexual assault. Results showed that a history of sexual assault was associated with increased psychological distress, which in turn contributed to alcohol use via negative reinforcement. Taken together, these findings provided support for the hypothesis that women who have been sexually assaulted consume alcohol, in part, to self-medicate. The implications for future research are discussed.

Trends in college binge drinking during a period of increased prevention efforts. Findings from 4 Harvard School of Public Health College Alcohol Study surveys: 1993-2001

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.

Underage college students' drinking behavior, access to alcohol, and the influence of deterrence policies. Findings from the Harvard School of Public Health College Alcohol Study

Underage drinking is a major problem at American colleges, but little is known about the extent of alcohol use in different student groups, in different colleges, and in states with different control policies. We used data from the 2001 and 3 previous Harvard School of Public Health College Alcohol Studies that compared responses of underage students with those of their 21-23-year-old peers. Underage students drank alcohol less frequently but were more likely to drink to excess when they drank. College educational efforts and deterrent policies were limited in their outreach, and half of underage students obtained alcohol very easily. Underage students in states with extensive laws restricting underage and high-volume drinking were less likely to drink and to binge drink. A majority of underage students supported increasing efforts to control underage drinking. The results suggest that additional policy efforts to control underage drinking may be effective and feasible.

Differential utility of three indexes of risky drinking for predicting alcohol problems in college students

This study evaluated the relationship between alcohol-related problems and 3 indexes of risky drinking in college student drinkers: number of drinks consumed per week, frequency of binge drinking, and estimated blood alcohol levels (BALs). Use of 2 independent samples (N1 = 204, N2 = 181) allowed a cross-validation of obtained associations. Results indicated that neither binge drinking frequency nor BAL were more highly related to alcohol-related problems than was weekly drinking. Furthermore, BAL did not provide unique explanatory power in accounting for alcohol-related problems; mixed results were obtained regarding the relationship of binge drinking estimates with problems.

The expected personality characteristics of alcohol-dependent individuals

The Big Five personality factors were used as a framework for examining the expected personality characteristics of individuals who are alcohol-dependent. In an experimental study, participants used a measure of the Big Five personality factors to rate two individuals, each described with either signs of alcohol dependence or not. The ratings of the participants showed that they expected the alcohol-dependent versions of both individuals to be less agreeable and less conscientious. The participants expected the alcohol-dependent college student to be more extraverted and the alcohol-dependent lawyer-father to be more neurotic. The expected personality characteristics of the alcohol-dependent versions of the two described persons were very similar to the actual personality characteristics of alcohol-dependent individuals. The results were consistent with prior findings regarding narrow-band personality traits related to the Big Five. The results help explain prior findings about the social handicap of problem drinking with regard to making friends, dating, marriage, and working. The findings have potential use in alcohol-problem prevention and treatment.

Increasing MDMA use among college students: results of a national survey

PURPOSE

To examine the prevalence and changing patterns of ecstasy use among college students, and to determine characteristics, associated behaviors, and interests of ecstasy users.

METHODS

The study analyzes data regarding ecstasy use and related behaviors from the 1997 and 1999 Harvard School of Public Health College Alcohol Study. This is a survey of a nationally representative sample of over 14,000 college students at 119 U.S. four-year colleges. Changes in self-reported annual ecstasy use were examined, and lifestyle and high-risk behaviors associated with Ecstasy use were identified. Data were analyzed using 2 x 2 Chi-square tests and multiple logistic regression fitted by the generalized estimating equations (GEE).

RESULTS

The prevalence of past year ecstasy use rose from 2.8% to 4.7% between 1997 and 1999, an increase of 69%. This increase was observed across nearly all subgroups of student and college type. A smaller sample of ten colleges revealed that the increase continued in 2000. Ecstasy users were more likely to use marijuana, engage in binge drinking, smoke cigarettes, have multiple sexual partners, consider arts and parties as important, religion as less important, spend more times socializing with friends, and spend less times studying. Unlike other illicit drug users, ecstasy users were not academic underachievers and their satisfaction with education was not different from that of non-ecstasy users.

CONCLUSION

Ecstasy use is a high-risk behavior among college students which has increased rapidly in the past decade.

The reliability of environmental measures of the college alcohol environment

Much of what we know about students' drinking patterns and problems related to alcohol use is based on survey research. Although local and national survey data are important to alcohol-prevention projects, they do not sufficiently capture the complexity of the alcohol environment. Environmental prevention approaches to alcohol-related problems have been shown to be effective in community settings and researchers have begun to study and adapt such approaches for use on college campuses. Many environmental approaches require systematic scanning of the campus alcohol environment. This study assessed the inter-rater reliability of two environmental scanning tools (a newspaper content analysis form and a bulletin analysis form) designed to identify alcohol-related advertisements targeting college students. Inter-rater reliability for these forms varied across different rating categories and ranged from poor to excellent. Suggestions for future research are addressed.

Effects of a social norm feedback campaign on the drinking norms and behavior of Division I student-athletes

Social norm feedback is a promising strategy for reducing alcohol misuse on college campuses. However, little is known about the impact of these interventions on at-risk populations, such as student-athletes. This study examined the effects of a campus-wide media campaign on Division I student-athletes at three universities. A discriminant function analysis revealed that a composite measure of perceived campus drinking norms distinguished between two campaign exposure groups. With the exception of one perceived norm measure (closest friends), the campaign-exposed group reported more conservative estimates of alcohol use in peers. However, there was no evidence that the campaign had reduced alcohol use. The inability of the campaign to reduce perceptions of alcohol use among one's closest friends may have accounted for the lack of change in drinking behavior. Discussion is directed to the potential limitations of using social norm feedback campaigns to reduce alcohol misuse in high-risk groups, such as student-athletes.

Clinical relevance of heavy drinking during the college years: cross-sectional and prospective perspectives

This study investigated the clinical relevance of heavy drinking during the college years and beyond on concurrent and prospective alcohol-related problems in a high-risk sample (N = 377). Measures of heavy drinking and alcohol-related problems were significantly correlated cross-sectionally over the study frame, regardless of how these constructs were operationalized. However, the magnitude of the association between heavy drinking and alcohol-related problems declined substantially over time, with the most pronounced decrease following the college years. Despite this cross-sectional decrease in the association between heavy drinking and alcohol-related problems over time, heavy drinking during the college years significantly and substantially predicted alcohol-use disorders up to 10 years later. Implications for assessment of heavy drinking as well as prevention of problematic alcohol use in college students are discussed.

Binge drinking and the American college student: what's five drinks?

The use of the term binge drinking and the 5/4 measure have helped to advance the understanding of college alcohol use over the past 10 years. The present article discusses the importance, relevance, and utility of this measure.

Finding common ground for effective campus-based prevention

This commentary reviews the controversy over use of the term binge drinking to describe college student alcohol consumption, argues for abandoning the term, and explains how doing so will help unify and reinvigorate campus-based prevention work. Binge drinking has been defined for men as 5 or more drinks in a row at least once in the previous 2 weeks and as 4 or more drinks for women. There is no scientific basis for focusing on this measure to the exclusion of other consumption measures; neither is there justification for labeling such consumption binge drinking, which reinforces an exaggerated view of student drinking. To build support for environmental management strategies to reduce alcohol-related problems, campus officials should avoid terminology that demonizes students and instead embrace the responsible majority of college students as an essential part of the solution.

Differential utility of three indexes of risky drinking for predicting alcohol problems in college students

This study evaluated the relationship between alcohol-related problems and 3 indexes of risky drinking in college student drinkers: number of drinks consumed per week, frequency of binge drinking, and estimated blood alcohol levels (BALs). Use of 2 independent samples (N1 = 204, N2 = 181) allowed a cross-validation of obtained associations. Results indicated that neither binge drinking frequency nor BAL were more highly related to alcohol-related problems than was weekly drinking. Furthermore, BAL did not provide unique explanatory power in accounting for alcohol-related problems; mixed results were obtained regarding the relationship of binge drinking estimates with problems.

Sensation seeking and hormones in men and women: exploring the link

Risky behaviors (e.g., binge drinking, drunk driving, risky sex) are increasing among U.S. college students, and the personality trait of sensation seeking provides a potential link between such norm-breaking behaviors and biological processes. We examined the relationship between sensation-seeking behaviors and two hormones, testosterone and cortisol, in male and female college students. Hormone levels were hypothesized to contribute to the variability of individual scores on Zuckerman's Sensation-Seeking Scale. As expected, males scored higher on the scale than females, but the data failed to support the generally accepted positive relationship between testosterone and sensation seeking for either sex. Instead, our results support the existence of a significant inverse relationship between cortisol and sensation seeking in men, but not in women, even after adjustment for testosterone levels and age. Our study contributes to the current literature by (a) supporting the association between risky behavior and a hormone other than testosterone, (b) being the first to examine the association between cortisol and sensation seeking in women, and (c) identifying a possible effect of gender on the association between hormones and sensation-seeking behaviors. Gendered social norms and expectations are likely to be partly responsible for this effect. Theory-guided interdisciplinary research is needed to improve understanding of the biological influences on human behavior, and special attention must be paid to social context, women's perceptions of their expected behavior, and gendered socialization regarding norm-breaking or risky behaviors, which may obscure biological links to female behavior.

The effects of eliminating alcohol in a college stadium: the Folsom Field beer ban

In fall 1996, the University of Colorado at Boulder instituted a ban on beer sales at football games. To evaluate the effects of the ban, the authors collected two types of data: first, they examined the effects of the ban on game-day security incidents; second, they looked at survey data from season ticket holders and students. They administered the surveys after the first two postban seasons to assess ticket holders' attitudes about the new policy. The incident data they found indicated dramatic decreases in arrests, assaults, ejections from the stadium, and student referrals to the judicial affairs office following the ban. Survey data also indicated moderately negative attitudes about the ban among students and some season ticket holders. However, all fans were likely to renew their tickets regardless of their attitudes toward the policy. The study illustrates what can be achieved when alcohol is eliminated from a setting that frequently fosters disorderly and aggressive behaviors.

The efficacy of the social norms approach to substance abuse prevention applied to fraternity men

Students tend to overestimate the amount of alcohol consumed among their peers and often drink to that imaginary level. The social norms strategy, designed to correct norm misperceptions, has been correlated with a decrease in reported consumption in the general college population. However, it has had little or no impact among Greek students, the group that consumes the most alcohol. The authors investigated and subsequently found three possible flaws in the application of the social norms strategy that may account for the failure to decrease binge drinking among fraternity men: there is no predominant, healthy drinking norm in this population; students are influenced more by people within their network(s) than by others; and binge drinking is the norm in this group and may serve to perpetuate the problem. The findings, though preliminary, provide the first step in developing interventions beyond the social norms approach to address binge drinking among fraternity men.

Results of a social norm intervention to prevent binge drinking among first-year residential college students

The effects of a primary prevention social norm intervention on binge drinking among 1st-year residential college students were examined. Six hundred thirty-four students attending a medium-sized public university in the South were randomly assigned to receive a two-phase social norm intervention or the standard campus psychoeducational prevention program. At posttest, no differences were found between intervention and control group students on any of the alcohol use and alcohol-use risk factor measures. Significant subgroup differences were found by stage of initiating binge drinking behaviors, for frequency of alcohol use, F(3, 507) = 3.69, p = .01; quantity of alcohol use, F(3, 507) = 2.51, p = .05; and social norms, F(3, 505) = 2.53, p = .05. These findings suggest the need for tailoring social norm binge drinking interventions to students' stage of initiating heavy drinking and carefully monitoring for potential negative, as well as positive, effects of norm-based prevention messages.

College students define binge drinking and estimate its prevalence: results of a national survey

Data from the 1999 College Alcohol Study were used to examine how students define the term binge drinking, to determine how much binge drinking the students think exists on their campuses, and to analyze how students' estimates compare with aggregated self-reports of student drinking. The findings indicate that the median of the students' definitions of binge drinking is 6 drinks in a row for men and 5 for women, 1 drink higher than the definition used by researchers. Students' definitions of binge drinking vary with their own drinking levels, suggesting that dissenting views of the research definition may represent voices of the heaviest drinkers. At the median, students estimated that 35% of all students were binge drinkers. Half (47%) of the students underestimated the binge drinking rate at their school, 29% overestimated it, and 13% were accurate. Although programs designed to reduce the frequency or prevalence of binge drinking by emphasizing healthier norms would be most useful in addressing binge drinkers who overestimate drinking norms, this group includes only 13% of college students.