Changes in binge drinking and related problems among American college students between 1993 and 1997. Results of the Harvard School of Public Health College Alcohol Study

More Canadian students drink but American students drink more: comparing college alcohol use in two countries

AIMS

To compare alcohol use among US and Canadian college students.

DESIGN

Results of the 1999 College Alcohol Study and the 1998 Canadian Campus Survey are compared.

SETTING

One hundred and nineteen nationally representative US 4-year colleges and universities in 40 states and 16 nationally representative Canadian 4-year universities.

PARTICIPANTS

Randomly selected students under 25 years (12 344 US and 6729 Canadian).

MEASUREMENTS

Self-reports of alcohol use and heavy alcohol use.

FINDINGS

The prevalence of life-time and past year alcohol use is significantly higher among Canadian students than US students (92% versus 86%, 87% versus 81%). The prevalence of heavy alcohol use (typically consuming five or more drinks in a row for males/four or more for females) among past-year and past-week drinkers is significantly higher among US students than Canadian students (41% versus 35%, 54% versus 42%). In both countries older [corrected] students and students living at home with their parents are less likely to be heavy drinkers; students who report first drunkenness before the age of 16 are more likely to be heavy drinkers in college.

CONCLUSION

Programs aimed at students' heavy alcohol use should target freshman at entry or earlier. Since students living with their parents are less likely to be heavy drinkers, parents may play a potentially important role in prevention efforts. The patterns of drinking in both countries may be influenced by the legal minimum drinking age. However, the relationship is complex and must be viewed in the context of other variables such as chronological age.

Prevalence and correlates of alcohol-induced blackouts among college students: results of an e-mail survey

The authors conducted an e-mail survey of 772 college students to learn more about their experiences with blackouts. Approximately half (51%) of those who had ever consumed alcohol reported they had experienced a blackout at some point in their lives, and 40% had experienced 1 in the year before the survey. Among those who drank in the 2 weeks before the survey, nearly 1 in 10 (9.4%) had experienced a blackout during that period. Many later learned that, during the blackout, they had vandalized property, driven an automobile, had sexual intercourse, or engaged in other risky behaviors. Experiencing 3 or more blackouts was associated with a variety of other experiences, including heavier drinking, lower grades, an earlier age of drinking onset, and having others express concerns about their drinking. The female students who reported blackouts during the 2 weeks before the survey drank far less than male students did during this time period, supporting the use of gender-specific definitions of risky drinking.

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.

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.

Alcohol, tobacco, and drug use among young adults prior to entering the military

This study examined the prevalence and correlates of alcohol, tobacco, and drug use among military recruits prior to enlistment. As part of a 5-year longitudinal study, a baseline survey was conducted with 2,002 Naval recruits. Despite being overwhelmingly underage, 75% of recruits consumed alcohol in the year before enlistment, and 26% had engaged in heavy drinking. About half had used tobacco, and 31% had used drugs. Multivariate logistic regression analysis revealed that although men were not at significantly greater risk than were women for preenlistment alcohol, heavy drinking or drug use, they were at elevated risk for preenlistment tobacco use (Odds Ratio = 1.71; 95% Confidence Interval = 1.21, 2.41). Normative beliefs concerning best friend's drinking were highly predictive of each outcome. Prior use of each substance was significantly associated with prior use of other substances. Preenlistment drinking, smoking, and drug use are prevalent behaviors in this population. These data can help to heighten awareness among employers as to the prevalence of substance use in the 17-24-year-old age group, and thereby inform policy and prevention programs.

Data quality in evaluation of an alcohol-related harm prevention program

The authors report the reliability and convergent validity in a sample of college students for 27 composite scales and two items covering alcohol use, cigarette smoking, marijuana use, and other drug use; beliefs relating to alcohol use; perceived norms for alcohol-related behavior; harm prevention skills; intentions to take prevention action; harm prevention action taken; risk taken; experienced harm; and other health-related behaviors and person characteristics. Data quality assessment strategies and missing data procedures were illustrated for large, multivariate, longitudinal data sets. Results indicate 23 of the 27 composite scales had at least acceptable reliability, and the remaining 4 composite scales had at least marginally acceptable reliability. At least moderate construct validity was demonstrated for 25 scales.

Life-history theory and risky drinking

AIMS

Life-history theory, a major theory related to evolutionary biology and behavioral ecology, is applied to analyze patterns in alcohol abuse and dependence. The life-history approach examines how intensity of reproductive competition affects the benefits and costs of risk-taking, which are typically greater for young men than for women or older men. We used this framework to predict demographic variation in hazardous patterns of alcohol use, assuming that they reflect risk-taking in general.

DESIGN

This paper is a review of literature on demographic patterns in risky drinking and alcohol dependence. Predictions are generated using evolutionary analysis of risk-taking. Existing surveys of drinking behavior are reviewed, and findings are compared to predictions.

FINDINGS

Results were generally consistent with predictions. The frequency of risky drinking and dependence is higher for men, and people of younger age, single marital status, childless parental status or unstable environmental resources. An exception is the effect of educational attainment. which is inconsistent.

CONCLUSIONS

Risky drinking behavior, as with other forms of physical risk-taking, is more frequently observed in young men, and it increases where environmental instability is higher. The utility of life-history theory is compared to alternate conceptions of risky drinking and dependence. Implications of this perspective for research and clinical efforts are explored.

The relations of anxiety sensitivity, experiential avoidance, and alexithymic coping to young adults' motivations for drinking

The authors examined whether motivations for drinking alcohol are associated with the anxiety-related dispositional tendencies of anxiety sensitivity, experiential avoidance, and alexithymic coping. The authors administered the Anxiety Sensitivity Index, Experiential Avoidance Scale, 20-item Toronto Alexithymia Scale, Revised Drinking Motives Questionnaire, and a demographics questionnaire to 182 university drinkers. In multiple regressions, the dispositional factors significantly predicted the risky drinking motives of coping, enhancement, and conformity. Coping and enhancement motives were significantly predicted by experiential avoidance. Conformity motives were significantly and independently predicted by anxiety sensitivity and alexithymia. The process of experiential avoidance mediated the bivariate correlation between anxiety sensitivity and coping-motivated drinking to a greater extent than did the process of alexithymic coping. The authors discuss the observed relations in regard to the psychological functions of drinking behavior that may portend the development of heavy drinking and alcohol problems in dispositionally vulnerable individuals. They also review implications for refinements of behavior therapy for problem drinkers.

Prevention efforts underlying decreases in binge drinking at institutions of higher education

Analyses of 94 Fund for the Improvement of Post-Secondary Education (FIPSE)-sponsored drug-prevention programs and their outcomes used the Core Survey to identify 34 institutions where college students' binge drinking increased (M = 5.44%) and 60 institutions where it decreased (M = -4.59%) during 2 years of program operation. The authors used an inductively derived taxonomy of prevention program elements, student variables, student substance use, use-related variables, and institutional variables to compare the 2 groups of institutions. Only prevention program elements discriminated between groups. Factor analysis of discriminating elements identified 8 prevention factors that improved base-rate prediction of institutional decrease in binge drinking by 28.1%. Factor synthesis yielded a 3-construct binge-drinking prevention model based on student participation and involvement strategies, educational and informational processes, and campus regulatory and physical change efforts. This model improved base-rate prediction of decreased binge drinking by 33.2%.

Drinking perceptions and management strategies of college students with diabetes

PURPOSE

The purpose of this research was to explore how college students with diabetes perceive and manage alcohol consumption.

METHODS

Fifteen college students with diabetes attending a large northeastern university participated in a single semistructured interview that focused on the impact of starting college on diabetes management and situational obstacles to diet-related self-care. Interviews were audiotaped, transcribed verbatim, and analyzed using the constant comparative method of analysis.

RESULTS

Students perceived alcohol as a pervasive part of the university environment and felt strong peer pressure to drink in alcohol-related social situations. Students described 3 distinct drinking practices and identified factors that shaped decisions about drinking. Most students developed personal strategies to manage drinking, usually without guidance.

CONCLUSIONS

Some of the students' strategies appeared reasonable for avoiding adverse outcomes of drinking; however, other strategies may have increased their risk of hypoglycemia or poor glucose control. More research is needed to understand how students' management strategies influence diabetes control and to explore how education and counseling from healthcare providers can improve students' management of drinking.

Making the transition from high school to college: the role of alcohol-related social influence factors in students' drinking

Using a sample of entering college freshmen (N = 311), the purposes of this study were to examine 1). whether perceived norms for college student alcohol use and problems differed by gender and level of intended Greek involvement (Greek intent); 2). associations between perceived norms, Greek intent, and alcohol use and problems; and 3). whether relations between perceived norms, Greek intent, and alcohol use and problems were moderated by gender. Results revealed no differences in levels of perceived norms for alcohol use and problems as a function of gender or intention to affiliate with a Greek letter organization. Perceived norms demonstrated consistent, significant associations with both alcohol use and problems, while Greek intent demonstrated significant associations only with alcohol problems. Examination of gender effects in associations between perceived norms, Greek intent, and alcohol use and problems revealed a number of differences in these relations. Specifically, Greek intent was significantly associated with measures of alcohol use and problems for men, but not for women. Likewise, the association between perceived norms and alcohol use and problems were significant for men, but not for women. Finally, although perceived norms were a significant predictor of heavy drinking for both men and women, the association was much stronger among male students. These findings suggest that alcohol prevention interventions may benefit from specifically targeting perceived norms among incoming students who are at highest risk (i.e., male pledges).

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.

The interactive effects of low self-control and commitment to school on substance abuse among college students

This study examined the combined influence of two predicting factors-low self-control and commitment to schooling-that research has shown have independent effects on substance abuse. In a sample of 598 college students, this study tested the interactive effects of these factors while controlling for other established predictors of binge drinking and drug use. Analysis showed that participants who had both low self-control and low schooling commitment had significantly higher scores on substance abuse than would be expected from the independent influences of the component factors, which suggests that the combined effects of these predictors on substance abuse have a greater influence than their direct influences.

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.

Impact of perceived second-hand consequences related to alcohol use on college students' drinking behavior intent: a test of feasibility

This article presents the results of an experiment designed to determine the impact of a group discussion about second-hand consequences of alcohol use on college students' intentions to consume alcohol. Participants were students enrolled in two large Community Health courses at a large Midwestern university (n = 184). After randomization of class sections into an intervention or a control group, intervention group students participated in a class discussion on the negative consequences college students experience as a result of other students' drinking behavior, prior to answering survey questions regarding their drinking behavior intent. Compared to controls who completed the questionnaire only, intervention group participants reported intent to limit themselves to fewer drinks per drinking occasion (p = .003) and fewer drinks per week (p = .004). The effects of the brief educational intervention were analyzed using structural equation modeling, to test the feasibility of a hypothesized intervention mechanism.

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.

Binge drinking in Chinese, Korean, and White college students: genetic and ethnic group differences

Studies of Asian college students have found that rates of binge drinking are associated with variation in the aldehyde dehydrogenase (ALDH2) gene. Chinese and Koreans have different prevalence rates of the ALDH2*2 allele, alcohol use, and alcoholism. The association of ALDH2 status and ethnic group with binge drinking was examined in 328 Chinese, Korean, and White college students. Ethnic group differences were found, with Whites having the highest rate of binge drinking, followed by Koreans and then Chinese. Among Asian participants, ALDH2 status and ethnicity related to binge drinking in an additive manner. Possessing an ALDH2*2 allele and being Chinese were protective factors, and being White and being Korean without an ALDH2*2 allele were risk factors for binge drinking. These results suggest that ALDH2 status, as well as other factors that differ in Koreans and Chinese, but do not interact with ALDH2, are associated with binge drinking among Asians.

Preventing binge drinking during early adolescence: one- and two-year follow-up of a school-based preventive intervention

The authors examined the effectiveness of a school-based prevention program on reducing binge drinking in a sample of minority, inner-city, middle-school students. Rates of binge drinking were compared among youth who received the program beginning in the 7th grade (n = 1,713) and a control group (n = 1,328) that did not. The prevention program had protective effects in terms of binge drinking at the 1-year (8th grade) and 2-year (9th grade) follow-up assessments. The proportion of binge drinkers was over 50% lower in the intervention group relative to the control group at the follow-up assessments. There were also several significant program effects on proximal drinking variables, including drinking knowledge, pro-drinking attitudes, and peer drinking norms. These findings indicate that a school-based drug abuse prevention approach previously found to be effective among White youth significantly reduced binge drinking among urban minority youth.

Examination of the short-term efficacy of a parent intervention to reduce college student drinking tendencies

The research evaluated the efficacy of an intervention to reduce the onset and extent of binge drinking during the 1st year of college. The approach was on influencing the students before they start college, through their parents, during the critical time between high school graduation and the beginning of college. Specifically, parents were educated about binge drinking and how to convey information to their teens, and then encouraged to talk with their teens just before their teens embarked on their college education. Teens whose parents implemented the intervention materials were compared with a control sample during their 1st semester on drinking outcomes, perceptions about drinking activities, perceived parental and peer approval of drinking, and drinking-related consequences. As anticipated, teens in the treatment condition were significantly different (p < .05) on nearly all outcomes in the predicted directions (e.g., lower drinking tendencies, drinking consequences). The benefits of a parent-based intervention to prevent college drinking are discussed.

Relative efficacy of a brief motivational intervention for college student drinkers

The authors evaluated the efficacy of Brief Alcohol Screening and Intervention for College Students (BASICS - L. A. Dimeff, J. S. Baer, D. R. Kivlahan, & G. A. Marlatt, 1999), a single session of drinking-related feedback intended to reduce heavy drinking and related harm. College student drinkers (N = 99) were assigned to BASICS, an educational intervention, or an assessment-only control group. At 3 months postintervention. there were no overall significant group differences, but heavier drinking BASICS participants showed greater reductions in weekly alcohol consumption and binge drinking than did heavier drinking control and education participants. At 9 months, heavier drinking BASICS participants again showed the largest effect sizes. BASICS participants evaluated the intervention more favorably than did education participants. This study suggests that BASICS may be more efficacious than educational interventions for heavier drinking college students.

Alcohol use in high school: predicting students' alcohol use and alcohol problems in four-year colleges

This research examined the effect of students' drinking behaviors in high school on their alcohol use and alcohol problems in college. Five colleges in New York State were randomly selected for the study. The telephone interview method was employed to survey college students during the spring semester of 1998. Within each participating college, students were randomly selected through the use of complete student telephone directories provided by the college administration. A total of 813 students were interviewed. Alcohol problems were measured with items from DSM-IV. Results indicate that both frequency and quantity of alcohol use in high school significantly affect students' alcohol consumption in college. Furthermore, the impact of alcohol use in high school on alcohol problems in college tends to be composed of a moderate direct effect and a relatively strong indirect effect via its impact on current alcohol consumption in college. Prevention efforts for drinking in college may need to start in high school to reduce or delay alcohol use by high school students. Additional assessment services and more readily available treatment services may be required to address potential alcohol problems among college students. Future research should examine the effect and longevity of students' alcohol problem symptoms after they graduate from college.

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.

Trends in alcohol consumption in undergraduate third level students: 1992-1999

BACKGROUND

Alcohol consumption has increased in the Irish population in recent years. It is not known to what extent the student population has been affected by this increase.

AIM

To determine levels of alcohol consumption among undergraduates in one Irish university and identify changes in drinking patterns in the years 1992-1999.

METHODS

Information on alcohol use was obtained by anonymous self-completed questionnaire in a stratified random cross-faculty sample of undergraduates in 1992 and 1999. The CAGE questionnaire to determine problem drinking was included in both surveys.

RESULTS

A statistically significant (p=0.01) drop in weekly alcohol consumption by males was found, although the proportion of male problem drinkers increased. Consumption for females remained the same.

CONCLUSIONS

Findings are contrary to recent figures for drinking patterns in young Irish people in general. The fall in alcohol consumption in male students may be linked to improved male insight into the negative effects of alcohol or to the substitution of cheaper available substances.

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.

Evaluation of alcohol education programs on attitude, knowledge, and self-reported behavior of college students

This research was conducted as a pilot study to evaluate the effectiveness of two different types of alcohol education programs for college students. The educational programs were a teacher-centered motivational speech and "Alcohol 101," a new student-centered CD-ROM interactive program. The research was conducted at a public university in the Northeastern United States. A pretest/posttest quasi-experimental control group design was used. The instrument used was the Student Alcohol Questionnaire (SAQ). Univariate analysis of covariance was used to test for postintervention differences across groups for attitudes and knowledge about alcohol and self-reported alcohol consumption behavior. A statistically significant difference between groups for the second postintervention measure of attitude was identified. No significant differences in knowledge that could be attributed to the interventions were found, and no statistically significant differences were found for self-reported behavior.

Urging college alcohol and drug policies that target adverse behavior, not use

Although "zero tolerance" policies are being enacted on campuses nationwide, these policies may not be the most effective means of creating safer and healthier environments for students. Many historical precedents illustrate the value of moderation over prohibition. College drug and alcohol policies should focus primarily on dysfunctional and disruptive student behaviors, not on student drug and alcohol use only.

Why physicians are unprepared to treat patients who have alcohol- and drug-related disorders

Most primary care physicians do not feel competent to treat alcohol- and drug-related disorders. Physicians generally do not like to work with patients with these disorders and do not find treating them rewarding. Despite large numbers of such patients, the diagnosis and treatment of alcohol- and drug-related disorders are generally considered peripheral to or outside medical matters and ultimately outside medical education. There is substantial evidence that physicians fail even to identify a large percentage of patients with these disorders. Essential role models are lacking for future physicians to develop the attitudes and training they need to adequately approach addiction as a treatable medical illness. Faculty development programs in addictive disorders are needed to overcome the stigma, poor attitudes, and deficient skills among physicians who provide education and leadership for medical students and residents. The lack of parity with other medical disorders gives reimbursement and education for addiction disorders low priority. Medical students and physicians can also be consumers and patients with addiction problems. Their attitudes and abilities to learn about alcohol- and drug-related disorders are impaired without interventions. Curricula lack sufficient instruction and experiences in addiction medicine throughout all years of medical education. Programs that have successfully changed students' attitudes and skills for treatment of addicted patients continue to be exceptional and limited in focus rather than the general practice in U.S. medical schools. The authors review the findings of the literature on these problems, discuss the barriers to educational reform, and propose recommendations for developing an effective medical school curriculum about alcohol- and drug-related disorders.

Evaluation of a social norms marketing campaign to reduce high-risk drinking at The University of Mississippi

A social marketing campaign to change perceptions of peer drinking norms was conducted by the National Golden Key Honor Society at the University of Mississippi during the 1995-1996 school year. To assess the campaign's impact on perceptions of student drinking norms and alcohol consumption, Golden Key's national office administered a survey three times during the school year to all students enrolled in a random sample of required freshmen English courses. Regression analyses suggest that exposure to the marketing campaign may be associated with lower (and more accurate) estimates of student drinking norms. While offering promising results, this study was limited due to shortcomings in the research design. Future evaluations of social norms marketing campaigns should adhere to basic evaluation principles, such as using comparison groups, collecting contextual data, using a valid and reliable survey instrument, and ensuring proper survey administration techniques.

The College Alcohol Problems Scale

A short, reliable two-factor instrument measuring drinking-related negative consequences was developed from a previous measure using two samples of college students. In Study I, data on alcohol use and problems associated with alcohol use were collected on 382 introductory psychology students. The original College Alcohol Problems Scale (CAPS) was tested and found to fit the data poorly. Sequential methods were used to develop a revised instrument. Principal components analyses (PCA) on half of the sample were conducted on 20 items written to measure negative consequences related to college student drinking. Results indicated a two-factor solution measuring social and emotional problems. Confirmatory factor analyses (CFA) on the other half of the sample confirmed the two-factor structure. Further refinement of the instrument resulted in the revised CAPS (CAPS-r), an eight-item two-factor scale. In Study II, the response format was altered to coincide with the Young Adult Problem Screening Test. A total of 726 students completed the instrument as part of a university-wide random sample. CFA showed that the hypothesized model fit well across all measures of model fit and the factor structure was invariant across gender. Additional analyses revealed that the scale was internally consistent and externally valid. A short reliable and valid measure of alcohol-related problems is needed to enable low-cost data collection on college campuses across the nation, as well as to facilitate program evaluation and routine epidemiological surveillance and monitoring.

Environmental predictors of heavy episodic drinking

This study examined the relationship between environmental characteristics and heavy episodic drinking by examining college students' last drinking events. For this study, 409 undergraduate students attending a large public university were randomly selected. Students were asked to report on their last drinking event within the 30-day period prior to being surveyed. There were 274 drinking events analyzed. Bivariate analyses and multiple logistic regression analysis were used to identify contextual factors predictive of heavy episodic drinking in specific drinking events. Drinking with friends, drinking beer and hard liquor, and having many people intoxicated at an event were predictive of heavy episodic drinking events. Dating events were protective of heavy episodic drinking. Implications for future research and prevention are discussed.

Substance use problems reported by college students: combined marijuana and alcohol use versus alcohol-only use

This study examines the relationships among selected demographic characteristics, alcohol use only, alcohol plus marijuana use and substance-use related problems. Data are from 409 randomly selected undergraduate college students attending a large urban university. Poly-substance users were more likely than alcohol only users to be younger and experience all substance-use related problems studied. The relationship between poly-substance use and increased substance use-associated problems was also identified when controlling for other common predictors of substance use problems.

Heavy drinking is associated with more severe psychosocial dysfunction among girls than boys in Finland

PURPOSE

To investigate social, psychological, and environmental factors related to heavy drinking by 15-year-old Finnish school pupils.

METHODS

Each of 240 pupils completed a questionnaire about alcohol use, smoking, and illicit drug use; an Offer Self-Image Questionnaire; an Inventory of Parent and Peer Attachment; and a Psychosomatic Symptoms Questionnaire. Teachers assessed each pupil according to a Social Skills Rating Scale. Academic achievement was assessed on the basis of report grades.

RESULTS

Heavy drinking was associated with smoking, trial of drugs, poor social skills in class, and poor school achievement in both boys and girls. In girls, heavy drinking was associated with psychosomatic symptoms and a negative social self-image. Girls who drank heavily also had more difficulty with concentration and externalizing problems and more problems with teachers than those who were abstinent or consumed alcohol moderately. The self-images of boys who drank heavily were more negative than those of alcohol-abstinent boys. In boys, heavy drinking was associated with higher numbers of peer relationships.

CONCLUSIONS

Heavy drinking is associated with more severe psychosocial dysfunction among girls than boys. It may be possible to identify girls at school who drink heavily and guide them toward treatment.

Normative perceptions in relation to substance use and HIV-risky sexual behaviors of college students

In this study, 410 college students completed a survey assessing their personal substance use patterns and sexual behavior and their perceptions of other students' substance use and sexual behavior. Two parallel sets of questions were presented to reflect the two contextual conditions of being drunk or high versus being not drunk or high. Results indicated that number of recent sexual partners and normative perceptions of HIV-risky sexual behavior were the strongest predictors of personal HIV-risky behavior when not drunk or high. HIV-risky behavior when drunk or high was predicted by personal substance use as well as by number of recent partners and normative perceptions of peer sexual behavior. These findings suggest that HIV-prevention programs for college students should aim to correct overinflated perceptions of other students' high-risk sexual behavior.

A genetic association with the development of alcohol and other substance use behavior in Asian Americans

Studies of Asian adults have found that alcohol use and alcohol dependence are related to variation in the aldehyde dehydrogenase (ALDH2) gene. To investigate the association of ALDH2 with the development of drug involvement, the authors analyzed retrospective information about the onset and regular use of alcohol and other substances as reported by 180 Asian American college students. Possession of an ALDH2*2 allele was not related to initiation of alcohol use or having ever been intoxicated, but individuals with ALDH2*2 alleles were less likely to be regular drinkers, were less likely to have engaged in a binge-drinking episode, reported a lower number of maximum drinks consumed in a 24-hr period, and were less likely to have used tobacco regularly than those without this genetic variant. These findings suggest that ALDH2 is associated with the development of not only alcohol-related behavior but other substance use behavior as well.

The context-specific positive alcohol outcome expectancies of university women

Alcohol outcome expectancies are subjective beliefs about the psychological and physical effects of alcohol consumption. The primary purpose of the present study was to determine whether the types and strengths of university women's positive alcohol outcome expectancies differ across three typical student drinking contexts. Seventy-eight female undergraduates completed three versions of the Expectancy Context Questionnaire (ECQ) depicting Social, Sexual, and Tension drinking contexts, respectively, and then prospectively self-monitored their own drinking behavior. Respondent's total positive expectancies were strongest, overall, in the Sexual context and weakest in the Tension context. Consistent with hypothesis, the strengths of certain specific alcohol expectancies varied significantly across contexts: Arousal expectancies were strongest in the Sexual context and weakest in the Social context; Social/Sexual Enhancement expectancies were strongest in the Sexual context and weakest in the Tension context; and Global Positive Affect expectancies were strongest in the Social context and weakest in the Tension context. Drinking levels over the week of self-monitoring were significantly predicted by Global Positive Affect and Relaxation expectancies in the Social Context, and by Social/ Sexual Enhancement, Arousal, and Relaxation expectancies in the Sexual Context. The theoretical and clinical importance of identifying drinking context when examining alcohol expectancies is discussed.

Negative consequences of alcohol use among college students: victims or victimizers?

Focusing on reciprocity between primary and secondary consequences resulting from alcohol use among college students, this study hypothesizes that college students should not be dichotomously viewed as those who generate alcohol-related negative consequences and those who suffer from the consequences generated by fellow students; instead, since students usually live closely together and most of them use alcohol, they constantly affect one another with consequences of their alcohol use. Five colleges in New York State were randomly selected for the study. The telephone interview method was employed to survey college students during the spring semester of 1998. Within each participating college, students were randomly selected through the use of complete student telephone directories provided by the college administration. A total of 813 students were interviewed. Findings indicate that negative consequences of alcohol use among college students may be understood more in a form of group process than in separate individual circumstances. Through association and interaction with other alcohol users, students are frequently victimizing fellow students and being victimized by others in terms of alcohol-related consequences; the severity of alcohol-related hazard for students, thus, tends to be twice as severe as that for individuals who are not in a college environment.

Early findings from a disciplinary program to reduce problem drinking by college students

This article describes an intervention for college students cited for alcohol-related infractions of the student code of conduct. First-time offenders are required to attend a three-hour class that includes educational, attitudinal and skills-based activities. Students also complete self-report measures of quantity/frequency of consumption and are mailed personalized drinking feedback one week following the group session. A preliminary evaluation of the program is described and the intervention is discussed in relation to other programs available on campus.

Finding the meanings of college drinking: an analysis of fraternity drinking stories

College drinking has traditionally been studied from a public health perspective that attempts to quantify behavior as a means toward description, explanation, and intervention. This article offers a critical and cultural approach to understanding the meanings and functions of high-risk drinking and the ways in which those meanings are reproduced within the culture. Data were collected via an ethnographic study of fraternity members at a large midwestern university to explore the communication of excessive drinking norms. Viewed from various narrative and structural theories, the study examines collected drinking stories as a source for analyzing the construction of meanings surrounding drunkenness for the fraternity subculture. Five themes emerged as functions of drunkenness for the culture. Implications for prevention are discussed.

Binge-drinking-related consequences in college students: role of drinking beliefs and mother-teen communications

The present research contrasted theoretical models depicting the nature of the relation among drinking beliefs, drinking tendencies, and behavioral consequences in 266 incoming freshman college students. It also examined the theoretical relations between mother-teen communications and drinking beliefs relevant to behavioral consequences. The findings revealed direct relations between binge-drinking consequences and the drinking beliefs: Alcohol can make positive transformations, can enhance social behavior, and can increase negative affect and normative approval. Direct relations were not observed between consequences and the drinking beliefs regarding physical risk and health orientation. Finally, the present research found consistent support for the relation between mother-teen communications and drinking beliefs relevant to binge-drinking consequences.