Estimate of undergraduate university student alcohol use in China: a systematic review and meta-analysis

Understanding the Effect of External and Internal Assets on Hazardous/Harmful Drinking Among Chinese College Students: A Serial Mediation Model

Hazardous/harmful drinking among college students is increasingly becoming a global health concern. Previous studies have mostly paid more attention to the prevalence and risk factors of alcohol use disorder based on the public health approach, and less is understood about psychological mechanisms and protective factors of problem drinking behavior. Grounded in the framework of developmental assets, this study explored the predictive effect of external assets (i.e., social connectedness) and internal assets (i.e., self-concept clarity and drinking refusal self-efficacy) on hazardous/harmful drinking among Chinese college students. Participants were 598 college students with a mean age of 19.41 (SD = 1.21) years. The results of structural equation modeling showed that social connectedness negatively predicted college students' hazardous/harmful drinking. Moreover, our path analyses revealed a serial mediation among these variables: students with high social connectedness tended to report high self-concept clarity, which in turn increased drinking refusal self-efficacy, and consequently decreased the level of hazardous/harmful drinking. This study revealed the mechanisms underlying how external and internal assets predict risky drinking among college students. These findings made significant contributions to prevention and precision interventions for college-aged youth with drinking problems.

Smoking, alcohol consumption and corneal biomechanical parameters among Chinese university students

BACKGROUND/OBJECTIVES

Smoking and alcohol consumption are important risk factors for several ocular disorders, but their effects on corneal biomechanics remain unclear. Our study aims to explore the association between smoking and alcohol consumption with corneal biomechanical parameters measured by Corvis-ST (CST) among university students.

SUBJECTS/METHODS

A total of 1645 healthy university students from a university-based study were included, and all participants underwent corneal biomechanical parameters measurement by CST. We selected 10 reliable parameters that can reflect the corneal deformation response. All participants had a standardised interview to determine their smoking and alcohol consumption status.

RESULTS

The mean age of the participants was 19.0 ± 0.9 years, and 1132 (68.8%) were women. Smoking was significantly associated with stiffer corneas. Smokers showed significantly slower second applanation velocity (A2v) (β = 0.007 m/s, 95% confidence interval 0.001 to 0.014, P = 0.032) and lower integrated radius (IR) (β = -0.214 mm-1, 95% confidence interval -0.420 to -0.007, P = 0.043) than non-smokers after adjusting for age, gender, eye-rubbing, myopia, and body mass index (BMI). Smokers with BMI no less than 24.0 showed slower A2v and lower IR. Alcohol consumption and passive smoking were found no significant association with corneal biomechanics.

CONCLUSION

Smokers had less deformable corneas, especially those with BMI no less than 24.0. Our findings provide new evidence for the association between smoking and ocular disorders associated with corneal biomechanics like glaucoma.

Prevalence and Differences of Depression, Anxiety, and Substance Use Between Chinese College-Age Students Studying in China and America During the Coronavirus Disease 2019 Pandemic

Introduction

The coronavirus disease (COVID-19) swept the globe and harmfully influenced the mental health and behaviors of the college student population. This study aims to examine the prevalence and difference of mental health and the substance use problems of the Chinese college-age students studying in China and America (CSA) during the COVID-19 pandemic.

Methods

One thousand five hundred four students participated in this study. A total of 42.12% of students are enrolled in Chinese colleges, and 57.78% of students are enrolled in American colleges, aged 17-23 years (x ¯ ± s = 19.90 ± 1.50). Binary logistic regression and independent t-test were used in this study to find the predictor variables and association among mental health, substance use problems, and student population.

Results

The two student groups had a statistical difference in General Anxiety Disorder-7 scale, alcohol, medicines, drinks, drugs and cigarettes (p < 0.01). The students suffering depression problems from the two groups have statistical significance with drinks (odds ratio = 0.89, 95% confidence interval = 0.81-0.97, p < 0.05; odds ratio = 1.11, 95% confidence interval = 1.04-1.19, p < 0.01). CSA experiencing anxiety problem had a significant association with alcohol, drinks, cigarette, and desserts (p < 0.05).

Conclusion

This is the first cross-sectional study focusing on the comparison of the Chinese college-age students' mental health and substance use problems who are studying in China and America during the pandemic. Our study revealed severe mental health and substance use problems in both student groups, particularly in the CSA during the COVID-19 pandemic. The findings of our study also highlight the evidence to find more interventions and preventions to solve the different mental health and substance use problems for college students.

Alcohol Use in China: Unrecorded and Recorded Bai Jiu in Three Rural Regions

In China, approximately 70% of beverage alcohol is consumed in the form of spirits. An estimated 25% of all alcohol consumed is unrecorded, mostly spirits (bai jiu), produced outside regulatory systems in small neighborhood distilleries, mostly in rural areas. Unrecorded bai jiu drinkers are generally older, male, prefer higher-strength bai jiu, and drink daily and mostly at home. To explore possible regional differences, researchers used interview data from 2919 bai jiu drinkers in rural areas in Hebei, Anhui, and Hubei provinces in China. Results confirmed that patterns varied by province. The sample in Hubei preferred unrecorded bai jiu with a more stable preference to alcohol type, tended to drink less frequently, and reported experiencing less drinking pressure, suggesting lower-risk drinking patterns in this region. The Hebei and Anhui sample reported higher frequency and greater amount of alcohol consumption, were more likely to experience drinking pressure, indicating higher-risk patterns in alcohol use in these two regions. The results provide needed details about regional differences in unrecorded bai jiu drinking patterns that are not evident in aggregated data and suggest variations in drinking patterns that may reflect local geography, local values, traditions, and ethnic differences.

Relationship between Alcohol Consumption and Drinking Refusal Self-Efficacy among University Students: The Roles of Sports Type and Gender

The present study examines the relationship between drinking behaviour and drinking refusal self-efficacy among university students, with a focus on the influential roles of sports type and gender. A total of 354 students from Seoul National University of Science and Technology volunteered and participated in this study. The Korean Alcohol Use Disorders Identification Test (AUDIT-K), the Korean Drinking Refusal Self-Efficacy (DRSE) Questionnaire-Revised, and a questionnaire measuring participation in sports activities were administered to measure students’ alcohol drinking behaviours, refusal self-efficacy and sport-related activities, respectively. The data were analysed using descriptive statistics, two-way ANOVAs, correlation analysis, and regression analysis. The subdomains of DRSE had significant influences on binge drinking. Specifically, low DRSE in situations involving social pressure played a key role in predicting increased binge drinking. There was also a significant relationship between sports type and drinking behaviour, but only for male students. Those who participated in individual sports binge drank less than those who participated in team sports. Finally, gender differences were also revealed in drinking behaviour. Male students were more likely to binge drink compared to their female counterparts. This study offers a foundation for practical interventions to help control problematic drinking behaviour among university students.

A Systematic Umbrella Review on the Epidemiology of Modifiable Health Influencing Factors and on Health Promoting Interventions Among University Students

Background: Universities represent an important setting for health promotion. The unique collective of university students is of particular relevance since they are the leaders, decision-makers, and parents of tomorrow. In this context, modifiable health influencing factors as well as interventions to prevent these, play a crucial role. Therefore, the present umbrella review aims to (i) provide an overview of review articles addressing epidemiological issues (prevalence and determinants) of modifiable health influencing factors in university students and (ii) to provide an overview of review articles addressing the evidence of interventions to promote/enhance modifiable health influencing factors in university students. Methods: A systematic literature search was performed in the databases PubMed, Cochrane Reviews Library und Web of Science according to the PRISMA guidelines. Only systematic reviews and meta-analyses were included. The AMSTAR-2-Tool was used for the quality assessment. Result: The initial search resulted in 10,726 records of which 81 fulfilled the inclusion criteria, with a further distinction in articles with an epidemiological focus (n = 39) and in articles with interventional approaches (n = 42). Topics of the different review articles ranged from physical activity over mental health, substance use, sleep, diet and nutrition, and media consumption. Many review articles had a specific focus on medical and nursing students and originated from the U.S.A., U.K., or China. Discussion: This umbrella review provides an overview of review articles on the epidemiology of modifiable health influencing factors and on the evidence of interventions targeting these factors among university students. Thereby, experts as well as stakeholders in the field could gain insights into crucial target points for health promotion. It identifies research gaps in terms of study region and groups of students.

Prevenção do suicídio: concepção de estudantes universitários

Introdução: O ingresso nas universidades representa uma mudança no modo de vida social, econômico, pessoal e mental dos estudantes. Às vezes, o processo de habituação representa um estressor que pode culminar em sintomas de ansiedade e depressão e, desse modo, representar um fator de risco para saúde mental. Objetivo: Analisar a percepção dos discentes sobre a experiência de vivenciar discussões sobre temática de suicídio. Métodos: Trata-se de um estudo descritivo-exploratório, com abordagem qualitativa, realizado em uma Universidade Federal do Nordeste do Brasil. Participaram da pesquisa 15 estudantes do curso Bacharelado em Enfermagem que integravam o Projeto de Intervenção Ser, Saber, Ouvir, Viver, no qual eram desenvolvidas ações de prevenção ao suicídio e valorização da vida direcionado aos estudantes universitários da instituição. Resultados: Ao analisar a nuvem de palavras e a representação gráfica da análise de similitude entre as palavras observou-se de forma geral as percepções dos discentes frente à vivência no projeto de valorização da vida. Cada palavra destacada indicou repetições nas falas, como consequência, significados semelhantes. Conclusão: Portanto, o projeto em questão além de favorecer um ambiente de liberdade de diálogo no âmbito acadêmico, proporciona também alívio mental que, com o passar das reuniões, pode minimizar os sintomas depressivos e ansiosos que os discentes podem apresentar, em consequência, reduzindo os índices de suicídio na instituição.

Analysis of the alcohol drinking behavior and influencing factors among emerging adults and young adults: a cross-sectional study in Wuhan, China

BACKGROUND

The relationship between alcohol use in adolescents and young adults and outcomes has not been widely researched in China. The aim of the current study was to understand the current status of drinking behavior of Chinese youth transitioning into adulthood.

METHODS

The cross-sectional study included 1634 participants between 18 and 34 years of age. The participants were randomly chosen from 13 administrative districts in Wuhan, and invited to complete a questionnaire. Univariate analysis was performed to describe the demographic distribution of alcohol consumption and the association with drinking status. Stepwise Logistic regression analysis was undertaken analyzing the factors influencing the drinking behaviors. The data were weighted to the population in Wuhan and analyzed using SAS version 9.3.

RESULTS

For our sample of emerging and young Chinese adults the prevalence of drinking alcohol was 45.84%. The non-drinkers predominated, accounting for 54.16% and light drinkers accounted for 42.94%, while moderate and heavy drinkers were in the minority (2.90%). The earlier the age of first alcohol drinking or the age of first being intoxicated, the greater the likelihood of being a moderate or heavy drinker. People with high emerging adulthood were more likely to have moderate or heavy drinking behaviors. The logistic regression analysis indicated that heavy drinkers were more likely to not be married and to be classified as high emerging adulthood.

CONCLUSIONS

Our findings suggested that the drinking pattern should be further evaluated over time to explore the ways in which social and cultural factors shape the drinking route of this age group. Effective drinking behavior prevention and interventions and appropriate guidance should be formulated to establish an appropriate attitude towards drinking alcohol and develop a drinking behavior which is conducive to physical and mental health between this particular demographic.

Depression among Chinese Left-Behind Children: A systematic review and meta-analysis

BACKGROUND

In China, there are approximately 70 million children, nearly 25% of the child population, who are left behind in the care of other family members when their parents migrate to urban areas, for increased economic opportunities. This paper presents a systematic review and a meta-analysis of studies that have examined the phenomenon of depression among these left-behind children (LBC).

METHODS

Six hundred three papers published between 2000 and 2017 were retrieved from five databases (China National Knowledge Infrastructure, Wanfang, Weipu, PubMed, and Web of Science).

RESULTS

Twenty-one studies (18 in Chinese and 3 in English) met the criteria for inclusion in this meta-analysis. The pooled estimate of depression among LBC was 26.4%. A significant heterogeneity has been found in reported findings, and this heterogeneity was associated with three types of study characteristics, including using an unclear definition of LBC and using invalidated depression instruments, and the geographic location.

CONCLUSIONS

The risk of mental health problems among this large number of LBC suggests the need to quantify the extent and distribution of their mental health state. Implications for methodological improvements for future research have been discussed.

Psychometric properties of a Chinese version of the Brief Young Adult Alcohol Consequences Questionnaire (B-YAACQ)

AIM

This study evaluated the psychometric properties of the Chinese version of the Brief Young Adult Alcohol Consequences Questionnaire (B-YAACQ).

METHOD

In this study, 1616 Chinese university students (male = 58.66%; M_age = 19.88) reporting past-year drinking experience voluntarily completed an anonymous questionnaire. Rasch analysis, reliability analysis, and linear modeling were performed to examine the psychometric properties of the Chinese version of B-YAACQ.

RESULTS

Results of Rasch analysis and reliability analysis supported the assumption of uni-dimensionality, local independence, and internal consistency of the 24-item B-YAACQ in our Chinese sample. However, six items had marginal outfit statistics and/or potential gender bias; therefore, a model with 18 items was also tested after removing these items. The 18-item model showed excellent fit to the uni-dimensional model with no gender bias. However, the Pearson correlation between the 24-item and 18-item versions was r = 0.98, suggesting highly similar measurement. Both versions demonstrated concurrent validity through positive association with the Alcohol Use Disorder Identification Test (AUDIT) subscales, even after controlling for the effects of age and gender.

CONCLUSION

This study is the first to validate a measurement tool for negative drinking consequences for university students in China. Despite some limitations, the original 24-item B-YAACQ was shown to have satisfactory psychometric properties when applied to Chinese university students. We recommend the shorter 18-item version without significant gender bias for testing gender differences.

Perceived peer norms and alcohol use among college students in China

INTRODUCTION

Currently, there has been little research on peer drinking norms with non-English speaking college populations. Using a Chinese college student sample, the present study investigated perceived peer norms and their associations with individual alcohol-related behaviors.

METHODS

Past six-month drinkers (n = 436, 50% men, mean age = 20.49) recruited from one college in China took an anonymous paper-and-pencil survey. To examine the differences in alcohol-related behaviors among groups, one-way repeated measures analysis of variance and chi-square tests were conducted. To investigate the associations between perceived peer norms and individual alcohol-related behaviors, sequential linear and logistic regression analyses were conducted.

RESULTS

There were overall mean differences in alcohol use among participants, perceived best friends, and perceived average student for both men (F (1.98, 421.06) = 13.12, p < .001) and women (F (1.89, 399.70) = 5.79, p < .01). The proportion of best friends perceived as having had heavy episodic drinking was higher than that of participants who had had heavy episodic drinking (χ² (1, N = 415) = 61.85, p < .001). So was the proportion of the average student perceived as having had heavy episodic drinking (χ² (1, N = 414) = 68.17, p < .001). After controlling for demographic variables, perceived peer alcohol use explained 17% of the variance in individual alcohol use; perceived peer heavy episodic drinking contributed to 2.6 to 3.6 times higher odds of participants' reporting heavy episodic drinking.

CONCLUSIONS

Replication research is needed to inform social norms interventions for Chinese college students.

Variables Associated with Alcohol Consumption and Abstinence among Young Adults in Central China

This paper presents a descriptive analysis of data gathered by personal interviews from a multistage random sample of 1640 residents aged 18–34 years in Wuhan, China. First, alcohol drinkers and abstainers were compared based on demographic, attitude, and belief variables. Next, the drinkers from the sample were classified into four groups based on frequency-quantity of alcohol use, and the frequency-quantity groups were compared on the same variables. For Abstainers versus Drinkers, we found no difference by age or gender in this sample. Married people and people with children were more likely to be abstainers. University-educated, currently-employed individuals in mid-level jobs were more likely to abstain from alcohol. Vocational/Technical graduates, people who were currently attending college, currently unemployed and never-employed individuals were more likely to be drinkers. Abstainers also responded with less-positive attitudes and beliefs about drinking and attached more importance to reasons for not drinking compared to drinkers. When the drinking frequency-quantity groups were compared, gender differences became significant: more high-quantity drinkers were women; however the guideline for quantity for women was >1 drink at a time compared to >2 drinks at a time for men. Quantity and frequency of drinking was significantly associated with having children, educational level, employment status, and type of occupation. Age, marital status, and being in college did not relate significantly with quantity and frequency of drinking alcohol. Attitudes and beliefs about drinking tended to be more positive among high-frequency and high-quantity drinkers. Drinkers in all frequency-quantity groups attached greater importance to social reasons for drinking compared to personal/psychological reasons for drinking. Drinkers in the lowest frequency-quantity group attached the most importance to reasons for not drinking. These findings confirmed that in China drinking plays an important role in socializing and celebrating, and that there are important differences between alcohol drinkers and abstainers and between frequency/quantity groups of drinkers. Western models of individualized motivation of behaviors may not accurately explain alcohol use in China. We believe the findings from this study suggest the need for more detailed studies of alcohol drinking and abstaining.

University Students' Willingness to Assist Fellow Students Who Experience Alcohol-Related Facial Flushing to Reduce Their Drinking

This study explored bystanders’ willingness to help a friend who flushes when drinking to reduce his/her drinking. Alcohol-related facial flushing is an indicator of an inherited variant enzyme, aldehyde dehydrogenase (ALDH), that impairs alcohol metabolism and increases drinkers’ lifetime risk of certain aerodigestive cancers. Individuals who flush should reduce their alcohol exposure, but they may continue to drink if social pressures and rules of etiquette make not drinking socially risky. The analysis used data from 2912 undergraduate students from 13 universities in southwestern, central and northeastern China from a survey asking how they respond to someone’s flushing in various scenarios. Latent class analysis grouped students by similar responses to flushing. A multinomial logistic regression explored how class membership was associated with knowledge, drinking status, and reactions to one’s own flushing. Five classes were derived from the latent class analysis, ranging from always intervene to mostly hesitate to help; in between were classes of students who were willing to help in some scenarios and hesitant in other scenarios. Only 11.6% students knew the connection between facial flushing and impaired alcohol metabolism, and knowledgeable students were somewhat more likely to assist when they saw someone flushing. In the absence of knowledge, other factors—such as drinking status, the gender of the bystander, the gender of the person who flushed, and degree of friendship with the person who flushed—determined how willing a person was to help someone reduce or stop drinking. Class membership was predicted by knowledge, gender, drinking status, and reactions to one’s own flushing. Of these 4 factors, knowledge and reactions to one’s own flushing could be influenced through alcohol education programs. It will take some time for alcohol education to catch up to and change social and cultural patterns of drinking. Meanwhile, motivational strategies should be developed to increase the willingness of bystanders to assist friends and to create a social expectation that flushers should stop or reduce their drinking.