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.

High-risk versus low-risk football game weekends: differences in problem drinking and alcohol-related consequences on college campuses in the United States.

UNLABELLED: Collegiate football games provide multiple social opportunities for alcohol use by students over the course of the weekend. The goal of this study was to examine alcohol use and alcohol-related consequences on football game weekends to determine differences based on characteristics of the game. METHODS: A random sample of students from two large, public universities in the United States completed a survey on the Sunday-Friday following a high-risk weekend (HRW, important, home game) and low-risk weekend (LRW, no home game or game of importance) (N = 3,238 total). The survey measured the number of days students drank (0-3) and got drunk (0-3) over the weekend and whether 1+ consequences were experienced due to one's own drinking (yes/no) and due to others' drinking (yes/no). RESULTS: Ordinal logistic regression analyses revealed greater odds of drinking alcohol (OR = 1.70, CI = 1.46-1.97) and getting drunk (OR = 1.49, CI = 1.27-1.76) on HRW versus LRW. Logistic regression analyses revealed greater odds of experiencing 1+ consequences as a result of one's own drinking (OR = 1.38, CI = 1.16-1.63) and experiencing 1+ consequences as a result of others' drinking (OR = 1.52, CI = 1.30-1.78) on HRW versus LRW. DISCUSSION: These findings suggest that additional prevention efforts aimed at reducing risky drinking are needed over HRW and have implications for campus administrators, law enforcement, and substance abuse program coordinators.

Attrition bias in a U.S. Internet survey of alcohol use among college freshmen.

OBJECTIVE: Attrition bias is an important issue in survey research on alcohol, tobacco, and other drug use. The issue is even more salient for Internet studies, because these studies often have higher rates of attrition than face-to-face or telephone surveys, and there is limited research examining the issue in the field of drug usage, specifically for college underclassmen. This study assessed whether measures of high-risk drinking and alcohol-related consequences were related to attrition groups ("stayers" or "leavers") in a cohort of college freshmen. METHOD: Data were collected in 2003 and 2004 from 2,144 first-year college students at 10 universities in the southeastern United States. Demographics, indicators of high-risk drinking, and alcohol-related consequences were compared between cohort stayers and leavers in statistical analyses using two methods. RESULTS: Analyses indicated that cohort leavers reported significantly higher levels of high-risk drinking (past-30-day heavy episodic drinking, weekly drunkenness) and past-30-day smoking but not significantly increased alcohol-related consequences. The directionality of bias was modestly consistent across outcomes and comparison methods. CONCLUSIONS: The current study's findings suggest that intervention efforts to reduce smoking or high-risk drinking need to consider attrition bias during study follow-up or account for it in analyses.

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.

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.

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.

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.

Randomized controlled trial comparing four strategies for delivering e-curriculum to health care professionals [ISRCTN88148532].

BACKGROUND: Internet education is increasingly provided to health professionals, but little is known about the most effective strategies for delivering the content. The purpose of this study is to compare four strategies for delivering an Internet-based (e-) curriculum on clinicians' knowledge (K), confidence (CONF), and communication (COMM) about herbs and other dietary supplements (HDS). METHODS: This national randomized 2 x 2 factorial trial included physicians, pharmacists, nurses, nutritionists and trainees in these fields. Participants were randomly assigned to one of four curriculum delivery strategies for 40 brief modules about HDS: a) delivering four (4) modules weekly over ten (10) weeks by email (drip-push); b) modules accessible on web site with 4 reminders weekly for 10 weeks (drip-pull); c) 40 modules delivered within 4 days by email (bolus-push); and d) 40 modules available on the Internet with one email informing participants of availability (bolus-pull). RESULTS: Of the 1,267 enrollees, 25% were male; the average age was 40 years. The completion rate was 62%, without significant differences between delivery groups. There were statistically significant improvements in K, CONF and COMM scores after the course (P<0.001 for all), although the difference in COMM was small. There were no significant differences in any of the three outcomes by delivery strategy, but outcomes were better for those who paid for continuing education credit. CONCLUSION: All delivery strategies tested similarly improved K, CONF, COMM scores about HDS. Educators can use the strategy that is most convenient without diminishing effectiveness. Additional curricula may be necessary to make substantial changes in clinicians' communication practices.