Do state expenditures on tobacco control programs decrease use of tobacco products among college students?

The objective of this paper is to investigate the effects of state tobacco control program expenditures on individual-level tobacco use behaviors among young adults. Data come from the 1997, 1999 and 2001 waves of the Harvard School of Public Health College Alcohol Study (CAS). Our findings indicate that a higher level of state spending on tobacco control programs in the prior year is associated with a statistically significant increase in the probability that current daily smokers report at least one attempt to quit smoking in the past year. We also find evidence that higher state expenditures on tobacco control programs in the prior year are associated with reductions in the prevalence of daily smoking and 30-day cigar use among college students. We do not find any statistically significant association between state tobacco control program expenditures and the number of attempts to quit smoking among those with at least one attempt, or on the prevalence of smokeless tobacco use in the past month.

Will increasing alcohol availability by lowering the minimum legal drinking age decrease drinking and related consequences among youths?

Alcohol use health consequences are considerable; prevention efforts are needed, particularly for adolescents and college students. The national minimum legal drinking age of 21 years is a primary alcohol-control policy in the United States. An advocacy group supported by some college presidents seeks public debate on the minimum legal drinking age and proposes reducing it to 18 years. We reviewed recent trends in drinking and related consequences, evidence on effectiveness of the minimum legal drinking age of 21 years, research on drinking among college students related to the minimum legal drinking age, and the case to lower the minimum legal drinking age. Evidence supporting the minimum legal drinking age of 21 years is strong and growing. A wide range of empirically supported interventions is available to reduce underage drinking. Public health professionals can play a role in advocating these interventions.

Student drinking at U.S. college sports events.

Alcohol consumption control policies at U.S. intercollegiate sports events, and their association with student drinking, were assessed using data from a 2001 nationally representative survey of students and administrators (n = 7,261 students, N = 117 colleges). Alcohol was available to sports event attendees through in-stadium sales, tailgating parties, and allowing spectators to bring in alcohol. Policies varied by college, with fewer restrictions at large public schools with NCAA Division I athletics. Permitting alcohol at tailgate parties was associated with more students drinking at sports events. Future research should evaluate whether enacting policy restrictions can reduce drinking and related problems at intercollegiate sports events.

Trends and college-level characteristics associated with the non-medical use of prescription drugs among US college students from 1993 to 2001.

AIMS: The present study examines the prevalence trends and college-level characteristics associated with the non-medical use of prescription drugs (i.e. amphetamines, opioids, sedatives, tranquilizers) and illicit drug use among US college students between 1993 and 2001. DESIGN: Data were collected from self-administered mail surveys, sent to independent cross-sectional samples of college students from a nationally representative sample of 119 colleges in 4 years between 1993 and 2001. SETTING: Nationally representative 4-year US colleges and universities in 1993, 1997, 1999 and 2001. PARTICIPANTS: Representative samples of 15,282, 14,428, 13,953 and 10,904 randomly selected college students at these colleges in 1993, 1997, 1999 and 2001, respectively. FINDINGS: The results indicate that life-time and 12-month prevalence rates of non-medical use of prescription drugs (NMPD) increased between 1993 and 2001. Specific college-level characteristics were found to be correlated positively (marijuana use) and negatively (historically black college status and commuter status) with NMPD, consistently across the four cross-sectional samples. Significant between-college variation in terms of trajectories in the prevalence of NMPD over time was found in hierarchical linear models, and selected college-level characteristics were not found to explain all of the variation in the trajectories, suggesting the need for further investigation of what determines between-college variance in the prevalence trends. CONCLUSIONS: The findings of the present study suggest that continued monitoring of NMPD and illicit drug use among college students is needed and collegiate substance prevention programs should include efforts to reduce these drug use behaviors.

Trends in non-medical use of anabolic steroids by U.S. college students: results from four national surveys.

This study assessed the prevalence, trends, and student- and college-level characteristics associated with the non-medical use of anabolic steroids (NMAS) among U.S. college students. Data were collected through self-administered mail surveys, from 15,282, 14,428, 13,953, and 10,904 randomly selected college students at the same 119 nationally representative colleges in 1993, 1997, 1999 and 2001, respectively. The prevalence of lifetime, past-year and past-month NMAS was 1% or less and generally did not change significantly between 1993 and 2001, with one exception: past-year NMAS increased significantly among men from 1993 (0.36%) to 2001 (0.90%). Multiple logistic regression analyses revealed that lifetime and past-year NMAS were associated with student-level characteristics such as being male and participation in intercollegiate athletics. Lifetime and past-year NMAS were also positively associated with several risky behaviors, including cigarette smoking, illicit drug use, drinking and driving, and DSM-IV alcohol use disorders. Nearly 7 out of every 10 lifetime non-medical users of anabolic steroids met past-year criteria for a DSM-IV alcohol use disorder. Although the overall prevalence of NMAS remained low between 1993 and 2001, findings suggest that continued monitoring is necessary because male student-athletes are at heightened risk for NMAS and this behavior is associated with a wide range of risky health behaviors. The characteristics associated with NMAS have important implications for future practice and research.

Disparities in overweight and obesity among US college students.

OBJECTIVES: To examine social disparities and behavioral correlates of overweight and obesity over time among college students. METHODS: Multilevel analyses of BMI, physical activity, and television viewing from 2 representative surveys of US college students (n=24,613). RESULTS: Overweight and obesity increased over time and were higher among males, African Americans, and students of lower socioeconomic position and lower among Asians. Television viewing and in activity were associated with obesity, and disparities in these behaviors partially accounted for excess weight among African Americans. CONCLUSIONS: Social disparities in overweight and obesity exist among college students. Promoting physical activity and reducing television viewing may counteract increasing trends.

Non-medical use of prescription stimulants among US college students: prevalence and correlates from a national survey.

AIMS: To examine the prevalence rates and correlates of non-medical use of prescription stimulants (Ritalin, Dexedrine or Adderall) among US college students in terms of student and college characteristics. DESIGN: A self-administered mail survey. SETTING: One hundred and nineteen nationally representative 4-year colleges in the United States. PARTICIPANTS: A representative sample of 10 904 randomly selected college students in 2001. MEASUREMENTS: Self-reports of non-medical use of prescription stimulants and other substance use behaviors. FINDINGS: The life-time prevalence of non-medical prescription stimulant use was 6.9%, past year prevalence was 4.1% and past month prevalence was 2.1%. Past year rates of non-medical use ranged from zero to 25% at individual colleges. Multivariate regression analyses indicated non-medical use was higher among college students who were male, white, members of fraternities and sororities and earned lower grade point averages. Rates were higher at colleges located in the north-eastern region of the US and colleges with more competitive admission standards. Non-medical prescription stimulant users were more likely to report use of alcohol, cigarettes, marijuana, ecstasy, cocaine and other risky behaviors. CONCLUSIONS: The findings of the present study provide evidence that non-medical use of prescription stimulants is more prevalent among particular subgroups of US college students and types of colleges. The non-medical use of prescription stimulants represents a high-risk behavior that should be monitored further and intervention efforts are needed to curb this form of drug use.

Nonmedical use of prescription opioids among U.S. college students: prevalence and correlates from a national survey.

OBJECTIVES: This study examined the prevalence rates and correlates of nonmedical use of prescription opioid analgesics among U.S. college students in terms of student and college characteristics. METHODS: This study analyzed data from a nationally representative sample of 10,904 randomly selected students attending 119 four-year colleges in 2001. RESULTS: The lifetime prevalence of nonmedical prescription opioid use was 12% and the past year prevalence was 7%. Approximately one in every four colleges had a prevalence of 10% or higher for past year nonmedical use of prescription opioids. Multivariate regression analyses indicated nonmedical use was more likely to occur among college students who were white, residents of fraternity and sorority houses, attended more competitive colleges, earned lower grade point averages, and reported higher rates of substance use and other risky behaviors. CONCLUSIONS: This study provides evidence that the nonmedical use of prescription opioids represents a problem on college campuses. These findings have important implications for developing prevention efforts and therapeutic strategies aimed at reducing the nonmedical use of prescription opioid analgesics among college students while not hindering necessary medication management for pain.

The effect of a campus-community environmental alcohol prevention initiative on student drinking and driving: results from the "a matter of degree" program evaluation.

OBJECTIVE: Motor vehicle crashes involving alcohol are a major contributor to morbidity and mortality among college students in the United States. This study evaluates the effect on drinking and driving outcomes of the "A Matter of Degree" program, a campus-community coalition initiative to reduce college binge drinking. METHODS: We used a quasi-experimental longitudinal study design that compared student responses at 10 colleges participating in the program and students attending 32 similar colleges that did not participate in the program. We also divided the program sites into two groups of five according to their level of program implementation and compared each with the non-program colleges. We examined driving after any alcohol consumption and driving after five or more drinks among drinkers who drove one or more times a week per month and riding with a high or drunk driver among all students at these colleges beginning in 1997 through 2001. Outcomes were based on data collected from repeated cross-sectional surveys using the Harvard School of Public Health College Alcohol Study. Analyses were conducted using MLwiN multilevel statistical software. RESULTS: We found significant reductions in driving after drinking, driving after five or more drinks and riding with a high or drunk driver at the program colleges relative to the comparison colleges. Further analyses indicated that these reductions among the AMOD program colleges occurred at the sites with high program implementation relative to comparison sites, while no statistically significant change was noted at the program sites with low implementation. The program effect on the two drinking and driving outcomes appeared to be mediated by frequent binge drinking, while significant decline in the riding with an intoxicated driver outcome was not mediated by the individual's drinking. CONCLUSIONS: Campus-community based environmental alcohol prevention is a promising approach for reducing alcohol-impaired motor vehicle crashes among this population.

The marketing of alcohol to college students: the role of low prices and special promotions.

BACKGROUND: Heavy episodic or binge drinking has been recognized as a major problem on American college campuses affecting the health, safety, and education of students. The present study examines the alcohol environment surrounding college campuses and assesses the impact on students' drinking. This environment includes alcohol promotions, price specials, and advertising at drinking establishments that serve beer for on-premise consumption as well as retail outlets that sell beer for off-premise consumption. METHODS: The study used student self-report data from the 2001 College Alcohol Study (CAS) and direct observational assessments by trained observers who visited alcohol establishments in communities where the participating colleges were located. The analytic sample included more than 10,000 students as well as 830 on-premise and 1684 off-premise establishments at 118 colleges. RESULTS: Alcohol specials, promotions, and advertisements were prevalent in the alcohol outlets around college campuses. Almost three quarters of on-premise establishments offered specials on weekends, and almost one half of the on-premise establishments and more than 60% of off-premise establishments provided at least one type of beer promotion. The availability of large volumes of alcohol (24- and 30-can cases of beer, kegs, party balls), low sale prices, and frequent promotions and advertisements at both on- and off-premise establishments were associated with higher binge drinking rates on the college campuses. In addition, an overall measure of on- and off-premise establishments was positively associated with the total number of drinks consumed. CONCLUSIONS: The regulation of marketing practices such as sale prices, promotions, and advertisements may be important strategies to reduce binge drinking and its accompanying problems.

Drinking and driving among college students: the influence of alcohol-control policies.

BACKGROUND: Studies have reported high rates of heavy episodic drinking and alcohol-related problems, including drinking and driving, among college students. However, most studies have been conducted in single colleges or states. This study used a national sample to examine policy factors associated with alcohol-involved driving. METHODS: A random sample of full-time students (N=10,904) attending a nationally representative sample of 4-year colleges in 39 states (n=119) completed self-administered questionnaires. The questionnaire examined driving after consuming any alcohol, driving after > or = 5 drinks, and riding with a high or drunk driver. Individual-level data about driving after > or = 5 drinks were linked to information on the policy environment at both local and state levels and to ratings of enforcements for drunk driving laws. RESULTS: Drinking and driving behaviors are prevalent among a minority of college students and differ significantly among student subgroups. Students who attend colleges in states that have more restrictions on underaged drinking, high volume consumption, and sales of alcoholic beverages, and devote more resources to enforcing drunk driving laws, report less drinking and driving. CONCLUSION: The occurrence of drinking and driving among college students differs significantly according to the policy environment at local and state levels and the enforcement of those policies. Comprehensive policies and their strong enforcement are promising interventions to reduce drinking and driving among college students.

Reducing drinking and related harms in college: evaluation of the "A Matter of Degree" program.

OBJECTIVES: To examine the effects of a multisite environmental prevention initiative, the "A Matter of Degree" (AMOD) program, on student heavy alcohol consumption and resultant harms at ten colleges. METHODS: A quasi-experimental longitudinal analysis of alcohol consumption and harms was employed, using repeated cross-sectional survey data from the Harvard School of Public Health College Alcohol Study (CAS). Areas examined included seven measures of alcohol consumption, thirteen measures of alcohol-related harms, and eight measures of secondhand effects of alcohol use by others. Comparisons were conducted on self-reported behavior of students for the ten AMOD sites in aggregate and by level of program implementation, with students at 32 comparison colleges in the CAS, for each outcome. RESULTS: No statistically significant change was found in the overall ten-school AMOD program for outcome measures of interest from baseline (1997) to follow-up (2001). However, there was variation in the degree of environmental program development within AMOD during the intervention period. A pattern of statistically significant decreases in alcohol consumption, alcohol-related harms, and secondhand effects was observed, reflecting minor to more substantial changes across measures among students at the five program colleges that most closely implemented the AMOD model of environmental change. No similar pattern was observed for the low implementation sites or at 32 comparison colleges. CONCLUSIONS: While there was no change in the ten AMOD schools in study measures, significant although small improvements in alcohol consumption and related harms at colleges were observed among students at the five AMOD sites that most closely implemented the environmental model. Fidelity to a program model conceptualized around changing alcohol-related policies, marketing, and promotions may reduce college student alcohol consumption and related harms. Further research is needed over the full course of the AMOD program to identify critical intervention components and elucidate pathways by which effects are realized.

More Canadian students drink but American students drink more: comparing college alcohol use in two countries.

AIMS: To compare alcohol use among US and Canadian college students. DESIGN: Results of the 1999 College Alcohol Study and the 1998 Canadian Campus Survey are compared. SETTING: One hundred and nineteen nationally representative US 4-year colleges and universities in 40 states and 16 nationally representative Canadian 4-year universities. PARTICIPANTS: Randomly selected students under 25 years (12 344 US and 6729 Canadian). MEASUREMENTS: Self-reports of alcohol use and heavy alcohol use. FINDINGS: The prevalence of life-time and past year alcohol use is significantly higher among Canadian students than US students (92% versus 86%, 87% versus 81%). The prevalence of heavy alcohol use (typically consuming five or more drinks in a row for males/four or more for females) among past-year and past-week drinkers is significantly higher among US students than Canadian students (41% versus 35%, 54% versus 42%). In both countries older [corrected] students and students living at home with their parents are less likely to be heavy drinkers; students who report first drunkenness before the age of 16 are more likely to be heavy drinkers in college. CONCLUSION: Programs aimed at students' heavy alcohol use should target freshman at entry or earlier. Since students living with their parents are less likely to be heavy drinkers, parents may play a potentially important role in prevention efforts. The patterns of drinking in both countries may be influenced by the legal minimum drinking age. However, the relationship is complex and must be viewed in the context of other variables such as chronological age.

Social influences on substance-use behaviors of gay, lesbian, and bisexual college students: findings from a national study.

A variety of social factors are expected to contribute to health behaviors among college students. The goal of this paper is to describe the relationships of two different aspects of the campus social environment, namely the campus resources for gay, lesbian, and bisexual (GLB) students and the campus-wide behavioral norms of substance use, to the individual substance-use behaviors of college students with same-sex experiences. Individual-level data come from 630 college students reporting same-sex experience, who were part of a national random sample returning questionnaires. Current cigarette smoking and binge drinking were examined. College-level data regarding the campus resources designed for GLB students were collected and used with campus-wide substance-use norms to predict individual substance use in logistic regression analyses. One-third to one-half of students reported current smoking and binge drinking, by sex and sex-partner category. The presence of GLB resources was inversely associated with women's smoking and directly associated with men's binge drinking behaviors. The proportion of students reporting same-sex behavior on campus was directly associated with these same outcomes, and behavioral norms were not associated with either outcome. Findings provide a glimpse into the influence of the social environment on the use of two of the most widely used substances at American colleges, and suggest that contextual approaches to explaining and controlling substance use may be important.

Secondhand effects of student alcohol use reported by neighbors of colleges: the role of alcohol outlets.

This is a study of the secondhand effects of student alcohol use experienced by residents of neighborhoods near college campuses. We examined the relationship of a college's level of binge drinking and the number of alcohol outlets in the immediate area, to lowered quality of neighborhood life through such secondhand effects. Adults from 4661 households in the United States were interviewed through a stratified list-assisted random digit dialing telephone survey. The interview schedule included questions about residents' experiences of secondhand effects of alcohol use such as noise, vandalism or public disturbances. Reports about the quality of neighborhood life provided by respondents residing near colleges were compared with those of respondents who did not live near colleges; and reports of neighbors of colleges with high rates of binge drinking were compared with those of neighbors of colleges with lower rates. The presence of alcohol outlets in these areas was also compared. Residents near colleges and particularly near colleges with heavy episodic drinking reported the presence of more alcohol outlets within a mile. Those neighborhoods were characterized by lower socioeconomic status. Neighbors living near college campuses were more likely to report a lowered quality of neighborhood life through such secondhand effects of heavy alcohol use as noise and disturbances, vandalism, drunkenness, vomiting and urination. A path analysis indicated that the number of nearby alcohol outlets was an important factor mediating the relationship between colleges, especially those with high rates of binge drinking, and such secondhand effects. The results suggest that neighborhood disruptions around colleges due to heavy alcohol use may be reduced by limiting the presence of alcohol outlets in those areas, and the marketing practices that this engenders.

Studying college alcohol use: widening the lens, sharpening the focus.

OBJECTIVE: The study was designed to assess current trends in studying, and emerging approaches to furthering understanding of, college drinking. METHOD: A literature review was conducted of findings and methods highlighting conceptual and methodological issues that need to be addressed. RESULTS: Most studies address clinical, developmental and psychological variables and are conducted at single points in time on single campuses. Factors affecting college alcohol use and methods of studying them are discussed. CONCLUSIONS: Most current studies of college drinking do not address the influence of the college and its alcohol environment. Our understanding of college drinking can be improved by expanding the scope of issues studied and choosing appropriate research designs.

Taking up binge drinking in college: the influences of person, social group, and environment.

PURPOSE: To identify person, social group, and environmental factors associated with uptake of binge drinking among a national sample of college students. METHODS: Using self-reported responses of students in the 1999 Harvard School of Public Health College Alcohol Study (CAS), we regressed conceptually important predictors of binge drinking onto a dichotomized variable describing uptake in the freshman year. This was a random sample of full-time undergraduates provided by the registrar at each participant school (n = 119). For this study, we analyzed data describing a subset of the total sample comprising first year students aged < or =19 years, excluding transfers (n = 1894). The student CAS is a 20-page voluntary, anonymous mailed questionnaire containing student reports about their alcohol and substance use, school activities, and background characteristics. Analyses included univariate and multivariate logistic regression adjusting for school response rate and using the Generalized Estimating Equations (GEE) in the Statistical Analysis Software package to handle the within-college clustering owing to the sampling scheme. RESULTS: College students who reported that they were exposed to "wet" environments were more likely to engage in binge drinking than were their peers without similar exposures. Wet environments included social, residential, and market surroundings in which drinking is prevalent and alcohol cheap and easily accessed. Findings held up in multivariate analyses that included variables describing person and social group characteristics. Students who picked up binge drinking in college also were more likely than their peers to report inflated definitions of binge drinking and more permissive attitudes about appropriate ages for legal consumption. CONCLUSIONS: Binge drinking can either be acquired or avoided in college among students who report they did not binge drink in high school. Reducing college binge uptake may require efforts to limit access/availability, control cheap prices, and maximize substance free environments and associations.

Increasing MDMA use among college students: results of a national survey.

PURPOSE: To examine the prevalence and changing patterns of ecstasy use among college students, and to determine characteristics, associated behaviors, and interests of ecstasy users. METHODS: The study analyzes data regarding ecstasy use and related behaviors from the 1997 and 1999 Harvard School of Public Health College Alcohol Study. This is a survey of a nationally representative sample of over 14,000 college students at 119 U.S. four-year colleges. Changes in self-reported annual ecstasy use were examined, and lifestyle and high-risk behaviors associated with Ecstasy use were identified. Data were analyzed using 2 x 2 Chi-square tests and multiple logistic regression fitted by the generalized estimating equations (GEE). RESULTS: The prevalence of past year ecstasy use rose from 2.8% to 4.7% between 1997 and 1999, an increase of 69%. This increase was observed across nearly all subgroups of student and college type. A smaller sample of ten colleges revealed that the increase continued in 2000. Ecstasy users were more likely to use marijuana, engage in binge drinking, smoke cigarettes, have multiple sexual partners, consider arts and parties as important, religion as less important, spend more times socializing with friends, and spend less times studying. Unlike other illicit drug users, ecstasy users were not academic underachievers and their satisfaction with education was not different from that of non-ecstasy users. CONCLUSION: Ecstasy use is a high-risk behavior among college students which has increased rapidly in the past decade.

Attendance and alcohol use at parties and bars in college: a national survey of current drinkers.

OBJECTIVE: This study examines attendance and alcohol use at parties and bars among college students by gender, residence, year in school and legal drinking age. METHOD: The study participants were respondents in the 1997 and 1999 Harvard School of Public Health College Alcohol Study (CAS). The combined sample consisted of 12,830 students (61% women) who reported use of alcohol in the past 30 days prior to interview. Their responses provided information on attendance and alcohol use at parties (dormitory, fraternity, off campus) and off-campus bars. Logistic regression analyses examined the influence of gender, residence, year in school and legal drinking age related to attendance, drinking/non-drinking and heavy drinking (5 or more drinks) at each select setting. RESULTS: Consistent with the literature, fraternity/ sorority parties were occasions of heavy drinking (49%) among drinkers in those settings, yet they drew upon smaller proportions of students (36%) when compared to off-campus parties (75%) and off-campus bars (68%). Off-campus parties (45%) and bars (37%) were also occasions for heavy drinking among drinkers in these settings. College residence was shown to relate to differential exposure to drinking settings, but residence had less impact on the decision to drink and the level of heavy drinking. Attendance at parties decreased with advance in school years, but attendance at off-campus bars increased. Although heavy drinking at off-campus bars decreased with advancing grade year in school, slightly higher proportions of under-age students (41%) compared to students of legal drinking age (35%) exhibited heavy drinking at off-campus bars. CONCLUSIONS: The identification of high-risk settings and their correlates serves to better understand the development of heavy drinking on college campuses. Off-campus parties, as compared to campus parties and bars, may pose greater difficulties related to successful intervention.

Alcohol-related aggression and drinking at off-campus parties and bars: a national study of current drinkers in college.

OBJECTIVE: This study examines relationships between alcohol-related aggression and drinking at off-campus parties and bars. Other background variables include gender, year in school, residence and heavy drinking in college. METHOD: The study participants were respondents in the 1997 and 1999 Harvard School of Public Health College Alcohol Study, national surveys of students attending 119 4-year U.S. colleges. Based on responses from 8,426 students, 18-24 years of age, who were never married and who reported attendance at off-campus parties and bars in the past month, an exploratory factor analysis of the alcohol problem items was specified in a confirmatory factor analysis framework based on a two-factor solution (disruptive behavior and victims of altercations). In addition, the two factors were related to study variables. RESULT: Among students attending both off-campus parties and bars, level of drinking was related to higher levels of Factor 1 (disruptive behaviors) at off-campus parties and bars. Level of drinking was related to higher levels of Factor 2 (victims of altercations) at off-campus bars but not off-campus parties. Factor 1 was higher among men, freshmen and residents in coed dorms and lower among students living off-campus with parents. Factor 2 was higher among women, freshmen compared with seniors and residents of Greek houses and lower among students living off-campus residence with parents. CONCLUSIONS: Findings from this study highlight environmental factors in collegiate drinking practices and support targeted and diverse strategies for prevention activities.