Impact of a randomized campus/community trial to prevent high-risk drinking among college students.

BACKGROUND: High-risk drinking by college students continues to pose a significant threat to public health. Despite increasing evidence of the contribution of community-level and campus-level environmental factors to high-risk drinking, there have been few rigorous tests of interventions that focus on changing these interlinked environments. The Study to Prevent Alcohol Related Consequences (SPARC) assessed the efficacy of a comprehensive intervention using a community organizing approach to implement environmental strategies in and around college campuses. The goal of SPARC was to reduce high-risk drinking and alcohol-related consequences among college students. METHODS: Ten universities in North Carolina were randomized to an Intervention or Comparison condition. Each Intervention school was assigned a campus/community organizer. The organizer worked to form a campus-community coalition, which developed and implemented a strategic plan to use environmental strategies to reduce high-risk drinking and its consequences. The intervention was implemented over a period of 3 years. Primary outcome measures were assessed using a web-based survey of students. Measures of high-risk drinking included number of days alcohol was consumed, number of days of binge drinking, and greatest number of drinks consumed (all in the past 30 days); and number of days one gets drunk in a typical week. Measures of alcohol-related consequences included indices of moderate consequences due to one's own drinking, severe consequences due to one's own drinking, interpersonal consequences due to others' drinking, and community consequences due to others' drinking (all using a past 30-day time frame). Measure of alcohol-related injuries included (i) experiencing alcohol-related injuries and (ii) alcohol-related injuries caused to others. RESULTS: We found significant decreases in the Intervention group compared with the Comparison group in severe consequences due to students' own drinking and alcohol-related injuries caused to others. In secondary analyses, higher levels of implementation of the intervention were associated with reductions in interpersonal consequences due to others' drinking and alcohol-related injuries caused to others. CONCLUSIONS: A community organizing approach promoting implementation of environmental interventions can significantly affect high-risk drinking and its consequences among college students.

The role of monthly spending money in college student drinking behaviors and their consequences.

OBJECTIVE: Alcohol use among college students is pervasive and affected by economic factors such as personal income and alcohol price. The authors examined the relationship among students' spending money, drinking rate, and alcohol-related consequences. PARTICIPANTS: In 2005, the authors conducted a Web-based survey among a random sample of 3,634 undergraduate students from 2 large universities. METHODS: The authors used multiple logistic regression to model drinking behaviors and multiple linear regression to model alcohol-related consequences. RESULTS: The lowest reported levels of average monthly spending money were associated with reduced levels of drinking and getting drunk. Spending money was independently associated with experiencing alcohol-related consequences caused by a student's own drinking, even after the authors controlled for personal drinking behaviors. The effects for consequences caused by others' drinking were significant for students who had gotten drunk. CONCLUSIONS: These findings have implications for alcohol price and marketing, particularly around colleges, and suggest actions for parents to consider.

The negative consequences of other students' drinking: inventory development and assessment of differences by student characteristics and risk behaviors.

UNLABELLED: College students continue to report being disrupted by other students' alcohol use. OBJECTIVE: This study was designed to develop measures to document the consequences resulting from other students' drinking and identify differences in experiencing these consequences by student characteristics and drinking behaviors. STUDY GROUP: A stratified random sample of undergraduate students (N = 3,908) from ten universities in North Carolina, USA, completed a web-based assessment. METHODS: Exploratory factor analysis (EFA) was performed on the random first split-half sample (n = 1,954) to identify factor structure. Confirmatory factor analysis (CFA) was performed on the remaining half sample (n = 1,954) using structural equation modeling. RESULTS: EFA revealed two inventories: interpersonal and community consequences of others' drinking inventories. CFA on the second split-half sample identified model fits for the two factor structure suggested by EFA. Of 3,908 participants, 78% reported experiencing one or more consequences due to others' drinking during the past 30 days. Multivariable generalized linear mixed modeling further validated the inventories and resulted in several associations. Male students who reported getting drunk experienced significantly more interpersonal consequences from others' drinking (p < .001). Minority students, students who lived on campus and students who reported getting drunk experienced significantly more community consequences from others' drinking (p < .01). CONCLUSIONS: These findings demonstrate that 4 out of 5 college students experience consequences from others' drinking, and consequences vary for different subgroups of students. Although these inventories should be tested further, these findings propose standardized measures that may be useful to assess the consequences of others' drinking among college students.

The social ecology of adolescent alcohol misuse.

A conceptual framework based on social ecology, social learning, and social control theories guided identification of social contexts, contextual attributes, and joint effects that contribute to development of adolescent alcohol misuse. Modeling of alcohol use, suggested by social learning theory, and indicators of the social bond, suggested by social control theory, were examined in the family, peer, school, and neighborhood contexts. Interactions between alcohol modeling and social bond indicators were tested within and between contexts. Data were from a longitudinal study of 6,544 students, 1,663 of their parents, and the U.S. Census. All contexts were uniquely implicated in development of alcohol misuse from ages 11 through 17 years, and most alcohol modeling effects were contingent on attributes of social bonds.

Contextual factors and health risk behaviors associated with date fighting among high school students.

Over 2,000 North Carolina high school students completed surveys measuring community risk and protective factors and individual health risk behaviors including dating violence perpetration and victimization. Females reported more date fighting perpetration than males (8.8% to 4.0%), as well as greater levels of date fighting victimization (7.2% and 5.0%). In multivariate models, factors associated with date fighting perpetration among females and males included riding with a drinking driver. Neighborhood organization was protective for both groups. Cigarette use, drinking and driving, and being a minority were also associated with perpetration among females, while tobacco use was associated with date fighting perpetration by males. Factors associated with victimization among both genders included riding with a drinking driver. Females were more likely to be victimized if they used marijuana, whereas males were less likely to be a victim of date fighting if they perceived their community to be "organized." Findings reflect comparable individual risk factors for date fighting across genders, with few exceptions, and warrant further investigation of the role of community assets in protecting young people from dating violence.

Viewing professional wrestling on television and engaging in violent and other health risk behaviors.

BACKGROUND: This study examined the relationships between watching wrestling on television (TV) and engaging in health risk behaviors among an older multi-state sample of adolescents. METHODS: In 2001, a random sample of 2,307 youth ages 16 to 20 years from 138 communities in 17 US states completed telephone surveys as part of the national evaluation of the Enforcing Underage Drinking Laws Program. The survey measured multiple health risk behaviors, including substance use, involvement in date fighting, other violent behaviors, and sexual risk behaviors. The frequency of watching wrestling on TV during the two week period before the survey was measured with a scale of 0 to 14 or more times. Multivariate analyses were conducted with logistic regression using a generalized estimating equation (GEE) model with an exchangeable correlation structure that controlled for within-group clustering. Data are presented as adjusted odds ratios (OR) and 95% confidence intervals. RESULTS: Males (22.4%) reported watching wrestling more than females (13.6%). After adjusting for ethnicity, sex, median family income, age, region of the country, other fighting behaviors, and family composition, the frequency of watching wrestling was associated with having tried to hurt someone with a weapon (OR = 1.67, CI = 1.05-2.66), engaging in sexual intercourse without using birth control (1.42, 1.01-1.98), being a current cigarette smoker (1.31, 1.02-1.69), and not drinking (0.64, 0.48-0.85). When the frequency of watching wrestling was treated as an independent variable, after adjusting for covariates, each additional time wrestling was watched on TV was associated with an increased risk of being in a date fight (1.16, 1.02-1.30), threatening to hurt someone with a weapon (1.14, 1.02-1.28), hurting someone with a weapon (1.19, 105-1.34), and engaging in sexual intercourse without using birth control (1.13, 1.03-1.23). For example, youth who had watched wrestling six times during the past two weeks were 144% more likely to have engaged in a date fight than adolescents who had not watched wrestling. CONCLUSIONS: The more frequently these adolescents reported watching wrestling on TV, the more likely they were to engage in violent and other health risk behaviors.

Party behaviors and characteristics and serial drunkenness among college students.

OBJECTIVE: This study examined the relationships between party behaviors and social contextual factors for the largest party attended by college students and serial drunkenness by students over the 3 traditional weekend party days (Thursday-Saturday). METHOD: On two separate 3-day party time periods in the spring of 2006, a random sample of 3,600 students from two large public universities completed a Web-based survey. The survey was administered on a Sunday evening and assessed alcohol consumption, party behaviors and observations, and other social contextual factors occurring during the 3 previous days. Serial drunkenness was measured as having gotten drunk on 0-3 days for the specified 3-day period for students who had attended one or more parties. RESULTS: Multivariate analysis indicated that serial drunkenness was associated with being white, being single without a partner, having ridden with a drinking driver over the weekend, drunken behaviors by other students at the largest party attended, the number of drinks the student consumed before attending the party, the number of drinks consumed at the largest party, and the number of friends that attended the party with the student. A lower frequency of serial drunkenness was associated with the perception that alcohol was difficult to obtain. CONCLUSIONS: The availability of alcohol before and at the largest party attended over the weekend, attending the party with a larger number of friends, and drunken behaviors by other students at the party, plus riding with a drinking driver after the party, were associated with serial drunkenness over the 3-day period by the students at these two universities.

Exploring the health behavior disparities of gay men in the United States: comparing gay male university students to their heterosexual peers.

Little is known about the health disparities that affect gay men in the United States. Using data collected from an online Internet-based assessment, we sought to compare health-compromising behaviors of gay male university students to their heterosexual peers. Participants included 1,014 self-reported males. Mean age was 20 years (+/-2.5; range 17-30). Of these men, 43 (4.2%) self identified as gay and 971 (95.8%) self identified as heterosexual. After adjusting for age, race, academic classification, residence type, and clustering within university, gay men had higher odds of reporting inconsistent condom use; reporting multiple partners within the past 30 days; reporting a lifetime history of illicit drug use. Understanding the health behavior disparities between gay and heterosexual men is crucial to identifying associated factors and intervening upon them using appropriate and meaningful tailored strategies to reduce these disparities and improve health outcomes.

Firearm ownership and storage patterns among families with children who receive well-child care in pediatric offices.

OBJECTIVE: In this study we examined firearm storage patterns and their associations in a diverse sample of families who attended pediatric practices from both rural and nonrural areas across the United States. METHODS: Parents who brought their children who were aged 2 to 11 years (N = 3745) to 96 Pediatric Research in Office Settings practices from 45 states, Canada, and Puerto Rico participated in an office-based survey before a well-child examination. The survey measured demographic variables; family history of guns in the home; and firearm types, storage behaviors, and ownership. RESULTS: Twenty-three percent of families reported firearm ownership. The majority (60%) of respondents reported making firearm storage decisions. Only one third of firearm owners reported safe firearm storage. Gun type owned was associated with storage habits, with long-gun owners storing their gun in places other than locked cabinets but with ammunition separate from guns and handgun users more likely to store guns loaded and to use gun locks. In a multivariate analysis, not being raised with a firearm was associated with safe storage behaviors. Families who had children aged 2 to 5 years and owned long guns were more likely to store their guns safely than families with older children. CONCLUSIONS: Few families reported safe firearm storage. Storage patterns are most influenced by firearm type(s) owned, family socialization with guns, and the age of the child. Primary care providers need to understand better not only whether firearms are in the home but also which types are present and whether parents were raised in homes with guns.

Date fighting experiences among college students: are they associated with other health-risk behaviors?

OBJECTIVE: The authors examined the clustering of health-risk behaviors among college students who reported date fight involvement. PARTICIPANTS AND METHODS: The authors administered a Web-based survey to a stratified random sample of 3,920 college students from 10 universities in North Carolina. RESULTS: Among men, 5.6% reported date fight victimization, and 1% reported date fight perpetration. Victimization among men was associated with (1) first drink at age 15 years or younger, (2) a recent threat of violence by someone who had been drinking, (3) smoking, (4) amphetamine use, and (5) older age. Among women, 6.7% reported date fight victimization, which was associated with (1) older age, (2) assault from a student who had been drinking, (3) sex with 2 or more persons, (4) consumption of alcohol in high school, (5) illegal drug use, (6) nonsexual assault requiring medical treatment, and (7) living off campus. Of the women, 4.2% reported date fight perpetration, which was associated with (1) minority race/ethnicity, (2) older age, (3) frequency of sexual intercourse, and (4) alcohol and marijuana use. CONCLUSIONS: Date fight experiences were associated with multiple health-risk behaviors among this sample of college students.

A Test of Biosocial Models of Adolescent Cigarette and Alcohol Involvement.

We tested biosocial models that posit interactions between biological variables (testosterone, estradiol, pubertal status, and pubertal timing) and social context variables (family, peer, school, and neighborhood) in predicting adolescent involvement with cigarettes and alcohol in a sample of 409 adolescents in grades 6 and 8. Models including the biological and contextual variables and their interactions explained significantly more variance in adolescent cigarette and alcohol involvement than did models including only the main effects of the biological and contextual variables. Post-hoc analyses of significant interactions suggested that, in most case, moderation occurred in the hypothesized direction. Consistent with dual hazards models of adolescent antisocial behaviors, the relationships between the biological and substance use variables became positive and stronger as the context became more harmful. Considerations of adolescent substance use, and perhaps other problem behaviors, should recognize the possible role of biological variables and how their influence may vary by social context.

The relationship between watching professional wrestling on television and engaging in date fighting among high school students.

CONTEXT: Previous research has found that exposure to violence in the home, community, and electronic media are associated with children's and adolescents' normative expectations concerning the use of violence and with other indicators of the violent behaviors by youth. OBJECTIVE: Our purpose with this study was to examine the relationships between the frequency that high school students reported watching wrestling on television and engaging in date fighting, weapon carrying, and other fighting behaviors. DESIGN: The initial analysis consisted of a cross-sectional study of a simple random sample of high school students, which was followed by a longitudinal analysis of these students over a 6- to 7-month period. SETTING: The setting was all public high schools in 1 city/county system. PARTICIPANTS: We used a simple random sample (N = 2228) of students. MAIN OUTCOME MEASURES: The primary outcome variables included the frequency of date fighting during the previous 12 months and alcohol or other drug involvement associated with the last date fight. RESULTS: There were significant correlations between frequency of watching wrestling on television during the previous 2 weeks and engaging in date fighting, fighting in general, and weapon carrying for both males and females, although the relationships were stronger among females than among males. The frequency of watching wrestling was highest among students reporting date fighting when either the victim or perpetrator had been drinking alcohol or using illegal drugs. When analyzed using logistic regression, the strongest relationships were observed between the frequency of watching wrestling and date-fight perpetration among females in cross-sectional and longitudinal analyses. These findings persisted after adjusting for multiple other factors. CONCLUSIONS: For males and females, the frequency of watching wrestling was highest among students who fought with their dates when alcohol or other drugs were involved. The association between watching wrestling and date fighting was stronger among females than males. The relationship between watching wrestling on television and being the perpetrator of dating violence was also stronger among females and remained consistent over a 6- to 7-month time period.

Single question about drunkenness to detect college students at risk for injury.

OBJECTIVES: To examine the frequency of injuries reported by college students who replied affirmatively to the question, "In a typical week, how many days do you get drunk?" METHODS: In Fall 2003, a Web-based survey was administered to a stratified random sample of 3,909 college students from ten North Carolina (NC) universities. Students answered questions regarding alcohol use and its consequences. Data were analyzed using multiple logistic regression, controlling for within-school clustering of drinking behaviors and adjusting for other significant covariates. Adjusted odds ratios (AORs) and 95% confidence intervals (CI) were calculated for significant predictors (p < 0.05). RESULTS: Two thousand four hundred eighty-eight students reported that they are current drinkers; 1,353 (54.4%) reported getting drunk at least once in a typical week. Compared with students who did not report getting drunk at least once a week, these students had higher odds of being hurt or injured at least once as a result of their own drinking (AOR = 4.97; 95% CI = 3.47 to 7.09), experiencing a fall from a height that required medical treatment (AOR = 2.16; 95% CI = 1.36 to 3.43), and being taken advantage of sexually as a result of another's drinking (AOR = 2.59; 95% CI = 1.72 to 3.89). Students who reported getting drunk at least one day in a typical week also were more likely to cause an injury requiring medical treatment to someone else. They had higher odds of causing injury in an automobile crash (AOR = 1.84; 95% CI = 1.01 to 3.40), of causing a burn that required medical treatment (AOR = 2.85; 95% CI = 1.51 to 5.39), and of causing a fall from a height that required medical treatment (AOR = 2.02; 95% CI = 1.01 to 4.04). Getting drunk was a better indicator of "self-experienced injury" and of "injury caused to someone else" than was binge drinking, for all outcomes (p < 0.05). CONCLUSIONS: The single question, "In a typical week, how many days do you get drunk?" identifies college students who are at higher than normal risk of injury as a result of their own drinking and the drinking of others. Future research should assess this question's effectiveness as a screening tool in campus health centers and in emergency departments.

An evaluation of a mass media campaign to encourage parents of adolescents to talk to their children about sex.

PURPOSE: We evaluated a mass media campaign in North Carolina that used television (TV) public service announcements (PSAs), radio PSAs, and billboards to encourage parents of adolescents to talk to their children about sex. The primary message of the campaign was "Talk to your kids about sex. Everyone else is." METHODS: Thirty-two of the 100 counties in North Carolina were chosen to evaluate the mass media campaign. Paid TV PSAs were aired in 22 of these counties, radio PSAs were aired in 21 counties, and billboards were displayed in 6 counties over a period of 9 months. The counties in our sample varied from no exposure to exposure to all 3 types of media. To assess the impact of the campaign, a sample of 1,132 parents of adolescents living in the 32 counties was administered a postexposure survey via a telephone interview. Questions about exposure to the media campaign were embedded among questions concerning media exposure to other health-related messages. The parent survey assessed the frequency the parents reported exposure to each type of media message, correct knowledge of the message, and multiple item scales that assessed how often they had talked to their child about various issues related to sex during the previous 6 months, intentions to talk to their child about these issues during the next month, and attitudes about discussing sexual issues with their child. RESULTS: In bivariate analyses the levels of parental exposure to the 3 types of media messages were associated with both having talked to their children and intentions to talk to their children about sex (p < .0001). When analyzed with multiple regression, female gender, minority ethnicity, frequency of seeing a billboard on teenage pregnancy, frequency of seeing a TV PSA about sex, and frequency of hearing a radio PSA about sex and teenage pregnancy accounted for 12.8% (p < .0001) of the variance in having talked to their child about sex. Female gender, minority ethnicity, and previously talking to their child about sex accounted for 9.9% of the variation in positive communication attitudes about sex. Positive communication attitudes, female parent, minority ethnicity, frequency of seeing a billboard about sex, frequency of seeing a TV PSA about sex, and frequency of hearing radio PSAs about sex accounted for 12.3% of the variation in parental intentions to talk to their child about sex during the next month. CONCLUSIONS: Exposure to each component of this mass media campaign was associated with parents recently having talked to their adolescent children about sex and intentions to talk to their children during the next month.

How ready are colleges for and environmental approach that utilizes campus/community coalitions?

While there is optimism about an environmental management approach that utilizes campus/community coalitions to reduce levels of high-risk drinking, the readiness of schools to implement such an approach is unknown. We surveyed 100 colleges regarding their readiness based on eight factors: existance of a task force to address alcohol use on campus; the inclusion of the college/university President; inclusion of a community representative; frequent meetings; external funding to address alcohol use; previous environmental training; changes implemented as a result of environmental training; and a plan to institute environmental training in the future. Having an alcohol task force or coalitions (57 percent) was associated with participation by the president and/or community representative on the task force, having extramural funding to address high-risk drinking, training in environmental management, implementation of changes after the training, plans for uture training, school size, Greek organizations on campus, and being a state university(AU)

How ready are colleges for an environmental approach that utilizes campus/community coalitions?

While there is optimism about an environmental management approach that utilizes campus-community coalitions to reduce levels of high-risk drinking, the readiness of schools to implement such an approach is unknown. We surveyed 100 colleges regarding their readiness based on eight factors: existence of a task force to address alcohol use on campus; the inclusion of the college/university President; inclusion of a community representative; frequent meetings; external funding to address alcohol use; previous environmental training; changes implemented as a result of environmental training; and a plan to institute environmental training in the future. Having an alcohol task force or coalition (57%) was associated with participation by the president and/or community representative on the task force, having extramural funding to address high-risk drinking, training in environmental management, implementation of changes after the training, plans for future training, school size, Greek organizations on campus, and being a state university.

Adolescent sexual victimization, use of alcohol and other substances, and other health risk behaviors.

PURPOSE: To examine the relationship between substance use, other health risk behaviors, and sexual victimization among adolescent females. METHODS: A cross-sectional telephone survey of 16-20-year-olds, including 647 female "ever drinkers" (1999) and 1236 female "never drinkers" and "ever drinkers" (2000) from 17 states, was conducted as part of the National Evaluation of the Enforcing Underage Drinking Laws Program. The survey assessed underage alcohol use, sexual victimization, and other risky behaviors. Logistic regression modeling was used to measure the association among sexual victimization, substance use, and other risk behaviors. RESULTS: In 1999, 8.2% and in 2000, 7.1% of the participants reported having experienced actual or attempted sex against their will. Logistic regression analyses revealed that binge drinking in the past 2 weeks (1999), age at first drink (2000), sex without birth control (1999 and 2000), marijuana use in the past 30 days (1999 and 2000), and ever having been in a fight (2000) were associated with sexual victimization. CONCLUSIONS: Indicators of substance abuse and other health risk behaviors were strongly associated with sexual victimization among adolescent females. Implications for the direction of causal relationships are discussed.

Adults' approval and adolescents' alcohol use.

PURPOSE: To compare adults' approval of adolescents' alcohol use among white, black, and Latino youth and to evaluate the effects of approval on most recent alcohol consumption, past 30-day use and binge drinking. METHODS: A cross-sectional telephone survey of N = 6245 adolescents from 242 communities was conducted as part of the National Evaluation of the Enforcing Underage Drinking Laws Program. The survey assessed perceived availability of alcohol, underage alcohol use, and problems related to underage drinking. Ordinary least squares regression modeling was used to test the relationships between adults' approval and most recent consumption. Logistic regression modeling was used to measure the association among approval, past 30-day use and binge drinking. RESULTS: Perceived consequences, parent and adult relative provision of alcohol, and drinking with a parent were protective of underage drinking. Providing alcohol at a party, however, was associated with a two-fold increase in past 30-day use and binge drinking. There were minimal differences on adults' approval across the three racial/ethnic groups. CONCLUSIONS: Adults' approval of alcohol use is highly correlated with youth drinking behavior and has differential effects on adolescents' alcohol use depending on the social context in which the alcohol is provided.