Peer influences on college drinking: a review of the research

Standardized measures for substance use stigma

Despite indications that the stigma associated with substance use is high and may play a role in discouraging treatment participation, there is limited research in this area and only a few psychometrically sound measures of substance use stigma exist. The purpose of this study was to formulate and evaluate the psychometric properties of three substance use stigma measures. College students (N=565) completed three measures of substance use stigma that were modified from three established measures of mental illness stigma. Two of the three modified measures (Social Distance Scale for Substance Users and Affect Scale for Substance Users) emerged as having acceptable psychometric properties, whereas one modified measure (Dangerousness Scale for Substance Users) had inadequate psychometric properties. In regard to sex differences, women had significantly higher substance use stigma on the two psychometrically sound measures (p<.01). Perhaps, with standardized measures, there can be greater progress towards better understanding the mechanisms leading to high levels of substance use stigma and ultimately address failures to seek out treatment due to stigma.

Vulnerability to peer influence: a moderated mediation study of early adolescent alcohol use initiation

Affiliation with deviant peers is a correlate of adolescent alcohol use; however, the mechanism accounting for this association remains unclear, particularly with respect to initiation of alcohol use in early adolescence. This prospective study examines perceived peer attitudes and use as a mediator between peer delinquency and initiation of alcohol use, and how parenting may moderate vulnerability to this risk pathway. Participants included 371 11-13 year-old adolescents (55.5% female, 83.0% Caucasian). Results suggested that high levels of peer delinquency prospectively predicted perceived peer approval and use of alcohol and that peer approval and use of alcohol prospectively predicted initiation of alcohol use. Thus, reinforcement and modeling of alcohol use appear to be important mechanisms by which delinquent peers influence the initiation of drinking. There was no support for parental warmth or control as moderators of peer influence.

Overestimation of peer drinking: error of judgement or methodological artefact?

AIMS

To examine whether inclusion of both self- and peer-referent items in the context of a single social norms drinking questionnaire plays an active role in producing the much-reported tendency for young people to overestimate the extent of peers' alcohol-related behaviour and the permissiveness of their attitudes towards alcohol.

DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS

In a between-subjects design pupils attending two Scottish secondary schools (n=1074; 12-18 years; 52.5% male) completed one of three questionnaires designed to measure a range of alcohol-related behaviours, attitudes and perceptions: a paradigmatic multiple-target questionnaire included self- and peer-referent items while two single-target questionnaires included self-referent or peer-referent items only.

FINDINGS

Pupils' self-reported drinking behaviours and attitudes were similar, regardless of whether multiple or single-target versions of the questionnaire were used, as were perceptions of peers' frequencies of alcohol use and drunkenness. In contrast, by comparison with pupils who responded to a single-target version that omitted self-referent items, use of a multiple-target questionnaire was significantly more likely to result in reports that peers would consume alcoholic drinks when with friends and hold more permissive or liberal attitudes towards alcohol.

CONCLUSIONS

Social norms research and related health promotion programmes that seek to reduce the extent of overestimation of peer drinking norms are heavily reliant upon multiple-target drinking questionnaires. The use of such a questionnaire may lead to more distorted or extreme perceptions being reported by pupils compared to single-target versions, which omit self-referent drinking items. By implication, use of multiple-target questionnaires may encourage young people to 'over-overestimate' peer drinking norms.

Prospective protective effect of parents on peer influences and college alcohol involvement

This prospective study used a conceptually based risk and protective framework to investigate whether parental influences exert a protective effect on the robust association between peer influences and college alcohol involvement. Participants were incoming freshmen in the control condition of a randomized clinical trial, N = 256, 57.0% female, baseline age: M = 18.36 years (SD = 0.41). Participants completed telephone surveys in the summer before matriculation (baseline) and in the spring of the freshman (10-month) and sophomore years (22-month) with 85.6% retention at 22-months. Latent growth models were estimated for heavy episodic drinking and alcohol-related consequences. Descriptive norms and social modeling among peers were positively associated with initial heavy drinking and consequences; parental drinking permissiveness was positively associated with initial heavy drinking. Greater social modeling among peers was associated with less growth in consequences. Parental monitoring was not significantly associated with alcohol involvement. Prematriculation social modeling exhibited a weaker positive association with initial heavy drinking and consequences at low prematriculation parental drinking permissiveness compared to high. Similarly, prematriculation descriptive norms exhibited a weaker positive association with initial heavy drinking at low prematriculation parental drinking permissiveness compared to high. Prematriculation descriptive norms were not significantly associated with growth in heavy drinking at low parental drinking permissiveness; in contrast, higher prematriculation descriptive norms were associated with less growth in heavy drinking at high parental drinking permissiveness. Findings provide support for a protective parental influence on peer-alcohol relations extending into college. Parental drinking permissiveness may be an important target for parent-based interventions.

Heavy episodic drinking on college campuses: does changing the legal drinking age make a difference?

OBJECTIVE

This article extends the compartmental model previously developed by Scribner et al. in the context of college drinking to a mathematical model of the consequences of lowering the legal drinking age.

METHOD

Using data available from 32 U.S. campuses, the analyses separate underage and legal age drinking groups into an eight-compartment model with different alcohol availability (wetness) for the underage and legal age groups. The model evaluates the likelihood that underage students will incorrectly perceive normative drinking levels to be higher than they actually are (i.e., misperception) and adjust their drinking accordingly by varying the interaction between underage students in social and heavy episodic drinking compartments.

RESULTS

The results evaluate the total heavy episodic drinker population and its dependence on the difference in misperception, as well as its dependence on underage wetness, legal age wetness, and drinking age.

CONCLUSIONS

Results suggest that an unrealistically extreme combination of high wetness and low enforcement would be needed for the policies related to lowering the drinking age to be effective.

Injunctive norms for alcohol-related consequences and protective behavioral strategies: effects of gender and year in school

Perceived drinking norms have received increased attention as one determinant of high levels of college alcohol consumption and alcohol-related problems. Excessive drinking is widely visible on college campuses, and students may therefore assume that it is peer-supported (Kitts, 2003). Research into peer relations indicates that the perceived approval of important others predicts drinking behavior (Neighbors, Lee, Lewis, Fossos, & Larimer, 2007). Neither the use of alcohol-related protective behavioral strategies nor alcohol-related negative consequences have been investigated in terms of their perceived approval. The purpose of this study was to extend previous research on injunctive norms and assess self-other discrepancies in levels of approval for campus drinking patterns, negative alcohol-related consequences, and protective behavioral strategies. Undergraduate volunteers (n=324, 61% female, 67% Caucasian) completed an online survey of drinking patterns; they rated comfort with overall campus drinking, and the acceptability of alcohol-related consequences and protective strategies for themselves and their close friends. As predicted, students expressed lower acceptance of consequences than their friends, and higher acceptance of alcohol-related protective strategies. We observed main effects of gender and year in school. Males and upperclassmen expressed higher acceptance of negative consequences for both self and others, and lower acceptance of protective strategies for both self and others. Implications for prevention programs are discussed.

Efficacy of web-based personalized normative feedback: a two-year randomized controlled trial

OBJECTIVE

Web-based brief alcohol interventions have the potential to reach a large number of individuals at low cost; however, few controlled evaluations have been conducted to date. The present study was designed to evaluate the efficacy of gender-specific versus gender-nonspecific personalized normative feedback (PNF) with single versus biannual administration in a 2-year randomized controlled trial targeting a large sample of heavy-drinking college students.

METHOD

Participants included 818 freshmen (57.6% women; 42% non-Caucasian) who reported 1 or more heavy-drinking episodes in the previous month at baseline. Participants were randomly assigned in a 2 (gender-specific vs. gender-nonspecific PNF) × 2 (single vs. biannual administration of PNF) + 1 (attention control) design. Assessments occurred every 6 months for a 2-year period.

RESULTS

Results from hierarchical generalized linear models provided modest effects on weekly drinking and alcohol-related problems but not on heavy episodic drinking. Relative to control, gender-specific biannual PNF was associated with reductions over time in weekly drinking (d = -0.16, 95% CI [-0.02, -0.31]), and this effect was partially mediated by changes in perceived norms. For women, but not men, gender-specific biannual PNF was associated with reductions over time in alcohol-related problems relative to control (d = -0.29, 95% CI [-0.15, -0.58]). Few other effects were evident.

CONCLUSIONS

The present research provides modest support for the use of biannually administered web-based gender-specific PNF as an alternative to more costly indicated prevention strategies.

Workplace substance-use norms as predictors of employee substance use and impairment: a survey of U.S. workers

OBJECTIVE

Although much research has explored the relation of substance-use norms to substance use among college students, much less research has focused on employed adults and the workplace as a social context for social norms regarding substance use. This study explored the relation of descriptive and injunctive workplace substance-use norms regarding alcohol and illicit drug use to employee substance use. Both alcohol use and illicit drug use were explored, as well as overall and context-specific use and impairment.

METHOD

Data were collected from a national probability sample of 2,430 employed adults (55% female) using a random-digit-dial telephone survey. Overall employee alcohol and illicit drug use were assessed, as well as use before work, use and impairment during the workday, and use after work.

RESULTS

After controlling for a number of potential covariates, injunctive norms regarding workplace alcohol and illicit drug use predicted substance use and impairment overall and across all contexts of use. Descriptive norms predicted alcohol and illicit drug use before and during work, as well as workplace impairment.

CONCLUSIONS

This study shows that both workplace injunctive and descriptive norms are important predictors of substance use in the U.S. workforce. There were two general patterns, however, that were consistent across both alcohol and illicit drug use. Social norms marketing campaigns, therefore, may be a useful way for employers to target employee substance use. The present results also helped to integrate the results of several prior studies that employed narrower samples and measures.

Social Influences, Alcohol Expectancies, and Hazardous Alcohol Use Among College Athletes

Research has shown that college student-athletes are at increased risk for hazardous alcohol use. As such, this study examined social and cognitive influences on athletes’ alcohol consumption by exploring the association between injunctive norms (parental, teammate, and coach approval) and hazardous alcohol use among college athletes, and testing whether alcohol expectancy outcomes and valuations would mediate this association. College student-athletes (n = 301; mean age = 19.4, SD = 1.3) completed self-report questionnaires assessing their drinking behaviors and perceptions of alcohol use in their social environment. Structural equation modeling revealed, in all but one case, a direct association between each of the injunctive norms variables and hazardous alcohol use. In addition, negative expectancy valuations mediated the association between teammate approval and hazardous alcohol use. Injunctive norms emerged as an important factor in student-athletes’ alcohol use. Implications for alcohol intervention programming among student-athletes are discussed.

Cultural and social network predictors of drinking among Korean American women

This study estimated the association of cultural and social mechanisms with Korean American women's drinking behaviors. Data were drawn from telephone interviews with 591 Korean women selected from a random sample of households in California with Korean surnames during 2007. About 62% of eligible respondents completed the interview. Respondents reported any lifetime drinking (yes/no), drinking volume (typical number of drinks consumed on drinking days), level of acculturation, and described their social network by assessing who encouraged or discouraged drinking (drinking support) or drank (drinking models). Multivariable regressions were used for analyses. About 70% (95% confidence interval [95%CI]:, 67, 74) of Korean American women reported any lifetime drinking and current drinkers drank 1.18 (95%CI: 1.07, 1.28) drinks on drinking days. Acculturation was not significantly associated with any lifetime drinking or drinking volume, whereas models and support for drinking were statistically significantly associated with a higher probability of any lifetime drinking and drinking more on drinking days. Each additional encourager, or one or fewer discourager, for drinking in women's social networks was associated with a 2% (95%CI: 1, 3) higher probability of any lifetime drinking and drinking 0.25 (95%CI: -0.53, 1.18) more drinks on drinking days. Each additional drinker in women's networks was associated with a 4% (95%CI: 1, 8) higher probability of any lifetime drinking and drinking 0.26 (95%CI: -0.05, 0.60) more drinks on drinking days. Korean American women's drinking appears to be strongly related to their social networks, although how women take on traits of their new environment was not.

Can stand-alone computer-based interventions reduce alcohol consumption? A systematic review

AIM

To determine the effects of computer-based interventions aimed at reducing alcohol consumption in adult populations.

METHODS

The review was undertaken following standard Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance for systematic reviews. The literature was searched until December 2008, with no restrictions on language. Randomized trials with parallel comparator groups were identified in the form of published and unpublished data. Two authors independently screened abstracts and papers for inclusion. Data extraction and bias assessment was undertaken by one author and checked by a second author. Studies that measured total alcohol consumption and frequency of binge drinking episodes were eligible for inclusion in meta-analyses. A random-effects model was used to pool mean differences.

RESULTS

Twenty-four studies were included in the review (19 combined in meta-analyses). The meta-analyses suggested that computer-based interventions were more effective than minimally active comparator groups (e.g. assessment-only) at reducing alcohol consumed per week in student and non-student populations. However, most studies used the mean to summarize skewed data, which could be misleading in small samples. A sensitivity analysis of those studies that used suitable measures of central tendency found that there was no difference between intervention and minimally active comparator groups in alcohol consumed per week by students. Few studies investigated non-student populations or compared interventions with active comparator groups.

CONCLUSION

Computer-based interventions may reduce alcohol consumption compared with assessment-only; the conclusion remains tentative because of methodological weaknesses in the studies. Future research should consider that the distribution of alcohol consumption data is likely to be skewed and that appropriate measures of central tendency are reported.

A Telephone Intervention for Substance-Using Adult Male Perpetrators of Intimate Partner Violence

OBJECTIVE: To preliminarily evaluate telephone-delivered motivational enhancement therapy (MET) in motivating unadjudicated and nontreatment seeking intimate partner violence (IPV) perpetrators, who also use substances, to self-refer into treatment. METHOD: 124 adult men were recruited via a multimedia marketing campaign and were randomly assigned to the intervention (MET) or comparison group following a baseline assessment. Participants in the MET condition received a personalized feedback report on their IPV and substance-use behaviors, consequences, and social norms beliefs. RESULTS: Results supported the likely effectiveness of MET in short-term reduction of IPV behavior, increasing motivation for treatment seeking, and changing perceived norms for IPV and substance abuse (SA). CONCLUSIONS: Applications for brief MET interventions to facilitate voluntary treatment entry among substance-using IPV perpetrators are discussed.

Group identification as a moderator of the relationship between perceived social norms and alcohol consumption

Previous research has shown that social norms are among the strongest predictors of college student drinking. Among college students, perceiving that others drink more heavily than themselves has been strongly and consistently associated with heavier drinking. Research has also shown that the more specifically others are defined, the stronger the association is with one's own drinking. In the current research, we evaluated whether group identification as defined by feeling closer to specific groups moderates the associations between perceived drinking norms in the group and one's own drinking. Participants included 3,752 (61% female) students who completed online assessments of their perceived drinking norms for 4 groups of students on their campus and identification with each group and participants' own drinking behavior. Results indicated that greater identification with same-sex students, same-race students, and same-Greek-status students was associated with stronger relationships between perceived drinking norms in the specific groups and own drinking.

Development and validation of a scale measuring attitudes toward non-drinkers

The idea that individuals drink alcohol to fit in with their peers has been investigated by many researchers. However, the related concept that consumption of alcohol may serve as a means of avoiding the social costs associated with being a non-drinker has received little attention. Three studies (N = 94, 148, 236) are outlined, which detail the construction and preliminary validation of the Regan Attitudes toward Non-Drinkers Scale (RANDS). Results indicated that scale score reliability for the RANDS was good (α values range from .82 to .89) with exploratory and confirmatory factor analyses suggesting that the scale possesses a unidimensional factor structure. Importantly, scores on the RANDS emerged as a stronger predictor of self-reported yearly alcohol consumption and binge-drinking than indicants commonly assessed in alcohol use and abuse research in adolescents and young adults (e.g., peer pressure). Limitations of these studies and directions for future research are outlined.

The effects of drinking status and believability of ads featured in a social norms campaign on college students' estimation and accuracy of other students' celebratory drinking

This study examined estimation and accuracy of normative perceptions for students during one celebratory drinking occasion. Students who drank on St. Patrick's Day overestimated the percentage of others who also drank, whereas the students who did not drink on St. Patrick's Day underestimated the percentage of others who also did not drink. The students' drinking behaviors on St. Patrick's Day did not substantially differentiate their accuracy scores. However, of the students who drank on St. Patrick's Day, those who did not believe the ads showed stronger overestimation of others who drank than did those who believed the ads.

The Role of Social Anxiety in a Brief Alcohol Intervention for Heavy-Drinking College Students

The Brief Alcohol Screening and Intervention for College Students (BASICS) reduces alcohol use and alcohol-related problems among undergraduates, yet variability in outcomes exists. Identifying individual difference variables related to outcomes could inform efforts to improve treatment protocols. The current study evaluated the role of social anxiety during BASICS. High socially anxious (HSA; n = 26) and low socially anxious (LSA; n = 44) heavy-drinking undergraduates were randomly assigned to BASICS (n = 38) or an assessment-only control (n = 32). HSA patients reported higher baseline alcohol consumption (typical drinks, weekly quantity, and frequency). BASICS significantly decreased weekly alcohol consumption and alcohol-related problems relative to the control group. Social anxiety moderated outcomes such that in the BASICS condition; HSA patients reported heavier typical drinks at posttest, even after controlling for referral status, baseline typical drinks, and trait anxiety. This was not the case in the control group. HSA patients may benefit from social anxiety-specific interventions during BASICS.

Social networks and alcohol use among nonstudent emerging adults: a preliminary study

We examined the social networks and alcohol use of a community-based sample of nonstudent emerging adults (N=59). The research examined (1) personal network characteristics and the drinking habits of its members, (2) the link between network alcohol use and personal alcohol involvement, (3) perceived social norms as they related to network alcohol use, and (4) relationship between perceived social norms and personal alcohol involvement. Men and women (M age=27 years) were equally represented in the social network. Level of educational attainment of members was diverse. On average, respondents were in contact on a daily basis with network members and about 38% of the network was known between 1 and 5 years. The majority (57%) of the network consisted of household or family members. There were some associations between network drinking and personal alcohol involvement. The proportion of "drinking buddies" in one's network was directly associated with perceived drinking norms. Perceived drinking norms also were positively associated with personal alcohol use, alcohol-related problems, and approval of drinking behaviors. Findings from this study have implications for understanding social factors in the drinking behavior of nonstudent emerging adults and could inform the development of effective prevention and treatment interventions for this important, but understudied group of drinkers.

Peer substance use associated with the co-occurrence of borderline personality disorder features and drug use problems in college students

OBJECTIVE

To determine if the substance use patterns of one's close friends and romantic partners would be a significant contributor to the co-occurrence of borderline personality disorder (BPD) features and drug use problems above and beyond impulsivity and negative emotionality.

PARTICIPANTS

Participants were 2,202 undergraduates who attended a large southeastern university between 2003 and 2006.

METHODS

All subjects completed measures assessing the presence of BPD symptoms, drug use problems, general personality traits, and the proportion of their friends and partners who had used illicit drugs within the past 12 months.

RESULTS

The illicit drug use patterns of one's friends and romantic partners was a significant contributor to the co-occurrence of BPD features and drug use problems even when controlling for levels of impulsivity and negative emotionality.

CONCLUSIONS

These findings suggest possible additional avenues for treatment focusing on helping students with BPD and drug use problems modify their social group.

Alcohol consumption among university students in North Rhine-Westphalia, Germany--results from a multicenter cross-sectional study

OBJECTIVE

To assess alcohol use and problem drinking among university students in the German Federal State of North Rhine-Westphalia (NRW) and to examine the associated factors.

METHOD

A multicenter cross-sectional study was conducted in 16 universities in 2006-2007 in NRW by a standardized questionnaire and 3,306 students provided information (response rate of 88%). Problem drinking was measured by the CAGE questionnaire.

RESULTS

Alcohol consumption in the last 3 months was reported by >90 % of students. About 80% reported heavy drinking, and 20% displayed problem drinking. Male students, students living in residence halls, and students from sport faculties had a higher risk of heavy drinking and problem drinking. When students were compared across study years, frequency of heavy drinking decreased with higher semesters.

CONCLUSIONS

Overall, heavy drinking and problem drinking are common among university students in this sample. Intervention programs should be designed for students at a particularly high risk.

College student perceptions on campus alcohol policies and consumption patterns

Environmental strategies for colleges and universities to reduce alcohol consumption among their students include the development and enforcement of campus alcohol policies. This study examines students' knowledge and attitudes toward campus alcohol policies and how they relate to alcohol consumption and alcohol social norms. A sample of 422 freshman students was surveyed during their first month at a 4-year public college. Findings indicated that the majority of students (89%) were aware of campus policies, yet of those who were aware, less than half (44%) were accepting of these campus rules and regulations. In addition, the majority (79%) of students drank at social events, despite this behavior being in direct violation of campus alcohol policies. However, those who supported campus rules consumed significantly less alcohol at social events than those who opposed or had no opinion of the rules. Also, those who supported the rules perceived that their peers and students in general consumed significantly less alcohol at social events than those who were opposed or had no opinion. This outcome supports the premise established by several theories of behavior change including the theory of planned behavior, which state that behavior is influenced less by knowledge than by attitude and intention.

Experiences of alcohol-related harassment among medical students

OBJECTIVES

Although fatal accidents caused by alcohol-related harassment occur frequently among college students, this issue has not been adequately examined. This study set out to investigate the prevalence of alcohol-related harassment among medical students in Japan.

METHODS

A multi-institutional, cross-sectional survey was carried out across seven medical schools in Japan. A self-report anonymous questionnaire was distributed to 1152 medical students; 951 respondents (82.6%) satisfactorily completed it. From the responses, we determined the reported prevalences of the following types of alcohol-related harassment among medical students by senior medical students or doctors: (i) being coerced into drinking alcohol; (ii) being compelled to drink an alcoholic beverage all at once (the ikki drinking game); (iii) being deliberately forced to drink until unconscious, and (iv) being subjected to verbal abuse, physical abuse or sexual harassment in relation to alcohol. The prevalence of becoming a harasser among medical students was also measured. Multivariate regressions were used to assess the associations between experiences of alcohol-related harassment and student characteristics.

RESULTS

A total of 821 respondents (86.3%) had experienced alcohol-related harassment and 686 (72.1%) had harassed others. Experiences of the ikki drinking game were frequently reported by both victims (n=686, 72.1% of all respondents) and harassers (n=595, 62.6% of all respondents). In multivariate regression, having an experience of alcohol-related harassment correlated with both being harassed (odds ratio [OR] 14.22, 95% confidence interval [CI] 8.73-23.98) and being a harasser (OR 13.19, 95% CI 8.05-22.34). The presence of senior members of medical college clubs who were regular drinkers also correlated with both being harassed (OR 2.96, 95% CI 1.88-4.67) and being a harasser (OR 2.97, 95% CI 2.06-4.27).

CONCLUSIONS

Alcohol-related harassment among medical students is common and tends to occur at drinking parties with senior college club members. Hence, one of the most important strategies for preventing alcohol-related harassment may be to disrupt this vicious cycle.

Immediate reductions in misperceived social norms among high-risk college student groups

The current quasi-experimental design evaluated whether a brief, live, interactive, normative group (BLING) intervention produced immediate reductions in group-specific normative perceptions and whether the magnitude of these misperceptions differed among three at risk undergraduate populations: first-year students (N=767), Greek-affiliated students (N=555), and student-athletes (N=524). In a live group setting, participants used wireless keypads to enter in normative perceptions of their group's drinking levels, followed by their own actual drinking behaviors. Feedback data illustrating the discrepancies between perceived and actual norms were then presented graphically on a large screen. Across all groups at pre-intervention, respondents reported significantly higher perceived group-specific norms than actual alcohol use, with magnitude of initial misperceptions varying by group. The BLING intervention was equally effective in immediately correcting normative misperceptions among all three groups regardless of gender or the magnitude of initial misperception. These data further validate the ability of live normative group-specific data-collection and feedback to overcome saliency and credibility issues exhibited by many existing social norms interventions.

Weight perception, substance use, and disordered eating behaviors: comparing normal weight and overweight high-school students

Disordered eating behaviors and substance use are two risk factors for the development of serious psychopathology and health concerns in adulthood. Despite the negative outcomes associated with these risky behaviors, few studies have examined potential associations between these risk factors as they occur during adolescence. The importance of accurate or inaccurate weight perception among adolescents has received increased interest given documented associations with nutritional beliefs and weight management strategies. This study examined the associations among the perceptions of weight and substance use with disordered eating behaviors among a diverse sample of normal weight and overweight adolescent males and females. Data came from the 2007 National Youth Risk Behavior Survey (YRBS). The sample consisted of 11,103 adolescents (53.4% female; 44% Caucasian, 21% African American; 13% Hispanic; age responses ranged from 12 and under to 18 and over), with 31.5% meeting criteria for being either at-risk for obesity or already obese (i.e., overweight). As hypothesized, overestimation of weight among normal weight adolescents and accurate perceptions of weight among overweight adolescents were associated with higher rates of disordered eating behaviors. In normal weight adolescents, use of all three substances (tobacco, binge drinking, and cocaine) was associated with each disordered eating behavior. In contrast, findings revealed differences for overweight adolescents between the type of substance use and disordered eating behavior. Post hoc analyses revealed that gender moderated some of these relationships among overweight individuals. Implications for the development and implementation of secondary prevention programs aimed at reducing disordered eating behaviors, substance use, and obesity risk among normal and overweight adolescents are considered.

Drinking at European universities? A review of students' alcohol use

BACKGROUND

High volumes of alcohol consumption and risky single occasion drinking (RSOD) among university students have been shown to be associated with considerable harm to both those who consume alcohol and their fellow students. The vast majority of these studies are based on US and Canadian samples.

AIM

The present article provides an overview of the characteristics of alcohol-consuming university students in Europe.

METHOD

65 relevant articles published within the last 20years using European student populations could be identified.

RESULTS

Sociodemographic, individual, social, and university-related characteristics associated with alcohol consumption patterns could be identified. Male students, in particular, tended to consume alcohol more often and in higher quantities, including RSOD. Students consumed alcohol chiefly during social gatherings and for social and enhancement motives. Those without family obligations and those living alone, with roommates or in areas with a high density of students were more likely to consume alcohol in higher quantities, and to engage in RSOD. Students tend to overestimate the extent of their fellow students' alcohol consumption.

CONCLUSIONS

Health promotion and prevention efforts which focus on these characteristics (i.e., gender, drinking motives, living conditions and social norms), and which have been successful and evaluated among university students in the US and Canada, may also be very promising for their European counterparts.

The social norms of alcohol-related negative consequences

Social norms for alcohol use are important influences on individual college student drinking. The present study extends social norms research by examining alcohol-related consequences and, in particular, whether similar misperceptions exist regarding the frequency and evaluation of these consequences over time. College student drinkers (N = 624) participating in a longitudinal study completed Web-based surveys assessing alcohol use and related consequences, as well as their beliefs about frequency and evaluation of consequences for the typical college student. Findings suggest that students overestimated how often typical college students experience negative consequences and underestimated how negatively other students evaluated those consequences. Finally, results support a bidirectional model for alcohol-related consequences, possibly indicating a reciprocal, mutually influential feed-forward loop of norms and consequences that promotes maintenance of college student drinking and consequences.

Examining the associations among severity of injunctive drinking norms, alcohol consumption, and alcohol-related negative consequences: the moderating roles of alcohol consumption and identity

This study examined a range of injunctive norms for alcohol use and related consequences from less severe behaviors (e.g., drinking with friends) to more severe behaviors (e.g., drinking enough alcohol to pass out), and their relationship with alcohol consumption and alcohol-related negative consequences among college students. In addition, this research aimed to determine whether these relationships between injunctive norms and consequences were moderated by alcohol consumption and level of identification with the typical same-gender college student. A random sample (N = 1,002) of undergraduates (56.9% women) completed a Web-based survey that was comprised of measures of drinking behavior, perceived approval of drinking behaviors that ranged in severity (i.e., injunctive norms), and level of identification with the typical same-gender college student. Results suggest that the association between negative consequences and injunctive drinking norms depend on one's own drinking behavior, identification with other students, and the severity of the alcohol use and related consequences for which injunctive norms are assessed. Findings are discussed in terms of false consensus and false uniqueness effects, and deviance regulation perspectives. Implications for preventive interventions are discussed.

Heavier drinking American college students may self-select into study abroad programs: An examination of sex and ethnic differences within a high-risk group

As with other heavier drinking groups, heavier drinking American college students may self-select into study abroad programs with specific intentions to use alcohol in the foreign environment. This cross-sectional study used a sample of 2144 students (mean age=20.00, SD=1.47) to explore differences in alcohol use and related negative consequences among (1) students intending to study abroad while in college, (2) students not intending to study abroad, and (3) students reporting prior study abroad participation. Results revealed that participants with no intention to study abroad drank less and experienced fewer alcohol-related consequences than participants intending to study abroad. In addition, students reporting prior completion of study abroad programs drank more and reported more hazardous alcohol use than those not intending to study abroad. Ethnic and sex differences existed; with White students, males, and females intending to study abroad and non-White students who previously completed study abroad programs demonstrating the most risk. These findings provide empirical support that study abroad students may be a heavier drinking subgroup necessitating intervention prior to beginning programs abroad.

Where Do Adolescents Get Drunk?

E. E. Storvoll & I. Rossow & H. Pape: Where do adolescents get drunk? A study of the relative importance of various drinking locations among Norwegian adolescents

To curb the harmful consequences of drunkenness among adolescents, it may be useful to know where they usually drink to the point of intoxication. We have analysed data from a school survey among 14–17 year-old Norwegians in 2005 to shed light on this issue (n=13 399). We assessed the prevalence of getting drunk at various locations and estimated the relative importance of various locations (i.e., the proportion of the total number of episodes of getting drunk that had taken place in various locations). About half of the episodes of getting drunk occurred in private homes. Although the respondents were too young to drink at licensed premises, about one in ten episodes took place in such locations. Relatively few episodes occurred at social events at school or in connection with organized leisure activities. The relative importance of the various locations varied with age and frequency of intoxication, whereas gender differences were less pronounced. Implications for prevention and further research are discussed.

A systems approach to college drinking: development of a deterministic model for testing alcohol control policies

OBJECTIVE

The misuse and abuse of alcohol among college students remain persistent problems. Using a systems approach to understand the dynamics of student drinking behavior and thus forecasting the impact of campus policy to address the problem represents a novel approach. Toward this end, the successful development of a predictive mathematical model of college drinking would represent a significant advance for prevention efforts.

METHOD

A deterministic, compartmental model of college drinking was developed, incorporating three processes: (1) individual factors, (2) social interactions, and (3) social norms. The model quantifies these processes in terms of the movement of students between drinking compartments characterized by five styles of college drinking: abstainers, light drinkers, moderate drinkers, problem drinkers, and heavy episodic drinkers. Predictions from the model were first compared with actual campus-level data and then used to predict the effects of several simulated interventions to address heavy episodic drinking.

RESULTS

First, the model provides a reasonable fit of actual drinking styles of students attending Social Norms Marketing Research Project campuses varying by "wetness" and by drinking styles of matriculating students. Second, the model predicts that a combination of simulated interventions targeting heavy episodic drinkers at a moderately "dry" campus would extinguish heavy episodic drinkers, replacing them with light and moderate drinkers. Instituting the same combination of simulated interventions at a moderately "wet" campus would result in only a moderate reduction in heavy episodic drinkers (i.e., 50% to 35%).

CONCLUSIONS

A simple, five-state compartmental model adequately predicted the actual drinking patterns of students from a variety of campuses surveyed in the Social Norms Marketing Research Project study. The model predicted the impact on drinking patterns of several simulated interventions to address heavy episodic drinking on various types of campuses.

A longitudinal investigation of heavy drinking and physical dating violence in men and women

Examinations of heavy drinking and dating violence have typically focused on either female victimization or male perpetration; yet recent findings indicate that mutual aggression is the most common pattern of dating violence. The current study investigated the relation between heavy drinking and dating violence for both men and women. Participants (N=2247) completed surveys that assessed their heavy drinking and dating violence frequency across the first three years of college. Findings indicated that heavy drinking and dating violence were both relatively stable across time for men and women, but the relation between heavy drinking and dating violence differed by gender. For men, heavy drinking and dating violence were concurrently associated during their freshman year (Year 1), whereas for women heavy drinking during their sophomore year (Year 2) predicted dating violence in their junior year (Year 3). In addition to providing educational material on healthy relationships and conflict resolution techniques, intervention efforts should target both heavy drinking and dating violence for men during or prior to their freshman year of college, whereas women may primarily benefit from efforts to reduce their heavy drinking.

The spread of alcohol consumption behavior in a large social network

BACKGROUND

Alcohol consumption has important health-related consequences and numerous biological and social determinants.

OBJECTIVE

To explore quantitatively whether alcohol consumption behavior spreads from person to person in a large social network of friends, coworkers, siblings, spouses, and neighbors, followed for 32 years.

DESIGN

Longitudinal network cohort study.

SETTING

The Framingham Heart Study.

PARTICIPANTS

12 067 persons assessed at several time points between 1971 and 2003.

MEASUREMENTS

Self-reported alcohol consumption (number of drinks per week on average over the past year and number of days drinking within the past week) and social network ties, measured at each time point.

RESULTS

Clusters of drinkers and abstainers were present in the network at all time points, and the clusters extended to 3 degrees of separation. These clusters were not only due to selective formation of social ties among drinkers but also seem to reflect interpersonal influence. Changes in the alcohol consumption behavior of a person's social network had a statistically significant effect on that person's subsequent alcohol consumption behavior. The behaviors of immediate neighbors and coworkers were not significantly associated with a person's drinking behavior, but the behavior of relatives and friends was.

LIMITATIONS

A nonclinical measure of alcohol consumption was used. Also, it is unclear whether the effects on long-term health are positive or negative, because alcohol has been shown to be both harmful and protective. Finally, not all network ties were observed.

CONCLUSION

Network phenomena seem to influence alcohol consumption behavior. This has implications for clinical and public health interventions and further supports group-level interventions to reduce problematic drinking.

The spread of alcohol consumption behavior in a large social network

BACKGROUND

Alcohol consumption has important health-related consequences and numerous biological and social determinants.

OBJECTIVE

To explore quantitatively whether alcohol consumption behavior spreads from person to person in a large social network of friends, coworkers, siblings, spouses, and neighbors, followed for 32 years.

DESIGN

Longitudinal network cohort study.

SETTING

The Framingham Heart Study.

PARTICIPANTS

12 067 persons assessed at several time points between 1971 and 2003.

MEASUREMENTS

Self-reported alcohol consumption (number of drinks per week on average over the past year and number of days drinking within the past week) and social network ties, measured at each time point.

RESULTS

Clusters of drinkers and abstainers were present in the network at all time points, and the clusters extended to 3 degrees of separation. These clusters were not only due to selective formation of social ties among drinkers but also seem to reflect interpersonal influence. Changes in the alcohol consumption behavior of a person's social network had a statistically significant effect on that person's subsequent alcohol consumption behavior. The behaviors of immediate neighbors and coworkers were not significantly associated with a person's drinking behavior, but the behavior of relatives and friends was.

LIMITATIONS

A nonclinical measure of alcohol consumption was used. Also, it is unclear whether the effects on long-term health are positive or negative, because alcohol has been shown to be both harmful and protective. Finally, not all network ties were observed.

CONCLUSION

Network phenomena seem to influence alcohol consumption behavior. This has implications for clinical and public health interventions and further supports group-level interventions to reduce problematic drinking.

Whose opinion matters? The relationship between injunctive norms and alcohol consequences in college students

Harm reduction approaches may benefit from research extending the exploration of predictors of alcohol use per se to those components most directly related to alcohol-related harm. This investigation evaluated the relationship between perceived injunctive norms of alcohol use (level of approval of drinking behaviors in specific situations) and the experience of alcohol-related consequences as a function of typical student reference groups at increasing levels of similarity to the respondent: based on race, gender, Greek status, and combinations of these dimensions, as well as parents, close friends, and the students' own attitudes. Participants were 3753 students (61% female) from two campuses who completed an online survey. Preliminary analyses determined that there were no differences in the relationship between perceived injunctive norms and consequences across the eight student groups of varying specificity, thus all eight levels were combined into one variable of perceived student injunctive norms. However, the relationship between this variable and consequences was weaker than the perceived attitudes of more proximal referents (parents, close friends, as well as their own personal attitudes). Subsequent analyses predicting consequences while controlling for demographic variables and drinking level, revealed that perceived injunctive norms for students, parents, and close friends as well as personal attitudes each significantly predicted consequences. Results suggest an important role for perceived injunctive norms in the experiencing of consequences over and above the amount of consumption and point to types of injunctive norms feedback that might form effective interventions (i.e., incorporating close friend and parent feedback as well as general student feedback).

Peer substance use overestimation among French university students: a cross-sectional survey

Background

Normative misperceptions have been widely documented for alcohol use among U.S. college students. There is less research on other substances or European cultural contexts. This study explores which factors are associated with alcohol, tobacco and cannabis use misperceptions among French college students, focusing on substance use.

Methods

12 classes of second-year college students (n = 731) in sociology, medicine, nursing or foreign language estimated the proportion of tobacco, cannabis, alcohol use and heavy episodic drinking among their peers and reported their own use.

Results

Peer substance use overestimation frequency was 84% for tobacco, 55% for cannabis, 37% for alcohol and 56% for heavy episodic drinking. Cannabis users (p = 0.006), alcohol (p = 0.003) and heavy episodic drinkers (p = 0.002), are more likely to overestimate the prevalence of use of these consumptions. Tobacco users are less likely to overestimate peer prevalence of smoking (p = 0.044). Women are more likely to overestimate tobacco (p < 0.001) and heavy episodic drinking (p = 0.007) prevalence. Students having already completed another substance use questionnaire were more likely to overestimate alcohol use prevalence (p = 0.012). Students exposed to cannabis prevention campaigns were more likely to overestimate cannabis (p = 0.018) and tobacco use (p = 0.022) prevalence. Other identified factors are class-level use prevalences and academic discipline.

Conclusions

Local interventions that focus on creating realistic perceptions of substance use prevalence could be considered for cannabis and alcohol prevention in French campuses.

Normative misperceptions of abuse among perpetrators of intimate partner violence

This research was designed to evaluate the applicability of social norms approaches to interventions with male perpetrators of intimate partner violence (IPV). Participants included 124 nonadjudicated IPV perpetrating men recruited from the general population who completed assessment of their own IPV behaviors via telephone interviews and estimated the prevalence of behaviors in other men. Results indicated that IPV perpetrators consistently overestimated the percentage of men who engaged in IPV and that their estimates were associated with violence toward their partner over the past 90 days. Findings provide preliminary support for incorporating social norms approaches into clinical applications.

Impact of Relative Residence Times in Highly Distinct Environments on the Distribution of Heavy Drinkers

Alcohol consumption is a function of social dynamics, environmental contexts, individuals' preferences and family history. Empirical surveys have focused primarily on identification of risk factors for high-level drinking but have done little to clarify the underlying mechanisms at work. Also, there have been few attempts to apply nonlinear dynamics to the study of these mechanisms and processes at the population level. A simple framework where drinking is modeled as a socially contagious process in low- and high-risk connected environments is introduced. Individuals are classified as light, moderate (assumed mobile), and heavy drinkers. Moderate drinkers provide the link between both environments, that is, they are assumed to be the only individuals drinking in both settings. The focus here is on the effect of moderate drinkers, measured by the proportion of their time spent in "low-" versus "high-" risk drinking environments, on the distribution of drinkers.A simple model within our contact framework predicts that if the relative residence times of moderate drinkers is distributed randomly between low- and high-risk environments then the proportion of heavy drinkers is likely to be higher than expected. However, the full story even in a highly simplified setting is not so simple because "strong" local social mixing tends to increase high-risk drinking on its own. High levels of social interaction between light and moderate drinkers in low-risk environments can diminish the importance of the distribution of relative drinking times on the prevalence of heavy drinking.

Sociodemographic, behavioral, and cognitive predictors of alcohol-impaired driving in a sample of U.S. college students

Alcohol-impaired driving continues to be a major public health concern, particularly among college students. The current study examined whether sociodemographic, behavioral, and cognitive variables predicted alcohol-impaired driving in a sample of college students. Data were collected via telephone interviews from a random sample of undergraduates, ages 18-25 years old, stratified by sex and class in school. Using hierarchical logistic regression analyses (n = 330), results revealed that higher levels of weekly alcohol use, being age 21 or older, and perceived difficulty in obtaining alternative transportation were associated with a greater likelihood of drinking and driving. In addition, perceived likelihood of drinking and driving-related consequences was associated with a lower likelihood of drinking and driving. Knowledge of the .08% per se and zero tolerance laws did not predict alcohol-impaired driving. Findings are discussed in terms of their implications for college media campaigns designed to reduce alcohol-impaired driving.

Before the party starts: risk factors and reasons for "pregaming" in college students

OBJECTIVE

"Pregaming"--drinking alcohol prior to going out-is believed to be common, yet empirical examinations are scarce. In this study, we examined who is at risk for pregaming, consequences resulting from it, and motives behind it.

PARTICIPANTS

Participants (N = 159, 52% female) were drinkers, aged 18 to 24, recruited from introductory psychology classes.

METHODS

In 2005 and 2006, interview measures of drinking and pregaming and self-report demographic, motivational, and reasons for pregaming measures were administered.

RESULTS

Two-thirds of students pregamed. Younger age, but not Greek affiliation, was associated with heavier pregaming drinking. We found minimal support for the prediction of pregaming by general drinking motives. Specific reasons for pregaming were identified, including saving money and obtaining alcohol when under 21.

CONCLUSIONS

Findings highlight the risk associated with pregaming, due to selection effects and to event characteristics. The unique reasons for pregaming must be further understood and addressed in targeted interventions.

‘Just don't eat chicken’: the challenge of engaging Australian adults in appropriate preventive behaviours for bird flu

Leading medical experts have cautioned about the risk of inappropriate behavioural responses as a result of fear of avian influenza (bird flu) even before a pandemic emerges, and have emphasised the need for appropriate risk communication strategies. There is a paucity of in‐depth qualitative research into the general public's understanding of, and reactions to, such potential health crises. Four focus groups were conducted in April 2006 and a further eight focus groups in July 2006, to examine people's knowledge, beliefs and behaviours in relation to avian influenza, with the primary aim being to inform the development of future communication strategies. It was clear from the focus groups that avian influenza is not a disease the participants perceive they are likely to acquire; it was not simply that Australia was far from mind when thinking of avian influenza, but that they also saw Australia as a haven protected from avian influenza. We found that, in general, participants see avian influenza as yet another example of media sensationalism—not as a disease that poses any real risk to Australia—and are clearly unprepared for a potential outbreak. Governments and health authorities should conduct further research to understand consumer perceptions of avian (or other pandemic) influenza, and attitudes towards the recommended protective behaviours, in order to pro‐actively develop communication strategies to rapidly inform the public and encourage appropriate behavioural responses in the event that the potential risk is realised.

Copyright © 2009 John Wiley & Sons, Ltd.

Social and financial resources and high-risk alcohol consumption among older adults

BACKGROUND

This study examined long-term mutual predictive associations between social and financial resources and high-risk alcohol consumption in later life.

METHOD

A sample of 55- to 65-year-old older adults (n = 719) was surveyed at baseline and 10 years and 20 years later. At each contact point, participants completed an inventory that assessed social and financial resources and alcohol consumption.

RESULTS

Over the 20-year interval, there was evidence of both social causation and social selection processes in relation to high-risk alcohol consumption. In support of a social causation perspective, higher levels of some social resources, such as participation in social activities, friends' approval of drinking, quality of relationship with spouse, and financial resources, were associated with a subsequent increased likelihood of high-risk alcohol consumption. Conversely, indicating the presence of social selection, high-risk alcohol consumption was associated with subsequent higher levels of friends' approval of drinking and quality of the spousal relationship, but lower quality of relationships with extended family members.

CONCLUSIONS

These findings reflect mutual influence processes in which older adults' social resources and high-risk alcohol consumption can alter each other. Older adults may benefit from information about how social factors can affect their drinking habits; accordingly, information about social causation effects could be used to guide effective prevention and intervention efforts aimed at reducing the risk that late-life social factors may amplify their excessive alcohol consumption.

Perceived behavioral alcohol norms predict drinking for college students while studying abroad

OBJECTIVE

College students who study abroad may represent a subgroup at risk for increased drinking while living in foreign countries. The present study explores this idea as well as the extent to which students' pre-abroad perceptions of study-abroad student drinking are related to actual drinking while abroad.

METHOD

Ninety-one students planning to study abroad completed an online survey of demographics, pre-abroad drinking behavior, perceptions of study-abroad student drinking behavior while abroad, and intentions to drink while abroad. Halfway into their study-abroad experience, participants completed a follow-up survey assessing drinking while abroad.

RESULTS

Pre-abroad intentions of drinking and pre-abroad perceptions of study-abroad drinking were associated with actual drinking while abroad. However, perceptions predicted actual drinking while abroad over and above intended drinking. In addition, although participants overall did not significantly increase their drinking while studying abroad, participants with higher pre-abroad perceived norms significantly increased their own drinking behavior while abroad.

CONCLUSIONS

As in other samples of college students, perceived norms appear to be an important correlate of study-abroad student drinking behavior. Findings suggest that perceptions of study-abroad student-specific drinking predicted not only actual drinking while abroad but also increases in drinking from pre-abroad levels. Findings provide preliminary support for the idea that presenting prospective study-abroad students with accurate norms of study-abroad student-drinking behavior may help prevent increased or heavy drinking during this period.

Have I had one drink too many? Assessing gender differences in misperceptions of intoxication among college students

OBJECTIVE

The present study extends the literature on factors involved in college students' drinking tendencies by examining differences between men and women in their ability to accurately estimate personal intoxication. The study also assessed whether men and women who typically consume large quantities of alcohol when they attend parties have more difficulty accurately assessing intoxication compared with lighter drinkers.

METHOD

The research used the external cueing approach (ECA) of Turrisi and colleagues as the informational paradigm to examine 3,707 college students' gender, typical drinking at parties, and how they relate to perceptions of intoxication.

RESULTS

The study revealed that approximately 20% (n = 710) of participants underestimated their blood alcohol concentration using the ECA. Among participants who made underestimation errors, gender differences were observed in that women made significantly more underestimation errors in the scenarios that contained four to five drinks and men made more underestimation errors in the scenarios that contained six to seven drinks. In addition, a three-way interaction revealed that female students who reported typically drinking larger amounts of alcohol in party settings were more likely to make errors when estimating their intoxication for moderately high numbers of drinks (e.g., four to five drinks).

CONCLUSIONS

The results are discussed in terms of examining the importance of college student drinking, gender, typical alcohol consumption at a party, and estimation of intoxication. Implications of gender effects in relation to high-risk drinking activities (i.e., pregaming and drinking games) as well as prevention efforts are discussed.

The association between time perspective and alcohol consumption in university students: cross-sectional study

BACKGROUND

Heavy alcohol consumption is associated with significant morbidity and mortality. Levels of alcohol consumption among students and young people are particularly high. Time perspective describes the varying value individuals place on outcomes in the present and future. In general, it has been found that individuals prefer to receive a gain today rather than in the future. There is evidence that time perspective is associated with addictive health behaviours, including alcoholism and cigarette smoking, but less evidence of its association with non-addictive, but hazardous, levels of alcohol consumption. The objective was to determine if there is an association between time perspective and hazardous alcohol consumption.

METHODS

A cross-sectional survey using a self-completion questionnaire was administered to willing undergraduate students attending a convenience sample of lectures in two university faculties. Hazardous alcohol consumption was defined as a score of ≥8 on the Alcohol Use Disorders Identification Test (AUDIT) and time perspective was measured using the Consideration of Future Consequences Scale (CFCS). Participants were 322 undergraduate university students in two faculties at a university in Northern England, UK.

RESULTS

Hazardous alcohol consumption was reported by 264 (82%) respondents. After controlling for potential confounding by socio-demographic variables, greater consideration of future consequences was associated with lower odds of reporting hazardous drinking [odds ratio = 0.28; 95% confidence interval 0.15-0.54].

CONCLUSION

Interventions aimed at increasing future orientated time perspective may be effective in decreasing hazardous alcohol consumption in students.