Concurrent and prospective screening for problem drinking among college students

Predictors of alcohol consumption among in-school adolescents in the Central Region of Ghana: A baseline information for developing cognitive-behavioural interventions

BACKGROUND AND PURPOSE

Despite a recent shift in school going adolescents' engagement in health compromising behaviours and their related socio-economic implications on developing societies, it is surprising that baseline information for planned interventions is sparse. The purpose of this study was to investigate the prevalence of alcohol drinking and related behaviours among in-school adolescents in the Junior High Schools (JHS) in the Central Region of Ghana.

METHODS AND RESULTS

Descriptive cross-sectional design was employed with multistage sampling procedures to sample 1400 school going adolescents in JHS in the Central Region. Preliminary findings using simple frequencies and percentages revealed 42% alcohol drinking prevalence in the region. High prevalence of drunkenness (73%, n = 406) and early exposure to alcohol drinking when students were in primary school (52%, n = 286) were noted. Community festivals and use of alcohol as a form of medicine were enabling factors of alcohol consumption in the region. Binary logistic regression analysis also showed that geographical location was a significant predictor of alcohol drinking among school going adolescents, with students in the southern and central part of the region at greater risks of drinking alcohol than those from the northern part (OR = .696, 95% CI = 0.52-926, p = .013). However, no statistical significant variations were found in the odds of drinking alcohol for age (OR = 1.13, 95% CI = 0.86-1.48, p = .370), gender (OR = .81, 95% CI = 0.65-1.01, p = .06), religious affiliation (OR = 1.33, 95% CI = 0.94-1.89, p = .10), parental communication (OR = .86, 95% CI = 0.66-1.06, p = .13), academic performance (OR = 1.07, 95% CI = 0.79-1.45, p = .05) and socioeconomic status (OR = 1.20, 95% CI = 0.95-1.53, p = .12).

CONCLUSIONS

With this baseline data, it was recommended that schools' curricula should include preventive cognitive-behavioural interventions that teach drug resistance skills and anti-drug norms. These interventions would foster the development of requisite knowledge and social skills (e.g., developing competence) for resisting social and peer influences that may trigger alcohol use and perhaps other drugs. Potentially, the motivation for alcohol use among school going adolescents in the region would be minimized, if not prevented.

Projection, conformity and deviance regulation: a prospective study of alcohol use

We examine how alcohol-related attitudes and behaviour are related to injunctive and descriptive norms over time, and how these perceptions are linked to the experience of alcohol-related problems. In a longitudinal study of alcohol use (n=239, over three time points), we explored the presence of projection, conformity and deviance in college students--a group in the process of identity formation and redefining peer relationships. We found that the first year of college was characterised by both conformity and projection, and that positive attitudes towards alcohol, greater drinking, and higher descriptive norms were associated prospectively with more alcohol-related problems. However, in the second year, the pattern changed such that alcohol consumption behaviour was characterised by deviance such that those who believed others engaged in more drinking reported relatively lower consumption. The longitudinal findings support deviance regulation theory (Blanton, H., & Christie, C. (2003). Deviance regulation: A theory of action and identity. Review of General Psychology, 7, 115-149), which states that individuals form identities by deviating from peers in ways they perceive as desirable. In general, one must consider the role and stage of identity development when making predictions about how attitudes and perceived norms influence alcohol use and the experience of alcohol-related problems.

A brief image-based prevention intervention for adolescents

The authors evaluated the efficacy of a brief image-based prevention intervention and assessed current drug use as a moderator of intervention effects. In a clinical trial, 416 high school-age adolescents were randomized to either the brief intervention or usual care control, with data collected at baseline and 3-month follow-up. The brief intervention consisted of a tailored in-person communication and a series of parent/guardian print materials based on the behavior-image model. Health behavior goal setting increased for participants receiving the brief intervention, with an effect size in the small range (d = 0.33). Overall effect sizes for cigarette smoking frequency and quantity and alcohol use frequency and quantity were small (ds = 0.16-0.21) and in favor of the brief intervention. However, adolescents reporting current substance use who received the brief intervention reduced their frequency and heavy use of alcohol, frequency and quantity of cigarette smoking, and reported fewer alcohol/drug problems, with larger effects ranging from small to approaching medium in size (ds = 0.32-0.43, ps < .01). This study suggests that brief image-based messages may increase health behavior goal setting and reduce substance use, particularly among drug-using older adolescents.

Are social norms associated with smoking in French university students? A survey report on smoking correlates

Background

Knowledge of the correlates of smoking is a first step to successful prevention interventions. The social norms theory hypothesises that students' smoking behaviour is linked to their perception of norms for use of tobacco. This study was designed to test the theory that smoking is associated with perceived norms, controlling for other correlates of smoking.

Methods

In a pencil-and-paper questionnaire, 721 second-year students in sociology, medicine, foreign language or nursing studies estimated the number of cigarettes usually smoked in a month. 31 additional covariates were included as potential predictors of tobacco use. Multiple imputation was used to deal with missing values among covariates. The strength of the association of each variable with tobacco use was quantified by the inclusion frequencies of the variable in 1000 bootstrap sample backward selections. Being a smoker and the number of cigarettes smoked by smokers were modelled separately.

Results

We retain 8 variables to predict the risk of smoking and 6 to predict the quantities smoked by smokers. The risk of being a smoker is increased by cannabis use, binge drinking, being unsupportive of smoke-free universities, perceived friends' approval of regular smoking, positive perceptions about tobacco, a high perceived prevalence of smoking among friends, reporting not being disturbed by people smoking in the university, and being female. The quantity of cigarettes smoked by smokers is greater for smokers reporting never being disturbed by smoke in the university, unsupportive of smoke-free universities, perceiving that their friends approve of regular smoking, having more negative beliefs about the tobacco industry, being sociology students and being among the older students.

Conclusion

Other substance use, injunctive norms (friends' approval) and descriptive norms (friends' smoking prevalence) are associated with tobacco use.

University-based prevention campaigns should take multiple substance use into account and focus on the norms most likely to have an impact on student smoking.

Alcohol use and alcohol-related problems before and after military combat deployment

CONTEXT

High rates of alcohol misuse after deployment have been reported among personnel returning from past conflicts, yet investigations of alcohol misuse after return from the current wars in Iraq and Afghanistan are lacking.

OBJECTIVES

To determine whether deployment with combat exposures was associated with new-onset or continued alcohol consumption, binge drinking, and alcohol-related problems.

DESIGN, SETTING, AND PARTICIPANTS

Data were from Millennium Cohort Study participants who completed both a baseline (July 2001 to June 2003; n=77,047) and follow-up (June 2004 to February 2006; n=55,021) questionnaire (follow-up response rate = 71.4%). After we applied exclusion criteria, our analyses included 48,481 participants (active duty, n = 26,613; Reserve or National Guard, n = 21,868). Of these, 5510 deployed with combat exposures, 5661 deployed without combat exposures, and 37 310 did not deploy.

MAIN OUTCOME MEASURES

New-onset and continued heavy weekly drinking, binge drinking, and alcohol-related problems at follow-up.

RESULTS

Baseline prevalence of heavy weekly drinking, binge drinking, and alcohol-related problems among Reserve or National Guard personnel who deployed with combat exposures was 9.0%, 53.6%, and 15.2%, respectively; follow-up prevalence was 12.5%, 53.0%, and 11.9%, respectively; and new-onset rates were 8.8%, 25.6%, and 7.1%, respectively. Among active-duty personnel, new-onset rates were 6.0%, 26.6%, and 4.8%, respectively. Reserve and National Guard personnel who deployed and reported combat exposures were significantly more likely to experience new-onset heavy weekly drinking (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.36-1.96), binge drinking (OR, 1.46; 95% CI, 1.24-1.71), and alcohol-related problems (OR, 1.63; 95% CI, 1.33-2.01) compared with nondeployed personnel. The youngest members of the cohort were at highest risk for all alcohol-related outcomes.

CONCLUSION

Reserve and National Guard personnel and younger service members who deploy with reported combat exposures are at increased risk of new-onset heavy weekly drinking, binge drinking, and alcohol-related problems.

Fraternity and sorority involvement, social influences, and alcohol use among college students: a prospective examination

This study used latent growth curve modeling to investigate whether the effects of gender and Greek involvement on alcohol use and problems over the first 2 years of college are best characterized by selection, socialization, or reciprocal influence processes. Three social influences (alcohol offers, social modeling, and perceived norms) were examined as potential mediators of these effects. Undergraduate participants (N = 388) completed self-report measures prior to enrollment and in the spring of their freshmen and sophomore years. Male gender and involvement in the Greek system were associated with greater alcohol use and problems prior to college. Both gender and Greek involvement significantly predicted increases in alcohol use and problems over the first 2 years of college. Cross-domain analyses provided strong support for a mediational role of each of the social influence constructs on alcohol use and problems prior to matriculation, and prematriculation social modeling and alcohol offers mediated relations between Greek involvement and changes in alcohol use over time. Findings suggest that students, particularly men, who affiliate with Greek organizations constitute an at-risk group prior to entering college, suggesting the need for selected interventions with this population, which should take place before or during the pledging process.

How the quality of peer relationships influences college alcohol use

Peer relationships are consistently linked to alcohol use in college students. However, this disparate literature often reveals contradictory findings regarding the precise mechanisms of peer influence. In this review, we use an organisational framework based on social learning theory (SLT) to demonstrate how the quality of peer relationships may influence personal alcohol use. We propose that the quality of peer relationships enhance the influence of social reinforcement, modelling and cognitive processes on personal alcohol use. Research indicates that the quality of peer relationships influences drinking via three pathways: the lack or breakdown of quality peer relationships, alcohol use being an integral part of peer interactions, and if peers disapprove of alcohol use or do not drink. This conceptualisation of peer influence informs the consistent finding of gender differences in college student drinking. Limitations of the reviewed research include reliance on cross-sectional surveys, self-report and homogeneous populations. Future directions for research on quality peer relationships involve detailed longitudinal assessment and the application of advanced statistical methods.

The proximal association between smoking and alcohol use among first year college students

OBJECTIVE

This study was undertaken to evaluate the association between patterns of day-to-day smoking and drinking among first year college students.

METHOD

Using 210 days of weekly time-line follow-back diary data, the authors examined the within-person relationships between smoking and drinking. Bivariate time series procedures were utilized.

RESULTS

Findings revealed a high degree of significant cross-correlations between smoking and drinking in which the amount of use of one substance could be predicted by current, as well as past and future use of the other. For the majority of participants, smoking and drinking were positively associated with the alternate behavior. The most common pattern of prediction for individuals was within day (i.e. synchronous correlations). When examining rates of individuals showing significant cross-correlations according to their level of either smoking or drinking, those smoking less than one cigarette on average per day were found to be less likely to demonstrate a synchronous cross-correlation between the two behaviors than those smoking at higher rates. No significant association was found between level of drinking and the rate of significant synchronous cross-correlations between smoking and drinking.

CONCLUSIONS

Reports of daily behavior over long periods of time have the potential to provide insight into the more proximal influences of smoking and alcohol use on one another. Future research is needed to establish the specific factors (i.e. third variables) and related mechanisms that may drive both behaviors.

Characteristics of binge drinkers in Europe

Binge drinking has been shown to be associated with considerable social harm and disease burden. This review aims to give an overview from a European perspective of the socio-demographical, individual, and social factors that affect binge drinking and to identify effective interventions to reduce binge drinking. To this end, a computer-assisted search of relevant articles was conducted. Results showed that males tended to binge drinking more frequently than females. Binge drinking was most prevalent among adolescents and young adults, and prevalence levelled off later in life. Socio-economic conditions seemed to have an effect on binge drinking, independent of their effects on the volume of alcohol consumed. The early onset of binge drinking was associated with a history of drinking in the family, but pathways into adulthood are less clear. Binge drinking often co-occurred with other substance use. Motives for binge drinking included both social camaraderie and tension reduction. Which aspect prevails may vary according to the type of binge drinker, but to date has not been satisfactorily explained. Binge drinkers were not likely to know enough about or be aware of the potential risks of bingeing. Pressure from peers was one of the strongest influencing factors for binge drinking and seemed to outweigh parental influences, especially from late adolescence onwards. Binge drinking also varied according to both the predominant adult and adolescent drinking culture with more binge drinking in the northern and middle parts of Europe compared to the southern parts. Thus, a variety of socio-demographical, individual, and social characteristics associated with binge drinking have been identified. However, knowledge in this area is limited, as most research has been conducted among particular groups in specific situations, in particular North American college students. More research in Europe is urgently needed, as results from other cultural backgrounds are difficult to generalize.

Peer influences on college drinking: a review of the research

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