Implementation of a computerized tool to address barriers to academic success among college students.

OBJECTIVE: Academic assistance professionals work with college students to address barriers to academic success, although few assessment tools exist. This feasibility study examined the results of implementing a computerized tool for academic assistance professionals to help students. The Measure of Obstacles to Succeeding Academically in College (MOSAIC) is a 31-item risk assessment tool used to characterize academic barriers. It utilizes a tailored computer algorithm on a mobile device to match students with resources to address academic barriers. METHODS: The MOSAIC was customized and administered at seven universities around the United States. Student responses were analyzed in Microsoft Excel. Academic assistance professionals were asked about implementation in unstructured interviews. RESULTS: Stress and study skill concerns were the most reported barriers. The MOSAIC was well received, especially among students experiencing academic difficulties, but integration into routine workflow was an obstacle to sustained implementation. CONCLUSIONS: The MOSAIC holds promise in addressing issues impeding academic success.

In harm's way: Do college students' beliefs about cannabis put them at risk for use?

Objective: This study describes beliefs held by college students about cannabis use and examines the association between three specific cannabis beliefs and likelihood of use. Participants: 3,720 undergraduate students ages 18 to 25 attending ten colleges in one state. Methods: Data were gathered via online survey. Results: The majority (80%) of the sample was unsure or believed that cannabis was an effective way to reduce stress; 67% were unsure or believed that cannabis was not related to an increased risk for mental health problems; and 62% were unsure or believed that students who use cannabis are not more academically disengaged. Holding these beliefs, which are not supported by scientific evidence, was associated with a greater likelihood of cannabis use, even after statistically adjusting for covariates. Conclusions: These findings suggest that beliefs unsupported by scientific evidence are widespread among college students. Dispelling misinformation about cannabis might hold promise for reducing use.

Graduate student burnout: Substance use, mental health, and the moderating role of advisor satisfaction.

Substance use and mental health problems are associated with academic difficulties among high school and undergraduate students, but little research has been conducted on these relationships among graduate students. The sample consisted of 2,683 graduate students attending two large, public universities. Standard measures were used to collect data on demographic and program characteristics, mental health, substance use, advisor satisfaction, and burnout (i.e., exhaustion, cynicism, and inefficacy). Linear regression models evaluated relationships between each mental health and substance use variable with burnout, as well as the moderating role of advisor satisfaction. Students with a greater number of substance use and mental health problems had higher levels of exhaustion, cynicism, and inefficacy. No statistically significant relationships between substance use and burnout were found. High levels of stress, moderate or severe anxiety symptoms, and moderate or severe depressive symptoms were associated with increased levels of burnout. Advisor support moderated the relationships between stress and both cynicism and inefficacy such that the effects of stress on these dimensions of burnout were lower among those who were satisfied with their advisor. Graduate students with mental health problems might be at increased risk for burnout; however, having a supportive advisor might buffer this association.

Substance use and mental health problems among graduate students: Individual and program-level correlates.

OBJECTIVE: This study evaluated variation in substance use and mental health among graduate student subgroups. PARTICIPANTS: A sample of 2,683 master's and doctoral students completed an online survey in October 2017. METHODS: Subgroup variation in behavioral health by demographic and program characteristics, particularly degree type and academic discipline, was explored. RESULTS: Compared with academic doctoral students (ie, PhD students), professional doctoral students (ie, MD, JD, etc.) were significantly more likely to report high stress levels and moderate or severe anxiety symptoms. Master's students were more likely to report moderate or severe anxiety symptoms and use marijuana than academic doctoral students. Students in the behavioral and social sciences, social work, and arts and humanities disciplines were more likely to use substances and report mental health problems than engineering and business students. CONCLUSIONS: These findings highlight graduate student subgroups who might require closer attention with respect to access to behavioral health services.

Nonmedical Use of Prescription Stimulants as a "Red Flag" for Other Substance Use.

BACKGROUND: Nonmedical use of prescription stimulants (NMPS) has increased on college campuses during the past two decades. NMPS is primarily driven by academic enhancement motives, and normative misperceptions exist as well. However, large, nationwide studies have not yet been conducted to generalize findings more broadly and gain a deeper understanding of the relationship between NMPS and other substance use (e.g. alcohol use, marijuana, etc.). The present study was conducted to lay the foundation for prevention efforts related to NMPS by establishing NMPS prevalence, practices surrounding NMPS, and other substance use. METHODS: N = 2,989 students from seven universities around the U.S. completed a web-based survey assessing NMPS practices and related behaviors. Prevalence and factors associated with NMPS were explored. RESULTS: Analyses revealed a 17% past-year prevalence of NMPS with associated widespread misperceptions of peer use. NMPS was significantly related to alcohol use, binge drinking, and marijuana use, as well as skipped classes and affiliation with Greek life. CONCLUSIONS: Although most college students do not report NMPS, those who do also are more likely to report alcohol use, binge drinking, and marijuana use, and NMPS could be a "red flag" for other risk behaviors worth exploring. Implications for prevention and intervention are discussed.

Stress and Burnout Among Graduate Students: Moderation by Sleep Duration and Quality.

BACKGROUND: There are high levels of stress among graduate students, and stress is associated with multiple negative outcomes among student populations, including academic burnout. Sleep could play an important role in explaining the association between stress and burnout, but these relationships have not been explored among the graduate student population. The current study assessed whether or not sleep duration and quality moderated the relationship between stress and burnout (i.e., exhaustion, cynicism, and inefficacy) among graduate students. METHODS: A sample of 2683 master's, doctoral, and professional graduate students from two large, public universities completed an online survey. Linear regression models with interaction terms were developed to evaluate the relationships between stress and burnout while examining moderation by sleep duration and quality. RESULTS: Participants slept an average of 6.4 h per night, with 62% indicating good sleep quality. Stress had significant, positive relationships with exhaustion, cynicism, and inefficacy. The relationship between stress and exhaustion lessened as sleep duration increased, and the relationship between stress and exhaustion was weaker among students with good sleep quality when compared with those with poor sleep quality. Neither sleep duration nor sleep quality moderated the relationships between stress and cynicism or stress and inefficacy. CONCLUSIONS: Improving sleep habits has the potential to lessen the negative association between stress and graduate student functioning. Future research utilizing longitudinal designs is needed to understand the temporality of these associations and the influence of possible co-factors like individual propensity for mental health problems and social support.

Prevalence and Correlates of Caffeine Use Disorder Symptoms Among a United States Sample.

Background: The DSM-5 recognizes caffeine use disorder as a condition for further study, but there is a need to better understand its prevalence and clinical significance among the general population. Methods: A survey was conducted among an online sample of 1006 caffeine-consuming adults using demographic quotas to reflect the U.S. population. Caffeine consumption, DSM-proposed criteria for caffeine use disorder, sleep, substance use, and psychological distress were assessed. Results: Eight percent of the sample fulfilled DSM-proposed criteria for caffeine use disorder. These individuals consumed more caffeine, were younger, and were more likely to be cigarette smokers. Fulfilling caffeine use disorder criteria was associated with caffeine-related functional impairment, poorer sleep, some substance use, as well as greater depression, anxiety, and stress. Conclusions: The prevalence of caffeine use disorder among the present sample suggests that the proposed diagnostic criteria would identify only a modest percentage of the general population, and that identified individuals experience significant caffeine-related distress.

Situational context and motives of alcohol use among graduate student drinkers.

Extensive research has examined alcohol use context and motives among undergraduates, but less is known about where, when, and why graduate students drink. The current study aimed to describe the motives and situational context of graduate student alcohol use, identify demographic and program characteristics associated with alcohol use motives and context, and assess how alcohol use motives and context are associated with alcohol use behavior. A sample of master's and doctoral-level students who drank during the past month (n = 2091; 63% female) completed an online survey. An exploratory factor analysis yielded two situational context factors: drinking in social situations (e.g., with friends, at a bar) and non-social situations (e.g., alone, at home). Graduate students most frequently endorsed social and enhancement drinking motives. Results of multivariate linear regression models showed that age, sex, race/ethnicity, and international student, marital, parental, and employment status were all associated with motives and context. Drinking for enhancement and drinking to cope were the motives most strongly associated with increased alcohol quantity and frequency, respectively. Drinking in social contexts was positively associated with alcohol quantity and frequency, and drinking in non-social contexts was positively associated with alcohol use frequency but inversely related to alcohol quantity. Graduate students who drink for enhancement reasons and in social situations might be at increased risk for higher quantity alcohol use, or graduate students who drink for coping reasons and in non-social situations might be at increased risk for more frequent alcohol use. Future longitudinal research is needed to explore whether drinking in certain contexts and with certain motivations is predictive of alcohol problems during and after graduate school.

Excessive drinking and drug use during college: Prospective associations with graduate school plans and attendance.

Objective: This study examines the prospective relationship between substance use during college and two outcomes: having definite plans to attend graduate school; and, among individuals with plans, enrolling in graduate school upon college graduation. Participants:n = 980 were originally enrolled as first-time, first-year college students in an ongoing longitudinal study (August 2004 to present). Methods: Measures from personal interviews included demographics, GPA, alcohol use, alcohol abuse/dependence, and other drug use during college. Results: Fifty-four percent had definite plans to attend graduate school, and 47% of students with definite plans enrolled in graduate school. Alcohol dependence was significantly associated with reduced likelihood of having graduate school plans. Among students with plans to attend graduate school, alcohol abuse and alcohol dependence during college were associated with decreased likelihood of enrolling in graduate school. Conclusions: Substance use during college might impact graduate school enrollment, and early intervention efforts could help students achieve their educational goals.

Risks associated with alcohol and marijuana use among college student athletes: The case for involving athletic personnel in prevention and intervention.

The purpose of this study was to describe alcohol and marijuana use patterns and related consequences among student athletes. A total of 12,510 students (n=1,233 athletes) completed four cross-sectional online annual surveys as part of a multi-site campus initiative. Chi-square tests of independence, t-tests, and regression models evaluated differences in alcohol and marijuana use between athletes and non-athletes. The prevalence of binge drinking and high intensity drinking was significantly higher among student athletes than non-athletes, even after controlling for demographic characteristics. Thirteen percent of student athletes experienced an alcohol-related injury during the past year; this was more common among binge drinkers than non-binge drinkers (20.5% and 2.6%, respectively). Among student athletes, past-month binge drinking and past-year marijuana use were significantly associated with lowered GPA (ps<.01). Skipping class was twice as prevalent among student athletes who used marijuana as compared with athletes who did not use marijuana, but no differences were found related to binge drinking. Components for a training for athletic personnel to reduce risks for alcohol-related injury and academic consequences that are associated with alcohol and marijuana use among student athletes are described. Involving athletic personnel might be an important strategy to identify and intervene with high-risk student athletes.

Graduate degree completion: Associations with alcohol and marijuana use before and after enrollment.

Research has shown that alcohol and marijuana use are associated with academic performance difficulties, but the relationship to completion of a graduate degree has not been explored. Undergraduate students (n = 1253) were assessed during their first year of college and annually thereafter until age 29. Among the subset of the original sample who enrolled in graduate school (n = 520), measures of alcohol and marijuana use were averaged separately for the time periods before and after graduate school enrollment. Logistic regression models were developed to examine the associations between these variables and graduate degree completion, adjusting for other factors. In general, a minority of the sample were excessive drinkers or frequent marijuana users. The majority of drinkers (70%) drank an average of twice a week or less each year, and 62% of marijuana users used marijuana once a month or less each year. After adjusting for demographic and program characteristics, marijuana use frequency after graduate school enrollment was negatively associated with odds of graduate degree completion. Alcohol use frequency before graduate school enrollment was positively associated with odds of graduate degree completion. Results add to the growing body of literature on marijuana use and decreased academic achievement, but results should be interpreted with caution given the small, but significant, effect sizes found. The positive association between alcohol use frequency and degree completion might be attributed to engagement in the academic environment. Future studies should examine the potential mechanisms through which alcohol and marijuana use are related to the academic achievement of graduate students.

Student Hunger on Campus: Food Insecurity Among College Students and Implications for Academic Institutions.

PURPOSE: To estimate the prevalence of food insecurity among students at a large mid-Atlantic publicly funded university; examine the association between food insecurity, demographic characteristics, potential financial risk factors, and self-reported physical and mental health and academic performance; and identify possible risk factors for food insecurity. DESIGN: Cross-sectional survey. SETTING: Large, public mid-Atlantic university. PARTICIPANTS: Two hundred thirty-seven undergraduate students. MEASURES: US Department of Agriculture (USDA) 18-item Household Food Security Survey Module (HFSSM) and questions on demographics, student status, economic factors, housing stability, living arrangements, academic performance, and self-rated physical health and depression symptoms. ANALYSIS: Multivariate logistic regression analysis. RESULTS: Among students surveyed, 15% were food insecure; an additional 16% were at risk of food insecurity. Students who were African American, other race/ethnicity, receiving multiple forms of financial aid, or experiencing housing problems were more likely to be food insecure or at the risk of food insecurity (Adjusted Odds Ratio [AOR] = 4.00, 95% confidence interval [CI] = 1.83-8.71, P value < .0001; AOR = 5.26, 95% CI = 1.85-14.98, P value = .002; AOR = 3.43, 95% CI = 1.85-6.37, P value <.001; AOR = 8.00, 95% CI = 3.57-17.93, P value < .0001, respectively). Food secure students were less likely to report depression symptoms than at-risk or food insecure students. CONCLUSION: Food insecurity among college students is an important public health concern that might have implications for academic performance, retention, and graduation rates. Universities that measure food insecurity among their students will be better positioned to advocate for policy changes at state and federal levels regarding college affordability and student financial assistance.

Perceived academic benefit is associated with nonmedical prescription stimulant use among college students.

INTRODUCTION: College students are at higher than average risk for nonmedical use of prescription stimulants (NPS). A commonly identified motive among students who engage in NPS is to improve grades. Several research studies have observed that NPS most likely does not confer an academic advantage, and is associated with excessive drinking and other drug use. This study documents the proportion of the general college student population who believe that NPS will lead to improvements in academic performance. METHODS: This study gathered online survey data from a large, demographically diverse sample of college students to document the prevalence of perceived academic benefit of NPS for improving grades and to examine the association between such belief and NPS. RESULTS: Overall, 28.6% agreed or strongly agreed that NPS could help students earn higher grades, and an additional 38.0% were unsure. Students with a higher level of perceived academic benefit of NPS and more frequent patterns of drinking and marijuana use were more likely to engage in NPS, even after adjustment for a wide range of covariates. CONCLUSIONS: The results underscore the need for interventions that simultaneously correct misperceptions related to academic benefit and target alcohol and marijuana use to reduce NPS.

Continuity of drunk and drugged driving behaviors four years post-college.

BACKGROUND: Driving under the influence of alcohol is a leading cause of injury and premature death among young adults, and college-educated individuals are at particularly high risk. Less is known about driving under the influence of other drugs, which is on the rise. METHOD: This study describes prospective seven-year trends in alcohol and other drug (AOD)-involved driving among a young-adult sample beginning with their second year of college (i.e., Years 2-8), and documents the extent of continuity in such behaviors across time. Originally recruited as incoming first-year students at one large public university, participants (n=1194) were interviewed annually about how frequently they drove while drunk/intoxicated (DWI), after drinking any alcohol (DAD), and/or while under the influence of other drugs (DD). Follow-up rates were high (>75% annually). RESULTS: Among participants with access to drive a car, annual prevalence peaked in Year 4 (modal age 21) for both DWI (24.3%wt) and DD (19.1%wt) and declined significantly thereafter through Year 8 (both ps<0.05). DAD was far more prevalent than DWI or DD, increasing from 40.5%wt in Year 2 to 66.9%wt in Year 5, and plateauing thereafter. Among marijuana-using participants, likelihood of DD was consistently greater than the likelihood of DWI among Heavy Episodic and Light-to-Moderate drinkers, and it declined significantly during Years 5-8 (p<0.05). CONCLUSION: Post-college declines in heavy drinking and DWI prevalence were encouraging but did not necessarily translate to reductions in likelihood of engaging in DWI, depending on drinking pattern. College-educated individuals represent an important target for AOD-involved driving prevention.

Risk factors for gambling and substance use among recent college students.

BACKGROUND: While it is well known that substance use and gambling overlap, the degree to which this overlap can be explained by shared risk factors has not been fully explored. This study aimed to identify common and unique risk factors for gambling and substance use among young adults. METHODS: Young adults (n=1,019) in a longitudinal study since college entry were interviewed annually. Past-year frequency of seven gambling activities was assessed once (Year 5). Structural equation models evaluated suspected risk factors in two models, one for gambling with substance use as an intermediary variable, and one for substance use with gambling as the intermediary variable. RESULTS: Sixty percent gambled; 6% gambled weekly or more. Examination of the two structural models supported the existence of significant paths (a) from two of the five substance use variables (alcohol, drugs) to gambling frequency, and (b) from gambling frequency to all five substance use variables. Every risk factor associated with gambling was also associated with one or more substance use variables. Risk factors common to gambling and substance use were sex, race/ethnicity, extracurricular involvement (fraternity/sorority, athletics), impulsive sensation-seeking, and behavioral dysregulation. Risk factors unique to substance use were conduct problems, anxiety, and parent's history of alcohol and mental health problems. CONCLUSIONS: Gambling and substance use are interrelated, but with incomplete overlap in their respective risk factors. Results underscore the need for longitudinal research to elucidate their distinct etiologies.

Trajectories of energy drink consumption and subsequent drug use during young adulthood.

BACKGROUND: Highly caffeinated energy drinks (EDs) are popular with adolescents and young adults, but longitudinal consumption patterns are poorly understood especially in relation to other substance use. METHODS: ED and other substance use were assessed annually (modal ages 21-25) among a sample (n=1099) who were originally recruited as first-year college students (modal age 18). Trajectory groups were derived based on probability of past-year use during ages 21-24, and compared for possible differences in substance use outcomes at age 25, holding constant demographics, sensation-seeking, other caffeine consumption, and age 21 substance use. RESULTS: From age 21-25, ED consumption declined in both annual prevalence [62.5%wt to 49.1%wt (wt=weighted)] and frequency of use among consumers (35.2-26.3 days/year). Yet individuals exhibiting a Persistent trajectory (51.4%) of consumption outnumbered those with Non-Use (20.6%), Intermediate (17.4%), or Desisting (10.6%) trajectories. Age 25 cocaine use, nonmedical use of prescription stimulants (NPS), and alcohol use disorder (AUD) risk were significantly associated with trajectory group membership, with Persistent and Intermediate groups exhibiting the highest risk for such outcomes, even accounting for prior substance use and other risk factors. Neither marijuana nor tobacco use were associated with group membership. CONCLUSIONS: The typical pattern of ED consumption among this sample was sustained use throughout young adulthood. Such individuals appear to be at high risk for adverse substance use outcomes, and results suggest possible specificity regarding cocaine use and NPS, and AUD risk. More research is needed to understand the mechanisms underlying the connection between ED and substance use.

Prevalence and incidence of drug use among college students: an 8-year longitudinal analysis.

BACKGROUND: Drug use among college students is associated with adverse academic and health outcomes and risks to personal safety. OBJECTIVES: This study utilized data from a longitudinal study to estimate annual prevalence, cumulative lifetime prevalence, and incidence of ten types of drug use during the eight years after college entry and the average age of onset of each drug used. METHODS: Participants (N = 1,253; 52% female) were young adults who were originally enrolled as first-time, first-year students at a university in the mid-Atlantic US. Annual personal interviews gathered data about the use of seven illicit drugs and three prescription drugs used nonmedically. Annual follow-up rates ranged from 76 to 91%. RESULTS: Marijuana was the most commonly used drug in every year of the study, with the highest annual prevalence estimates in Year 3 (47%wt). In Year 8, when the modal age of participants was 25, 29%wt used marijuana during the past year. Nonmedical use of prescription drugs was more prevalent during college than in the later years of the study. Although the prevalence of cocaine and ecstasy use was low (cumulative prevalence estimates of 17%wt and 13%wt, respectively), incidence for these drugs was particularly high in the later years of the study. CONCLUSION: Drug use is prevalent among college students, and drug use persists among young adults, even after many have graduated college. More attention should be directed at identifying and intervening with students at risk for drug use to mitigate possible academic, health, and safety consequences.

Drug involvement during and after college: Estimates of opportunity and use given opportunity.

BACKGROUND: College students perceive widespread availability of drugs and prescription medications for non-medical use on campus, but less is known about the relationship between opportunity to use, use, and use given opportunity of these drugs during and after college. The current study describes annual trends in (1) opportunity to use, (2) use, and (3) use given opportunity of eight drugs and three prescription medications used non-medically over seven years. METHODS: Data were derived from a longitudinal cohort study of 1253 first-year college students (52% female, 72% non-Hispanic white) at one large, public university. Annually, past-year opportunity to use and use were assessed for marijuana, hallucinogens, inhalants, cocaine, ecstasy, amphetamines, methamphetamine, heroin, and non-medical use of prescription stimulants, analgesics, and tranquilizers. Binary variables were created to represent opportunity to use, use, and use given opportunity for each drug. RESULTS: Participants had the greatest opportunity to use marijuana compared with other drugs during the study period, but there was a significant decline in the opportunity to use marijuana over time. Notably, opportunity for both drugs other than marijuana and prescription medications used non-medically consistently declined, while use given opportunity remained relatively stable over time. CONCLUSIONS: These findings suggest that changes in drug use are driven by changes in opportunity to use, even during the post-college years. Greater opportunity to use and use of all drugs during the college years in comparison with the post-college years confirms the high-risk nature of the college environment.

Do college students improve their grades by using prescription stimulants nonmedically?

INTRODUCTION: Many college students engage in nonmedical use of prescription stimulants (NPS) because they believe it provides academic benefits, but studies are lacking to support or refute this belief. METHODS: Using a longitudinal design, 898 undergraduates who did not have an ADHD diagnosis were studied. Year 3 GPA (from college records) of four groups was compared: Abstainers (did not engage in NPS either year; 68.8%); Initiators (NPS in Year 3 but not Year 2; 8.7%); Desisters (NPS in Year 2 but not Year 3; 5.8%); and Persisters (NPS in both years; 16.7%). Generalized estimating equations regression was used to estimate the association between NPS and change in GPA, controlling for sex and Year 2 GPA. RESULTS: GPA increased significantly within Abstainers (p<0.05), but did not change significantly within the other groups. Overall, the relationship between NPS pattern group and change in GPA was not statistically significant (p=0.081). NPS was generally infrequent, but Persisters used more frequently than Desisters (11.7 versus 3.4days in Year 2) and Initiators (13.6 versus 4.0days in Year 3, both ps<0.001), controlling for sex and Year 2 GPA. CONCLUSIONS: We cannot rule out the possibility that NPS prevented declines in GPA, but we can conclude that students who engaged in NPS showed no increases in their GPAs and gained no detectable advantages over their peers. The results suggest that prevention and intervention strategies should emphasize that the promise of academic benefits from NPS is likely illusory.

Energy Drink Use Patterns Among Young Adults: Associations with Drunk Driving.

BACKGROUND: Highly caffeinated "energy drinks" (ED) are commonly consumed and sometimes mixed with alcohol. Associations between ED consumption, risk-taking, and alcohol-related problems have been observed. This study examines the relationship between ED consumption-both with and without alcohol-and drunk driving. METHODS: Data were derived from a longitudinal study of college students assessed annually via personal interviews. In Year 6 (modal age 23; n = 1,000), participants self-reported their past-year frequency of drunk driving, ED consumption patterns (frequency of drinking alcohol mixed with energy drinks [AmED] and drinking energy drinks without alcohol [ED]), alcohol use (frequency, quantity), and other caffeine consumption. Earlier assessments captured suspected risk factors for drunk driving. Structural equation modeling was used to develop an explanatory model for the association between ED consumption patterns and drunk driving frequency while accounting for other suspected risk factors. RESULTS: More than half (57%) consumed ED at least once during the past year. Among ED consumers, 71% drank AmED and 85% drank ED alone; many (56%) engaged in both styles of ED consumption while others specialized in one or the other (29% drank ED alone exclusively, while, 15% drank AmED exclusively). After accounting for other risk factors, ED consumption was associated with drunk driving frequency in 2 ways. First, a direct path existed from ED frequency (without alcohol) to drunk driving frequency. Second, an indirect path existed from AmED frequency through alcohol quantity to drunk driving frequency. CONCLUSIONS: Among this sample, ED consumption with and without alcohol was common, and both styles of ED consumption contributed independently to drunk driving frequency. Results call for increased attention to the impact of different patterns of ED consumption on alcohol-related consequences, such as drunk driving.