Can Web-based preenrollment alcohol brief interventions be effective screening tools? Precollege drinking behavior predicts college retention and alcohol violations.

Objective: To test if precollege drinking data gathered during an online brief intervention are associated with problems and could inform screening for campus alcohol prevention efforts. Participants: Two cohorts of incoming students (N = 5300). Method: Precollege alcohol drinking was gathered through an online preenrollment alcohol brief intervention. Drop out was obtained from university records. On-campus alcohol violations were obtained from university judicial affairs, and off-campus alcohol citations were obtained from the city police. The 2011 cohort was tracked for 4 years, the 2012 cohort for 3 years. Results: Precollege abstaining and heavy drinking were significantly associated with retention and alcohol violations, even with ethnicity, residency, and gender controlled. Association of precollege drinking with later college problems extended beyond the first year and affected retention up to four years of enrollment. Conclusions: The findings support using data from preenrollment alcohol brief interventions as screening tools to customize further campus alcohol interventions.

Effects of a comprehensive nutrition education programme to change grade 4 primary-school students' eating behaviours in China.

OBJECTIVE: As part of a national initiative to reduce child obesity, a comprehensive school-based nutrition education intervention to change eating behaviours among grade 4 primary-school students was developed, implemented and evaluated. DESIGN: The intervention was developed by school staff, with technical assistance from outside health education specialists. The programme included school facility upgrades, school teacher/staff training, curriculum changes and activities for parents. Student scores on nine key eating behaviours were assessed prior to and after the programme. The quality of programme implementation in the schools was monitored by technical assistance teams. SETTING: Shandong Province (high household income) and Qinghai Province (low household income), China. Three programme schools and three control schools in each province.ParticipantsStudents in grade 4 (age 8-9 years). RESULTS: There were significant positive changes in self-reported eating behaviour scores from pre- to post-assessment in programme schools. At post-test students in programme schools had significantly higher scores than students in control schools after controlling for other variables. The programme was more effective in the high-income province. Observations by the technical assistance teams suggested the programme was implemented more completely in Shandong. The teams noted the challenges for implementing and evaluating programmes like these. CONCLUSIONS: This intervention increased healthy eating behaviours among 4th graders in both provinces and had more effect in the more affluent province. Results suggest that a scaled-up initiative using existing school and public health resources could change eating practices in a large population over time. The intervention also provided lessons for implementing and evaluating similar nutrition programmes.

Effects of a web-based pre-enrollment alcohol brief motivational intervention on college student retention and alcohol-related violations.

OBJECTIVE: To determine whether completing a pre-enrollment Web-based alcohol brief motivational intervention (BMI) increased student retention and reduced student alcohol-related violations. PARTICIPANTS: Fall 2011 (3,364) and Fall 2012 (3,111) entering cohorts of all first-year students at a midwestern state university. METHOD: Students completing the brief intervention (BI) were compared to students not completing the BI. Retention was tracked for four years for the 2011 cohort and three years for the 2012 cohort. Campus and community alcohol violations were tracked for two academic years following enrollment. Kaplan-Meier survival analysis and Cox regression were used to test retention survival. Logistic regression was used to test campus and community violations. RESULTS: Students in both cohorts who completed the BI had significantly higher retention and significantly fewer alcohol-related violations than noncompleters. CONCLUSIONS: Population-level Web-based BIs help prevent student dropout and decrease alcohol-related violations, with impacts extending multiple years. Web-based BI is an efficacious population-level prevention tool.

Pilot Study of a Brief WeChat Intervention in China to Increase Students' Willingness to Assist a Flushing Student to Reduce Alcohol Use.

OBJECTIVES: This pilot study tested the effectiveness of a brief alcohol-related intervention delivered by the social media app WeChat to teach about ethanol-induced facial flushing and increase the willingness of students who see another student flushing to suggest that he or she should reduce or stop drinking. In the context of Chinese drinking culture, it is sometimes socially difficult to refuse a drink, even when experiencing physical discomfort, such as flushing. METHODS: Classrooms of students in a medical university in China were randomly assigned to the intervention or control group. Students in the intervention group were invited to view 3 alcohol education lessons on WeChat during a 2-week period. A pretest and posttest before and after the 2-week period assessed changes in students' willingness to intervene if they saw someone flush while drinking. Data were collected about students' alcohol use and their ratings of the lessons. RESULTS: Mixed-design analysis of variance yielded a significant time-by-treatment interaction effect on the variable of willingness to suggest that a flushing person stop or slow down their drinking, and the change was significant between the intervention and control groups. One-way analysis of covariance yielded a significant treatment effect at the posttest, after controlling for the pretest score. Students rated the lessons above the midpoint of the scale for being informative, interesting, and useful. CONCLUSIONS: The pilot study showed that a brief alcohol-related intervention delivered by WeChat could produce a measurable positive change in the willingness of university students to suggest that a student who flushes should stop drinking. This pilot study also suggested improvements for future lessons and evaluation design.

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.

Comparison of Patterns of Use of Unrecorded and Recorded Spirits: Survey of Adult Drinkers in Rural Central China.

About 70% of the beverage alcohol consumed in China annually is spirits. Recorded spirits make up most spirit consumption, but about 25% of total alcohol consumption (1.7 L pure alcohol per capita annually) is unrecorded spirits (bai jiu), either homemade or made in unregulated distilleries. In some parts of China, the consumption of unrecorded spirits is higher than average. This paper compares the patterns of use of unrecorded distilled spirits and recorded distilled spirits among rural residents in Central China. Interviews were conducted with 3298 individuals in 21 towns/villages in 10 counties in the Hubei, Anhui, and Hebei provinces in the People's Republic of China. Unrecorded bai jiu drinkers chose it because of its taste and its low price. It was consumed mostly by older men, mostly at home with family, more regularly and at higher alcohol by volume (ABV) compared to recorded alcohol. Recorded bai jiu drinkers were more likely to drink away from their homes, consumed more bai jiu at memorable drinking occasions, and reported feeling sick after drinking more often than unrecorded bai jiu drinkers. This comparison of patterns of use of unrecorded bai jiu and recorded bai jiu does not suggest that unrecorded bai jiu is more problematic for drinkers.

Effects of selected socio-demographic characteristics on nutrition knowledge and eating behavior of elementary students in two provinces in China.

BACKGROUND: National and international child health surveys have indicated an increase in childhood obesity in China. The increase has been attributed to a rising standard of living, increasing availability of unhealthy foods, and a lack of knowledge about healthy diet. The objective of this study was to assess the effect of selected socio-demographic characteristics on the BMI, nutrition knowledge, and eating behavior of elementary school children. METHODS: Multistage stratified cluster sampling was used. Information on demographics, nutrition knowledge, and eating behavior was gathered by means of questionnaires. The schools' doctors provided the height and weight data. The study was set in one economically advantaged and one economically disadvantaged province in China. The participants were Grade 3 students, ages 8-10 years (N = 3922). RESULTS: A cluster analysis identified four socio-demographic variables distinguished by parental education and family living arrangement. A one-way ANOVA compared differences among the clusters in BMI, child nutrition knowledge, and child eating behavior. Students in the cluster with lowest parent education level had the lowest nutrition knowledge scores and eating behavior scores. There was no significant benefit from college education versus high school education of parents in the other three clusters. BMI was not affected by parent education level. CONCLUSION: The nutrition status of elementary school age children will benefit most by increasing the general level of education for those adults who are presently least educated.

How Social Reactions to Alcohol-Related Facial Flushing Are Affected by Gender, Relationship, and Drinking Purposes: Implications for Education to Reduce Aerodigestive Cancer Risks.

Alcohol-related facial flushing is a sign of compromised alcohol metabolism and increased risk of certain cancers. This project examined how facial flushing might be used to reduce alcohol use to lower cancer risks. Interviews with Chinese university students identified gender, friendship, and drinking purpose as important variables related to whether someone would encourage a person who flushes when drinking alcohol to stop or reduce their drinking. A questionnaire was developed that incorporated these variables into 24 drinking scenarios in which someone flushed while drinking. Students responded whether they would (a) encourage the flusher to stop or drink less; (b) do nothing while wishing they could; or (c) do nothing because there was no need. Analysis of survey responses from 2912 university students showed a three-way interaction of the variables and implied that the probability students will intervene when a drinker flushes was highest when the flusher was a female, a close friend, and the drinking purpose was for fun and lowest if the flusher was a male, the friendship was general, and the drinking purpose was risky. The results provide important details about the social factors affecting how other people respond to a person who flushes when drinking alcohol. This information is useful for those considering ways to reduce and prevent aerodigestive cancers through education and information programs.

Cultural Orientation and Its Associations with Alcohol Use by University Students in China.

Cultural orientation is defined as an individual's cultural preferences when encountering imported culture while still living in the native culture. Data was analyzed from 1305 Chinese university students attending universities in Beijing, Kunming, and Wuhan. Cultural orientation was assessed with the Chinese Cultural Orientation Questionnaire, which assesses both Western and Traditional Chinese cultural orientations. The analysis used hierarchical logistic regression with nondrinkers as the reference group and controlling for demographic factors (age, gender, and urban/rural background). Western cultural orientation was found to significantly increase the odds of recent drinking. The results indicated that higher Western cultural orientation was, after gender, the second most important factor associated with Chinese college student drinking frequency. Traditional Chinese cultural orientation was not associated with drinking frequency. This study highlights an unexpected outcome of globalization on students who have not left their home cultures.

Driver education and teen crashes and traffic violations in the first two years of driving in a graduated licensing system.

Our primary research question was whether teens obtaining their intermediate-level provisional operators permit (POP) in a graduated driver licensing (GDL) environment through driver education differed in crashes and traffic violations from teens who obtained their POP by completing a supervised driving certification log without taking driver education. A descriptive epidemiological study examining a census of all teen drivers in Nebraska (151,880 teens, 48.6% girls, 51.4% boys) during an eight year period from 2003 to 2010 was conducted. The driver education cohort had significantly fewer crashes, injury or fatal crashes, violations, and alcohol-related violations than the certification log cohort in both years one and two of driving following receipt of the POP. Hierarchical logistic regression was conducted, controlling for gender, race/ethnicity, median household income, urban-rural residence, and age receiving the POP. In both year one and two of driving, teens in the certification log cohort had higher odds of a crash, injury or fatal crash, violation, or alcohol-related violation. Findings support that relative to a supervised driving certification log approach, teens taking driver education are less likely to be involved in crashes or to receive a traffic violation during their first two years of driving in an intermediate stage in a graduated driver licensing system. Because teen crash and fatality rates are highest at ages 16-18, these reductions are especially meaningful. Driver education appears to make a difference in teen traffic outcomes at a time when risk is highest.

The educational potential of alcohol-related flushing among Chinese young people.

Aim: This paper describes Chinese university students' understanding of the meaning of the alcohol-related flushing response and how they reacted to their own and someone else's flushing in a group drinking situation. Method: The researcher surveyed 530 Chinese university students about their understanding of flushing and their perception of how people respond to a person who visibly flushes while drinking alcohol. Findings: Most students did not know about the physiological cause of flushing. There were significant gender differences in both reactions to and perception of responses to a person who flushes. There was no direct relationship between flushing and drinking behaviour. CONCLUSIONS: This description of flushing behaviour and responses to a flushing person is discussed in terms of educational opportunities to change behaviours that could reduce the cancer related risks of this visibly at-risk group.

The association between cultural orientation and drinking behaviors among university students in Wuhan, China.

OBJECTIVES: This study examines the association between cultural orientation and drinking behaviors among university students. Cultural orientation is the measure of how the cultural values of individuals living in their own society are influenced by cultural values introduced from the outside. METHODS: In 2011, a cross-sectional survey collected data from 1279 university students from six universities in central China. Participants used a likert scale to rank a series of statements reflecting cultural values from the previously validated Chinese Cultural Orientation Scale and answered questions about their drinking behaviors and socio-demographic characteristics. RESULTS: Statistically significant differences in cultural orientation were observed for gender, hometown and type of university attendance. Traditional-oriented students were more likely to be occasional drinkers or nondrinkers, while marginal-oriented students, bicultural-oriented students and western-oriented students were more likely to be regular drinkers. Bicultural orientation (OR = 1.80, P<0.05) and marginal orientation (OR = 1.64, P<0.05) increased the likelihood of the student being regular drinking, compared to students with traditional orientations. Males (OR = 4.40, P<0.05) had a higher likelihood of regular drinking than females, graduate students (OR = 2.59, P<0.05) had a higher likelihood of regular drinking than undergraduates, students from urban areas (OR = 1.79, P<0.05) had a higher likelihood of regular drinking than those from towns/rural areas, and students attending key universities (OR = 0.48, P<0.05) had a lower likelihood of regular drinking than those attending general universities. CONCLUSIONS: Cultural orientation influences drinking behaviors. Traditional cultural orientation was associated with less drinking while western cultural orientation, marginal cultural orientation and bicultural orientation were associated with more drinking. The role of gender, hometown and university attendance is partially moderated through the influence of cultural orientation. The relationship between a traditional cultural orientation and alcohol drinking suggests that traditional Chinese cultural values should be examined for their role in possibly reducing alcohol-related risks through education and policy initiatives.

Changing intentions to use smokeless tobacco: an application of the IMB model.

OBJECTIVE: To determine if the Information-Motivation-Behavioral Skills model was effective for development of a smokeless tobacco educational unit (STEU) and analysis of STEU effects. METHODS: Structural equation modeling was used to test component relations proposed by the IMB model and STEU effects on parallel growth of IMB components. RESULTS: Results confirmed IMB model component relationships and indicated that STEU effects were primarily on information with indirect effects on expectancies and self-efficacy change through information. CONCLUSIONS: Prevention programming needs to address all IMB model components. Organizing analysis around the IMB model provides better understanding of program outcomes.

The influence of cultural orientation, alcohol expectancies and self-efficacy on adolescent drinking behavior in Beijing.

OBJECTIVE: We hypothesized that the drinking behavior of adolescents in China is influenced by expectancies and self-efficacy and that adolescents' cultural orientation towards western versus traditional Chinese values influences expectancies, self-efficacy and drinking behavior, with western values leading to more dysfunctional patterns of beliefs and drinking, and that these beliefs are influenced by students' gender and school environment. METHODS: A total of 1020 high school students from Beijing completed the Chinese Adolescent Alcohol Expectancy, the Chinese Cultural Orientation and the Chinese Self-regulation Self-efficacy questionnaires. RESULTS: Results generally confirmed our hypotheses. Higher negative expectancies and higher self-efficacy reduced the likelihood of drinking significantly. Higher positive expectancies increased the likelihood of regular drinking but not occasional drinking. Having western cultural orientation increased the likelihood of drinking. Higher levels of western cultural orientation also increased positive expectancies, lowered negative expectancies and lowered self-efficacy. Having more western (less traditional) views towards traditional Chinese values decreased positive and negative expectancies. Gender influenced beliefs, with males having higher positive and lower negative expectancies, lower self-efficacy and more traditional cultural orientation. Students in key and general schools had less traditional cultural orientation and key school students had higher self-efficacy. CONCLUSIONS: Results indicate that cultural orientation influences adolescent drinking and this influence is mediated partially through cultural orientation influences on adolescent drinking expectancies and self-efficacy. Having more western and less traditional Chinese cultural orientation leads to more drinking, lower self-efficacy for regulating drinking and more risk-promoting alcohol expectancies.

Being bullied and psychosocial adjustment among middle school students in China.

BACKGROUND: Using the Chinese version of the Global School-based Health Survey (GSHS), this article describes the prevalence of being bullied among a nationally representative sample of Chinese students in grades 6-10 and explores the relationships between being bullied and selected indicators of psychosocial adjustment. METHODS: A total of 9015 students in middle schools in Beijing, Hangzhou, Wuhan, and Urumqi completed the Chinese version of the GSHS. Researchers analyzed the results from 2 questions about the frequency and form of being bullied and 11 questions about psychosocial adjustment. Descriptive statistics and logistic regression were used in the analysis. RESULTS: About 25.7% of middle school students reported being bullied on 1 or more of the past 30 days. Rates of being bullied were similar for males and females, but the forms of being bullied were different. Being bullied was significantly lower in Beijing than in the other 3 cities. There were significant psychosocial differences between students who had been bullied and students who had not been bullied. Students who had been involved in a physical fight, often felt lonely, or had considered suicide in the past 30 days were more likely to report being bullied. Students who thought that other students in their school were often kind and helpful, who felt parents often understood their troubles, or who were taught in school how to handle stress were less likely to report being bullied. CONCLUSIONS: Being bullied is not uncommon in Chinese middle schools. Chinese schools typically place great emphasis on academic achievement, perhaps at the expense of the social climate of the school. Results indicated schools could implement changes to the school climate to reduce the likelihood of students' being bullied.

Alcohol expectancies among high school students in Inner Mongolia, China.

OBJECTIVE: This study examines differences in Chinese high school students' alcohol expectancies by drinking status (nondrinker, occasional drinker, regular drinker) and gender (male, female). METHOD: The authors administered the Chinese Adolescent Alcohol Expectancy Questionnaire (CAEQ) to a convenience sample of 1244 high school students (M = 627; F = 617) from schools in Huhhot City and Tongliao City in Inner Mongolia, China. RESULTS: Differences were found in the 8 CAEQ factors (3 negative and 5 positive factors). Regular drinkers had lower negative consequences and higher positive perception expectancies than nondrinkers or occasional drinkers. Nondrinkers had higher harm to person/reputation expectancies than occasional or regular drinkers. Occasional drinkers had higher beneficial/moderation and lower harm to person/ reputation expectancies than nondrinkers. Boys had higher positive perception expectancies than girls. CONCLUSIONS: Expectancies are associated with Chinese adolescents' drinking. Identifying the characteristics of alcohol consuming youth can inform the development of prevention interventions and alcohol policies.

Pandemic influenza preparedness: a survey of businesses.

Several Omaha businesses were surveyed on pandemic influenza preparedness and general disaster preparedness. Most businesses had started pandemic influenza planning, but few had exercised the plan or used it to educate employees. Responses provided insight into the status of business planning. The survey uncovered a need for providing assistance to businesses in pandemic preparedness as well as training in infection control in the workplace, which should be a niche for infection control professionals.

Buddhism and adolescent alcohol use in Thailand.

A sample of 2019 Thai secondary school students in grades equivalent to U.S. 10 through 12 completed a 43-item alcohol expectancy questionnaire in June 2000. Factor analysis revealed four factors: (a) positive expectancies, (b) negative expectancies, (c) sex and power expectancies, and (d) religious expectancies. Practicing Buddhists were less likely to drink than nonpracticing Buddhists and had fewer positive and more negative expectancies about alcohol. Among students who did drink, Buddhist beliefs did not appear to influence whether or not they were binge drinkers. Buddhist beliefs may influence decisions to drink but not decisions related to drinking patterns.

Smokeless tobacco expectancies among a sample of rural adolescents.

OBJECTIVE: To examine the role of expectancies in adolescent smokeless tobacco (ST) use. METHODS: Self-report measures of students' ST expectancies, cigarette and ST use, and peer and family tobacco use were collected from a sample of 978 rural high school students. RESULTS: Student expectancy beliefs significantly predicted ST use and intention to try ST in the next year. Student expectancies about ST were influenced by gender, cigarette use, and peer tobacco use. Family-member tobacco use did not strongly affect expectancies. CONCLUSION: Expectancies play a meaningful role in students' current and future decisions whether to use ST.