The perceived impact that alcohol policy could have on Brazilian and British students' pre-drinking behaviour

BACKGROUND

Evidence on how pre-drinking (i.e., drinking in private or in unlicensed settings before going out) varies across cultures and its implications for defining policies and prevention strategies is needed. We explored the perceived impact that various alcohol policies could have on pre-drinking practices amongst Brazilian and British students that pre-drink.

METHODS

A cross-sectional, online survey amongst student drinkers aged 18-29 in England (N = 387) and Brazil (N = 1,048) explored sociodemographic, pre-drinking habits, and attitudes towards alcohol policies (increasing prices, regulating availability, and restricting promotions).

RESULTS

A greater proportion of British students were aged between 18 and 21 years old (67.2%) than Brazilian students (45.2%; p < 0.001). More British (ENG 85.8%) than Brazilian (BRA 44.8%, p < 0.001) students reported pre-drinking. Pre-drinkers' main motivation was to save money (BRA 66.5%, ENG 46.2%, p < 0.001). In multivariate analyses, in Brazil, male (Odds Ratio [OR]: 1.53, CI: 1.04-2.24) and white (OR: 1.60, CI: 1.03-2.49) pre-drinkers were more likely to believe that increasing prices policies could reduce their pre-drinking habits. In Brazil, white pre-drinkers (OR: 1.86, CI: 1.10-3.15) were more likely to believe that restricting alcohol promotions policies could reduce their pre-drinking habits. Regarding the perceived impact that the combined alcohol policies could have on students' pre-drinking practice, only in Brazil there were significant statistical results.

CONCLUSIONS

Whilst in Brazil none of the investigated alcohol policies are currently implemented, more Brazilian pre-drinkers believed that such legislation could reduce their pre-drinking practices (when compared with British pre-drinkers). These data may help legislators and stakeholders to better understand the characteristics of a more acceptable alcohol policy amongst university students.

Intention to drink and alcohol use before 18 years among Australian adolescents: An extended Theory of Planned Behavior

INTRODUCTION

Preventing adolescent alcohol use is an international public health priority. To further understand adolescent alcohol use, this study tested a model of adolescent intention to consume alcohol that incorporated multiple social systems influences.

METHODS

Participants included 2529 Australian secondary school students (M_age = 14.20; 53.7% female). Participants completed a survey about risk and protective factors for alcohol use at individual, family, school and community levels. Structural Equation Modeling (path analysis) was used to evaluate an extended Theory of Planned Behavior (TPB) that incorporated social system determinants of intention to consume alcohol.

RESULTS

The final model explained 60% of the variance in adolescent alcohol use intention. All TPB constructs correlated with intention and experience of lifetime alcohol use. More exposure to information about alcohol use had a weak but significant influence on adolescents' stronger perceived behavioral control. Having less friends who use alcohol, stricter parental rules for adolescent alcohol use, and unfavorable parent attitudes towards alcohol use, were associated with stronger adolescent anti-alcohol attitudes and subjective norms. Community level pro-abstinence attitudes predicted unfavorable adolescent attitudes to alcohol and intention to consume alcohol. Parental rules showed significantly stronger influences on alcohol use intention amongst younger adolescents.

CONCLUSIONS

Key social systems around adolescents significantly predicted intention to consume alcohol, and the extended TPB model explained the major variance in adolescent alcohol use. The findings emphasize the importance of multi-level approaches to the prevention of alcohol use. Situation-based factors that could trigger impulsive emotional response may be a future intervention focus.

Exploration of Alcohol Consumption Behaviours and Health-Related Influencing Factors of Young Adults in the UK

Hazardous alcohol consumption is ranked above illicit drug use with regards to health deterioration and social and economic burden. This study sought to clarify the factors influencing alcohol consumption and its prevalence in young adults. Demographics, alcohol consumption and lifestyle information were gathered via anonymous questionnaires during 2011-2019, crossing Reading, Surrey and Farnborough universities, UK. Controlling for confounders, a multinomial logistic regression was performed using SAS® 9.4 software. A total of 1440 students (43.5% males, 56.5% females; 54.4% Caucasians) with a mean (SD) age of 19.9 (2.73) were included. Among them, 68.9% consumed alcohol frequently and 31.7% had ≥12 units/week. Statistical analysis revealed that males consumed twice more alcohol than females, odds ratio (OR) 1.67 (95% confidence interval (CI) = 1.34-2.09), p-value < 0.01. Caucasians consumed up to five times more alcohol than other ethnicities, OR 4.55 (3.57-5.56), p-value < 0.01. Smokers consumed three times more alcohol than non-smokers, OR 2.69 (1.82, 3.99), p-value < 0.01. In general, the levels of alcohol consumption were positively associated with the levels of physical activity, OR 2.00 (1.17-3.42), p-value < 0.05 and negatively associated with recreational sedentary screen-time activities in males, OR 0.31 (0.12-0.86), p-value = 0.03. Focusing alcohol interventions toward Caucasians, smokers and physically active students, particularly males, may guide university strategies to reduce alcohol-related societal harm and risks of morbidity and mortality.

Population Attributable Fraction of Early Age of Onset of Alcohol Use in Alcohol Abuse and Dependence: A 3-Year Follow-Up Study in University Students

BACKGROUND

we aimed to determine the risk factors and associated population attributable fractions (PAFs) for the age of onset of alcohol use and also to identify protective factors.

METHODS

we analyzed follow-up data collected between autumn 2011 and spring 2016 (n = 5170) from the first two cohorts (2011, 2012) of the Spit for ScienceTM project. The dependent variables were alcohol abuse and dependence, and the independent variables were age of drinking onset, residence, ethnicity, religiosity, sexual orientation and work status. We determined the odds ratios (OR) using multilevel logistic regression for repeated measures in SPSSv.20.

RESULTS

the early onset of alcohol use was associated with an increased risk of alcohol abuse and dependence among females (OR = 14.98; OR = 11.83) and males (OR = 7.41; OR = 6.24). The PAFs for the early onset of alcohol use in alcohol abuse and dependence were respectively 80.9% and 71.7% in females and 71.0% and 63.5% in males. Among females, being white (OR = 1.58; OR = 1.51), living off-campus (OR = 1.73; OR = 2.76) and working full-time (OR = 1.69; OR = 1.78) were also risk factors. Strong religious beliefs were found to protect males from alcohol abuse (OR = 0.58), while same-gender sexual orientation increased the risk among females (OR = 2.09).

CONCLUSION

delaying the age of onset by one year would reduce alcohol abuse among young adults.

Modeling the Distinct Negative-Reinforcement Mechanisms Associated with Alcohol Misuse and Unhealthy Snacking

BACKGROUND

Negative personality characteristics have been implicated in promoting overconsumption of both alcohol and food. Furthermore, positive motivations (enhancement) and negative motivations (coping) may mediate the association between personality and alcohol or food (over)consumption.

OBJECTIVES

This study hypothesized that i.) drinking to cope and ii.) eating to cope would mediate the association between hopelessness/anxiety sensitivity and hazardous drinking/unhealthy snacking, respectively, and iii.) eating and drinking to cope would represent separate strategies.

METHODS

Participants were recruited via opportunity sampling through university schemes, social media, email and web page advertisements. Questionnaires included the Alcohol Use Disorders Identification Test, Substance Use Risk Profile Scale, Modified Drinking Motives Questionnaire Short Form, Palatable Eating Motives Scale and Snack/Meal Food Intake Measure.

RESULTS

Participants were 198 undergraduates, weight-related research volunteers and the public (83% female; 90% university educated). The hypothesized structural model fit the data well. As predicted, there were significant indirect associations between negative personality characteristics, hazardous drinking and unhealthy snacking via coping; specifically, individuals higher in anxiety sensitivity/hopelessness used food or alcohol to cope which, in turn, significantly predicted unhealthy snacking, and hazardous drinking, respectively. Importantly, drinking and eating to cope represented outcome-specific strategies, indicated by no significant association between eating to cope and hazardous drinking, or between drinking to cope and snacking.

CONCLUSIONS

This study demonstrates that coping motivations are critical to the relationship between negative personality characteristics and unhealthy behaviors and highlights the distinct negative-reinforcement pathways associated with hazardous drinking and unhealthy snacking in majority university-educated females from the UK.

Positive excessive drinker prototypes predict greater drinking and alcohol problems

OBJECTIVES

According to the prototype willingness model, risky behaviours such as heavy drinking may be influenced by images of others who engage in this behaviour. In this study, we examined whether college students' prototypes of an individual who frequently drinks "over the limit" were associated with their own alcohol consumption and experience of alcohol-related problems during their first 2 years in college.

METHODS

We assessed students' (N = 340) prototypes of excessive drinkers and their own alcohol consumption and problems at four time points, across their first 2 years in college. Along with examining the trajectory of prototypes, consumption, and problems, we tested whether prototypes significantly predicted consumption and problems across the 2 years. Additional analyses examined whether the predictive value of prototypes was unique from related variables including perceived descriptive norms, perceived injunctive norms, and peer pressure to drink alcohol.

RESULTS

Primary analyses indicated that more positive prototypes of an excessive drinker were significantly associated with greater alcohol consumption in both year 1 and year 2. More positive prototypes were also significantly associated with experiencing more alcohol-related problems in year 2. These findings held when controlling for perceived descriptive and injunctive norms, and peer pressure.

CONCLUSIONS

Findings further support the importance of drinker prototypes to one's own drinking behaviour. By examining prototypes over time and their relationship to alcohol-related problems, this study makes a novel contribution to the existing research. Statement of contribution What is already known on this subject? Perceived norms (beliefs about how much others drink and what they approve of) are associated with own drinking. Individuals construct "risk prototypes," or images of people who engage in risky behaviours like drinking alcohol. Positive risk prototypes of drinkers have been associated with own willingness to drink and subsequent drinking. What does this study add? This study shows the trajectory of drinker prototypes across the first 2 years of college. Findings highlight consistent patterns of positive associations between drinker prototypes and own drinking. More positive drinker prototypes are associated with a greater number of problems with alcohol.

Web-Based Alcohol Intervention: Study of Systematic Attrition of Heavy Drinkers

BACKGROUND

Web-based alcohol interventions are a promising way to reduce alcohol consumption because of their anonymity and the possibility of reaching a high numbers of individuals including heavy drinkers. However, Web-based interventions are often characterized by high rates of attrition. To date, very few studies have investigated whether individuals with higher alcohol consumption show higher attrition rates in Web-based alcohol interventions as compared with individuals with lower alcohol consumption.

OBJECTIVES

The aim of this study was to examine the attrition rate and predictors of attrition in a Web-based intervention study on alcohol consumption.

METHODS

The analysis of the predictors of attrition rate was performed on data collected in a Web-based randomized control trial. Data collection took place at the University of Konstanz, Germany. A total of 898 people, which consisted of 46.8% males (420/898) and 53.2% females (478/898) with a mean age of 23.57 years (SD 5.19), initially volunteered to participate in a Web-based intervention study to reduce alcohol consumption. Out of the sample, 86.9% (781/898) were students. Participants were classified as non-completers (439/898, 48.9%) if they did not complete the Web-based intervention. Potential predictors of attrition were self-reported: alcohol consumption in the last seven days, per week, from Monday to Thursday, on weekends, excessive drinking behavior measured with the Alcohol Use Disorder Identification Test (AUDIT), and drinking motives measured by the Drinking Motive Questionnaire (DMQ-R SF).

RESULTS

Significant differences between completers and non-completers emerged regarding alcohol consumption in the last seven days (B=-.02, P=.05, 95% CI [0.97-1.00]), on weekends (B=-.05, P=.003, 95% CI [0.92-0.98]), the AUDIT (B=-.06, P=.007, 95% CI [0.90-0.98], and the status as a student (B=.72, P=.001, 95% CI [1.35-3.11]). Most importantly, non-completers had a significantly higher alcohol consumption compared with completers.

CONCLUSIONS

Hazardous alcohol consumption appears to be a key factor of the dropout rate in a Web-based alcohol intervention study. Thus, it is important to develop strategies to keep participants who are at high risk in Web-based interventions.

Alcohol-induced impairment in adolescents admitted to inpatient treatment after heavy episodic drinking: effects of age and gender

OBJECTIVE

In Germany and many other countries, the number of adolescent heavy episodic drinking-induced hospital admissions (HEDHA) in pediatric units markedly increased during the past decade. A low level of response to alcohol in young adults is associated with high risk for later development of alcohol use disorders (AUDs).

METHOD

We performed a retrospective chart review of all 1,123 HEDHA cases in adolescents aged 11-17 years who were admitted to one of the pediatric inpatient units covering the cities of Dresden, Pirna, and Rostock, Germany, between 2000 and 2008. Blood alcohol concentration (BAC) and Glasgow Coma Scale (GCS) measures on admission were documented in 846 cases.

RESULTS

The mean (SD) BAC was 155 (50) mg/100 ml full blood, and M (SD) GCS was 12.21 (3.02). These parameters were negatively correlated with each other (r = -.256, p < .001), indicating more impairment at higher BACs. To describe a numerical estimate of how severely a subject was compromised relative to his BAC, the GCS scores were inverted (making high scores indicate severe impairment) and divided by BAC. The resulting alcohol-induced impairment index (AIII) was significantly influenced by an interaction between age and gender, decreasing with age in boys but increasing in girls.

CONCLUSIONS

During adolescence, alcohol-induced impairment develops differently in boys and girls, which may be because of the girls' developmental edge. The high variability of observed AIII might help to predict the risk for later AUDs in the emergency department, simply by measuring BAC and GCS.

Eating Behaviours of British University Students: A Cluster Analysis on a Neglected Issue

Unhealthy diet is a primary risk factor for noncommunicable diseases. University student populations are known to engage in health risking lifestyle behaviours including risky eating behaviours. The purpose of this study was to examine eating behaviour patterns in a population of British university students using a two-step cluster analysis. Consumption prevalence of snack, convenience, and fast foods in addition to fruit and vegetables was measured using a self-report “Student Eating Behaviours” questionnaire on 345 undergraduate university students. Four clusters were identified: “risky eating behaviours,” “mixed eating behaviours,” “moderate eating behaviours,” and “favourable eating behaviours.” Nineteen percent of students were categorised as having “favourable eating behaviours” whilst just under a third of students were categorised within the two most risky clusters. Riskier eating behaviour patterns were associated with living on campus and Christian faith. The findings of this study highlight the importance of university microenvironments on eating behaviours in university student populations. Religion as a mediator of eating behaviours is a novel finding.

Staying in the 'sweet spot': A resilience-based analysis of the lived experience of low-risk drinking and abstention among British youth

OBJECTIVE

The aim of this study was to understand how and why young people drink less or not at all when with their peers. Understanding the subjective experiences of moderate or non-drinkers may help identify protective processes facilitating resilience to cultural norm and influences that encourage excessive alcohol consumption among young people.

DESIGN

Semi-structured interviews were conducted with 25 moderate- or non-drinkers aged 17-25 years (13 young women) living in South East England. Interviews explored recent experiences of social situations and encounters that did or did not involve alcohol. Transcripts were analysed using Interpretative Phenomenological Analysis.

RESULTS

Analysis identified six conceptually coherent themes clustering within a superordinate theme of a healthy experience of moderate alcohol use or abstention: 'the sweet spot'. These themes were: feeling good in the body, feeling like you can be who you are, feeling like you belong, making a free choice, enjoying the moment, and feeling safe and secure.

CONCLUSIONS

This resilience-based analysis showed how non-drinking and moderate-drinking may be experienced as a positive and proactive choice. Understanding the subjective experiences of young people may aid development of specific, realistic interventions to promote moderate drinking and abstention among young people in drinking cultures.

Impulsivity as a Multifaceted Construct Related to Excessive Drinking Among UK Students

AIMS

A substantial number of university students exceed alcohol guidelines. Impulsivity has been repeatedly implicated in heavy alcohol use, yet despite knowledge that impulsivity is multifaceted, there have previously been few studies applying multiple measures of self-report and behavioural impulsivity to examine the relationship with excessive student drinking. This results in a limited understanding of the relationship of various facets of impulsivity to student drinking.

METHODS

Participants completed a comprehensive battery of impulsivity measures: the Barratt Impulsiveness Scale as a self-report index and the Stop Signal Task, Information Sampling Task and Monetary Choice Questionnaire as behavioural measures of three facets of impulsivity. Participants who exceeded UK drinking guidelines were compared to those who did not on measures of impulsivity. Hierarchical linear regression was then employed to test whether indices of impulsivity were associated with the average units consumed per week.

RESULTS

Participants who exceeded UK guidelines reported increased impulsivity in facets of self-report impulsivity. They also displayed performance deficits in normal adjustment of Go responses on the Stop Signal Task. In the regression model, nonplanning impulsivity on the Barratt Impulsiveness Scale was seen to predict quantity of alcohol consumed per month.

CONCLUSIONS

The study applies a comprehensive selection of behavioural and self-report measures of impulsivity and indicates that excessive drinkers are more impulsive in some but not all aspects. The results indicate that the wide range of deficits apparent in alcohol-dependent individuals are not evident in this younger, heavy drinking population, but that specific performance and self-identified deficits are already apparent.

Gray matter volume correlates of global positive alcohol expectancy in non-dependent adult drinkers

Alcohol use and misuse is known to involve structural brain changes. Numerous imaging studies have examined changes in gray matter (GM) volumes in dependent drinkers, but there is little information on whether non-dependent drinking is associated with structural changes and whether these changes are related to psychological factors-such as alcohol expectancy-that influence drinking behavior. We used voxel-based morphometry (VBM) to examine whether the global positive scale of alcohol expectancy, as measured by the Alcohol Expectancy Questionnaire-3, is associated with specific structural markers and whether such markers are associated with drinking behavior in 113 adult non-dependent drinkers (66 women). Alcohol expectancy is positively correlated with GM volume of left precentral gyrus (PCG) in men and women combined and bilateral superior frontal gyri (SFG) in women, and negatively correlated with GM volume of the right ventral putamen in men. Furthermore, mediation analyses showed that the GM volume of PCG mediate the correlation of alcohol expectancy and the average number of drinks consumed per occasion and monthly total number of drinks in the past year. When recent drinking was directly accounted for in multiple regressions, GM volume of bilateral dorsolateral prefrontal cortices correlated positively with alcohol expectancy in the combined sample. To our knowledge, these results are the first to identify the structural brain correlates of alcohol expectancy and its mediation of drinking behaviors. These findings suggest that more studies are needed to investigate increased GM volume in the frontal cortices as a neural correlate of alcohol expectancy.

How alike are young non-drinkers, former-drinkers, low-risk drinkers, and hazardous drinkers?

The aim of this study was to examine whether - in terms of personality characteristics and beliefs--former-drinkers and people who have never consumed alcohol exist on a continuum that includes low-risk drinkers and hazardous drinkers, or are distinct groups. An online questionnaire hosted on a secure server was completed by 1418 young people (642 men and 776 women) aged 16-21 living in South-East England. Participants' scores on the Alcohol Use Disorders Identification Test (AUDIT) were used to classify them as non-drinkers, former-drinkers, low-risk drinkers or hazardous drinkers. Multinomial logistic regression identified eight significant multivariate correlates that explained 39% of the variance in men's AUDIT category membership (χ(2)(24) = 263.32, p < .01), and seven significant multivariate correlates that explained 41% of the variance in women's AUDIT category membership (χ(2)(21) = 332.91, p < .01). The results suggest that non-drinkers and former-drinkers are more similar to each other than they are to both low risk and hazardous drinkers. We should not, therefore, treat these groups of young people as representing a drinking continuum. In particular, interventions for high risk young drinkers may be more effective if distinguished from general campaigns intended for all young people.

Being a non-drinking student: an interpretative phenomenological analysis

Recent research suggests that safer student alcohol consumption might be assisted by understanding how social occasions are managed by non-drinkers. In-depth, semi-structured interviews with five 19-22 year old non-drinking English undergraduates were subjected to interpretative phenomenological analysis. We present five inter-linked themes: 'living with challenges to non-drinking'; 'seeing what goes on in drinking environments'; 'dealing with conversations about non-drinking (making excuses vs. coming out)'; 'knowing which friends care about you'; and 'the importance of minimising "legroom" for peer pressure'. Participants felt under persistent peer scrutiny (as a form of peer pressure) and could feel alienated in drinking environments. Talking about non-drinking was characterised by whether to 'come out' (as a non-drinker) or 'fake it' (e.g. 'I'm on antibiotics'). Loyal friendships were reported as particularly important in this context. The decision not to drink was experienced as providing a successful buffer to peer pressure for former drinkers. Our findings unsettle traditional health promotion campaigns which advocate moderate drinking among students without always suggesting how it might be most successfully accomplished and offer tentative guidance on how non-drinking during specific social occasions might be managed more successfully. Findings are discussed in relation to extant literature and future research directions are suggested.

Alcohol treatment workers’ use of public health policy

Purpose

– The purpose of this paper is to explore the views of drug and alcohol workers on existing alcohol-related public health policies in the UK. Alcohol consumption is closely linked to negative health outcomes, social problems and increasing cost burdens for the UK public, yet alcohol consumption is legal and drinking alcohol is a normalised feature of society.

Design/methodology/approach

– Nine drug and alcohol workers completed semi-structured interviews, exploring awareness of alcohol-related public health strategies, views on how both their clients and the public orient towards drinking behaviour, and perceptions of links between alcohol treatment and public health services.

Findings

– Ambivalence towards alcohol-related public health strategies, and a lack of mutual awareness and coordination between public health and treatment services were expressed by participants. Participants felt that public health strategies around alcohol were out of reach to their client group, and failing to have a behavioural change effect on the wider public. Participants proposed several ways of improving public health strategies.

Research limitations/implications

– Drug and alcohol workers are potentially valuable contributors in developing public health policy. Their views, based both on interactions with service users and on occupationally influenced observations of society, could be utilised more effectively than is currently the case.

Originality/value

– This study uniquely ties together public health and treatment aspects of alcohol services and employs a methodology that opens the way for further research and clinical development.

Beyond personality-experimental investigations of the effects of personality traits on in situ alcohol consumption in social and solitary drinking contexts

Numerous studies have highlighted that personality traits are associated with alcohol problems and disorders; however, little is known on the link between personality and the quantities of alcohol actually ingested during given drinking episodes (i.e. in situ alcohol consumption, in grams of pure alcohol). Based on data of 123 young adults who participated in two wine-tasting assignments (one performed in group, the other individually; sequence of participation assigned at random), the results from regression models suggest that individual characteristics and personality traits are, to some extent, associated with in situ alcohol consumption, but contextual factors (e.g., in line with behavioral exposition and perceptions of norms) might overwhelm such associations in a social context, or later on in similar drinking contexts. These findings argue for the development of early preventive initiatives focusing on social influences and on specific drinking context.