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.     

Environmental correlates of underage alcohol use and related problems of college students

BACKGROUND: Underage alcohol use is a major contributor to morbidity and mortality in adolescents and young adults. This study examined drinking levels and ensuing problems among college students and factors associated with binge drinking. METHOD: The Harvard School of Public Health College Alcohol Study conducted a self-administered survey. The participants include a random sample of 7061 students aged <21 years (defined as underage drinkers), and 4989 between ages 21 and 23 in 1997 at 116 nationally representative 4-year colleges in 39 states. The outcomes of the study include self-reports of alcohol use, binge drinking (defined as five or more drinks in a row for men and four or more for women at least once in a 2-week period), alcohol-related problems, preferred type of drink, access to alcohol, and price paid per drink. RESULTS: Underage students drink less often but have more drinks per occasion, are more likely to drink in private settings (off-campus, dormitory, and fraternity parties), and pay less per drink than do of-age students. Correlates of underage binge drinking include residence in a fraternity or sorority (odds ratio [OR]=6.2), very easy access to alcohol (OR=3.3), obtaining drinks at lower prices (OR=2.1, for under $1 each or a set fee for unlimited drinks), and drinking beer (OR=9.5). CONCLUSIONS: Effective controls on price, access, and fraternity and off-campus parties, and reinforcing minimum drinking age laws are needed to reduce the high levels of binge drinking and related health and behavioral problems of underage students.     

Neighborhood Typologies Associated with Alcohol Use among Adults in Their 30s: a Finite Mixture Modeling Approach

There has been increasing interest in how neighborhood context may be associated with alcohol use. This study uses finite mixture modeling to empirically identify distinct neighborhood subtypes according to patterns of clustering of multiple neighborhood characteristics and examine whether these subtypes are associated with alcohol use. Neighborhoods were 303 census block groups in the greater Seattle, WA, area where 531 adults participating in an ongoing longitudinal study were residing in 2008. Neighborhood characteristics used to identify neighborhood subtypes included concentration of poverty, racial composition, neighborhood disorganization, and availability of on-premise alcohol outlets and off-premise hard liquor stores. Finite mixture models were used to identify latent neighborhood subtypes, and regression models with cluster robust standard errors examined associations between neighborhood subtypes and individual-level typical weekly drinking and number of past-year binge drinking episodes. Five neighborhood subtypes were identified. These subtypes could be primarily characterized as (1) high socioeconomic disadvantage, (2) moderate disadvantage, (3) low disadvantage, (4) low poverty and high disorganization, and (5) high alcohol availability. Adjusted for covariates, adults living in neighborhoods characterized by high disadvantage reported the highest levels of typical drinking and binge drinking compared to those from other neighborhood subtypes. Neighborhood subtypes derived from finite mixture models may represent meaningful categories that can help identify residential areas at elevated risk for alcohol misuse.     

Alcohol Outlet Characteristics and Alcohol Sales to Youth: Results of Alcohol Purchase Surveys in 45 Oregon Communities

Reducing youth access to commercial sources of alcohol is recognized as a necessary component of a comprehensive strategy to reduce underage drinking and alcohol-related problems. However, research on policy-relevant factors that may influence the commercial availability of alcohol to youth is limited. The present study examines characteristics of off-premise alcohol outlets that may affect alcohol sales to youth. Random alcohol purchase surveys (N = 385) were conducted in 45 Oregon communities in 2005. Underage-looking decoys who were 21 years old but did not carry IDs were able to purchase alcohol at 34% of the outlets approached. Purchase rates were highest at convenience (38%) and grocery (36%) stores but were relatively low (14%) at other types of outlets (e.g., liquor and drug stores). Alcohol purchases were less likely at stores that were participating in the Oregon Liquor Control Commission’s Responsible Vendor Program (RVP), when salesclerks asked the decoys for their IDs, and at stores with a posted underage alcohol sale warning sign. Alcohol purchases were also inversely related to the number of salesclerks present in a store, but were not related to salesclerks’ age and gender. Findings of this study suggest that more frequent compliance checks by law enforcement agents should target convenience and grocery stores, and owners of off-premise outlets should require training of all salesclerks to ensure reliable checks of young-looking patron IDs, and should post underage alcohol sales warning signs in clear view of patrons.     

Giving means receiving: the protective effect of social capital on binge drinking on college campuses

OBJECTIVES: We tested whether higher levels of social capital on college campuses protected against individual risks of binge drinking. METHODS: We used a nationally representative survey of 17,592 young people enrolled at 140 4-year colleges. Social capital was operationalized as individuals' average time committed to volunteering in the past month aggregated to the campus level. RESULTS: In multivariate analyses controlling for individual volunteering, sociodemographics, and several college characteristics, individuals from campuses with higher-than-average levels of social capital had a 26% lower individual risk for binge drinking (P < .001) than their peers at other schools. CONCLUSIONS: Social capital may play an important role in preventing binge drinking in the college setting.     

The state sets the rate: the relationship among state-specific college binge drinking, state binge drinking rates, and selected state alcohol control policies

OBJECTIVES: We assessed the relationship between college binge drinking, binge drinking in the general population, and selected alcohol control policies. METHODS: We analyzed binge drinking rates from 2 national surveys, the Harvard School of Public Health College Alcohol Study and the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System. Binge drinking data were linked to a summary measure of 7 salient alcohol control policies and a rating of resources devoted to law enforcement. RESULTS: State-level college and adult binge drinking rates were strongly correlated (Pearson correlation coefficient=0.43; P<.01). Attending college in states with the lowest binge drinking rates (adjusted odds ratio [OR]=0.63; 95% confidence interval [CI]=0.41, 0.97) and presence of more stringent alcohol control policies (adjusted OR=0.57; 95% CI=0.33, 0.97) were independent predictors of student binge drinking, after adjusting for state law enforcement and individual-, college-, and state-level covariates. CONCLUSIONS: State of residence is a predictor of binge drinking by college students. State-level alcohol control policies may help reduce binge drinking among college students and in the general population.     

The epidemiology of college alcohol and gambling policies

BACKGROUND: This article reports the first national assessment of patterns of drinking and gambling-related rulemaking on college campuses (e.g., punitive versus recovery oriented). Analyses relating school policies to known school rates of drinking or gambling identified potentially influential policies. These results can inform and encourage the development of guidelines, or "best practices," upon which schools can base future policy. METHODS: The college policy information was collected from handbooks, Web sites and supplemental materials of 119 scientifically selected colleges included in the fourth (2001) Harvard School of Public Health College Alcohol Study (CAS). A coding instrument of 40 items measured the scope and focus of school alcohol and gambling policies. This instrument included items to measure the presence of specific policies and establish whether the policies were punitive or rehabilitative. A total of 11 coders followed a process of information extraction, coding and arbitration used successfully in other published studies to codify policy information. RESULTS: Although all schools had a student alcohol use policy, only 26 schools (22%) had a gambling policy. Punitive and restrictive alcohol policies were most prevalent; recovery-oriented policies were present at fewer than 30% of schools. Certain alcohol and gambling policies had significant relationships with student binge drinking rates. CONCLUSIONS: The relative lack of college recovery-oriented policies suggests that schools might be overlooking the value of rehabilitative measures in reducing addictive behaviors among students. Since there are few college gambling-related policies, schools might be missing an opportunity to inform students about the dangers of excessive gambling.     

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.     

Correlates of college student binge drinking.

OBJECTIVES. This study examines the individual correlates of college student binge drinking. METHODS. Questionnaires were completed by a representative national sample (n = 17,592) of students on 140 campuses in 1993. Binge drinking was defined as five or more drinks per episode for men and as four or more drinks per episode for women. RESULTS. Overall, 44% of the students (50% of the men and 39% of the women) binged. While demographic factors such as sex and race were significantly related to binge drinking, prior binging in high school was crucial, suggesting that for many students, binge drinking begins before college. The strongest predictors of college binge drinking were residence in a fraternity or sorority, adoption of a party-centered life-style, and engagement in other risky behaviors. CONCLUSIONS. Interventions must be targeted at high school binge drinking as well as at several characteristics of college life--most notably fraternity residence. Legal drinking age fails to predict binge drinking, raising questions about the effectiveness of the legal minimum drinking age of 21 in college alcohol policies.     

What Do Binge Drinkers Drink?: Implications for Alcohol Control Policy

BACKGROUND: Although binge drinking (drinking five or more drinks on an occasion) is an important public health problem, little is known about which beverage types are consumed by binge drinkers. This knowledge could guide prevention efforts because beer, wine, and liquor are taxed, marketed, and distributed differently. METHODS: Data from 14,150 adult binge drinkers who responded to the Behavioral Risk Factor Surveillance System binge-drinking module in 2003 and 2004 were analyzed. Information pertained to the amount of alcohol consumed during a binge drinker's most recent binge episode, including beverage-specific consumption. RESULTS: Overall, 74.4% of binge drinkers consumed beer exclusively or predominantly, and those who consumed at least some beer accounted for 80.5% of all binge alcohol consumption. By beverage type, beer accounted for 67.1%, liquor for 21.9%, and wine accounted for 10.9% of binge drinks consumed. Beer also accounted for most of the alcohol consumed by those at highest risk of causing or incurring alcohol-related harm, including people aged 18-20 years (67.0% of drinks were beer); those with three or more binge episodes per month (70.7%); those drinking eight or more drinks per binge episode (69.9%); those binging in public places (64.4%); and those who drove during or within 2 hours of binge drinking (67.1%). CONCLUSIONS: Beer accounted for two thirds of all alcohol consumed by binge drinkers and accounted for most alcohol consumed by those at greatest risk of causing or incurring alcohol-related harm. Lower excise taxes and relatively permissive sales and marketing practices for beer as compared with other beverage types may account for some of these findings. These findings suggest that equalizing alcohol control policies at more stringent levels would be an effective way to prevent excessive drinking.     

The Utility of Keg Registration Laws: A Cross-Sectional Study

PurposeMany states have implemented keg registration policies to reduce adolescent binge drinking and related consequences. We examined the association between the strength and comprehensiveness of these policies and measures of beer consumption in the general population and adolescent binge drinking, as well as drinking and driving.MethodsData concerning the presence and stringency of the states' keg registration laws were secured from the Alcohol Policy Information System. Keg law ratings for each state were correlated with its (1) beer consumption per capita, as well as the 30-day prevalence of the following: (2) adolescent binge drinking, (3) adolescents who drive after drinking, and (4) adolescents who ride with a driver who has been drinking, as assessed by the Youth Risk Behavior Survey.ResultsAs hypothesized, the stringency and comprehensiveness of state level keg registration laws were moderately (?.31 to ?.41) and negatively associated with each of these outcomes. However, these relationships largely attenuated when controlling for per capita beer sales.ConclusionsLongitudinal research is needed to examine the relationships between keg registration policies and levels of adolescent alcohol consumption, hazardous drinking, and driving after drinking.     

The relationship of alcohol outlet density to heavy and frequent drinking and drinking-related problems among college students at eight universities

To determine whether alcohol outlet density was correlated with heavy and frequent drinking and drinking-related problems, we compared ecological measures of outlet density with survey measures of drinking using a geographic information system and the Harvard School of Public Health College Alcohol Study (n=3,421, site n=8). We identified 966 outlets within 8 2-mile study areas. Densities/site ranged from 32 to 185. Density was correlated with heavy drinking (r=0.82, p=0.01), frequent drinking (r=0.73, p=0.04) and drinking-related problems (r=0.79, p=0.02). Women, underage students and students who picked up binge drinking in college were affected. Implications for prevention and research are discussed.     

Youth smoking risk and community patterns of alcohol availability and control: a national multilevel study

STUDY OBJECTIVE: To test whether college youth smoking risks are independently associated with community patterns of alcohol availability and control. DESIGN: Hierarchical multilevel multivariable modelling of cross sectional survey data. Outcomes included self reported current (past 30 day) cigarette smoking and heavy episodic (binge) drinking. SETTING: 120 nationally representative US colleges. PARTICIPANTS: 10 924 randomly selected students. MAIN RESULTS: Individual risks for smoking and binge drinking are independently associated with community patterns of alcohol availability, policy enforcement and control over and above individual perceptions about these factors, student and college characteristics, and school binge drinking rates. Youth exposed to high levels of alcohol availability are at higher risk of smoking (OR 3.61, 95% CI 1.75, 7.44) and binge drinking (OR 4.22, 95% CI 2.25, 7.93) than youth not so exposed; youth exposed to strongly enforced alcohol policy environments are at lower risk for smoking (OR 0.30, 95% CI 0.16, 0.57) and binge drinking (OR 0.17, 95% CI 0.10, 0.31) than youth not so exposed; youth exposed to communities with strong parental controls are at lower risk for smoking (OR 0.05, 95% CI 0.01, 0.23) and binge drinking (OR 0.06, 95% CI 0.01, 0.21) than youth not so exposed. Individual risks related to environmental exposures differ for youth with varying perceptions about alcohol availability and policy control. CONCLUSIONS: Drinking environments in US college communities comprise strong independent risks for smoking. Smoking prevention models should be tested that include environmental drinking prevention strategies tailored to underlying perceptions and experiences of college youth.     

Watering down the drinks: The moderating effect of college demographics on alcohol use of high-risk groups

OBJECTIVES: This study examined whether colleges with larger enrollments of students from demographic groups with lower rates of binge drinking exert a moderating effect on students from groups with higher binge drinking rates. METHODS: The study analyzed data from 114 colleges included in the 1993, 1997, 1999, and 2001 College Alcohol Study surveys. RESULTS: The binge drinking rates of White, male, and underage students were significantly lower in schools that had more minority, female, and older students. Students who do not binge drink in high school are more likely to start binge drinking at colleges with fewer minority and older students. CONCLUSIONS: Student-body composition and demographic diversity should be examined by colleges wishing to reduce their binge drinking problems.     

Pregnancy, Alcohol Intake, and Intimate Partner Violence among Men and Women Attending Drinking Establishments in a Cape Town, South Africa Township

The highest rates of fetal alcohol syndrome worldwide can be found in South Africa. Particularly in impoverished townships in the Western Cape, pregnant women live in environments where alcohol intake during pregnancy has become normalized and interpersonal violence (IPV) is reported at high rates. For the current study we sought to examine how pregnancy, for both men and women, is related to alcohol use behaviors and IPV. We surveyed 2,120 men and women attending drinking establishments in a township located in the Western Cape of South Africa. Among women 13.3% reported being pregnant, and among men 12.0% reported their partner pregnant. For pregnant women, 61% reported attending the bar that evening to drink alcohol and 26% reported both alcohol use and currently experiencing IPV. Daily or almost daily binge drinking was reported twice as often among pregnant women than non-pregnant women (8.4% vs. 4.2%). Men with pregnant partners reported the highest rates of hitting sex partners, forcing a partner to have sex, and being forced to have sex. High rates of alcohol frequency, consumption, binge drinking, consumption and binge drinking were reported across the entire sample. In general, experiencing and perpetrating IPV were associated with alcohol use among all participants except for men with pregnant partners. Alcohol use among pregnant women attending shebeens is alarmingly high. Moreover, alcohol use appears to be an important factor in understanding the relationship between IPV and pregnancy. Intensive, targeted, and effective interventions for both men and women are urgently needed to address high rates of drinking alcohol among pregnant women who attend drinking establishments.     

Determinants of underage college student drinking: implications for four major alcohol reduction strategies

Guided by the assumptions of the social ecological model and the social marketing approach, this study provides a simultaneous and comprehensive assessment of 4 major alcohol reduction strategies for college campuses: school education programs, social norms campaigns, alcohol counter-marketing, and alcohol control policies. Analysis of nationally representative secondary survey data among 5,472 underage students reveals that alcohol marketing seems to be the most formidable risk factor for underage drinking, followed by perceived drinking norms (injunctive norm) and lax policy enforcement. This analysis suggests that, to make social norms campaigns and alcohol control policies more effective, alcohol reduction strategies should be developed to counter the powerful influence of alcohol marketing and promotions.     

Determinants of Underage College Student Drinking: Implications for Four Major Alcohol Reduction Strategies

Guided by the assumptions of the social ecological model and the social marketing approach, this study provides a simultaneous and comprehensive assessment of 4 major alcohol reduction strategies for college campuses: school education programs, social norms campaigns, alcohol counter-marketing, and alcohol control policies. Analysis of nationally representative secondary survey data among 5,472 underage students reveals that alcohol marketing seems to be the most formidable risk factor for underage drinking, followed by perceived drinking norms (injunctive norm) and lax policy enforcement. This analysis suggests that, to make social norms campaigns and alcohol control policies more effective, alcohol reduction strategies should be developed to counter the powerful influence of alcohol marketing and promotions.     

Risk modifying effect of social capital on measures of heavy alcohol consumption, alcohol abuse, harms, and secondhand effects: national survey findings

STUDY OBJECTIVE: To examine associations between social capital and individual risk for alcohol abuse and harms and identify protective effect mechanisms. DESIGN: Multilevel multivariate analysis with individual level data from a national panel survey of drinking and a contextual measure of social capital reflecting college mean aggregate reports of student volunteerism. Outcomes include heavy episodic (binge) drinking, frequent drinking, frequent drunkenness, diagnosable alcohol abuse, intentional drunkenness, acquisition of binge drinking, harms, secondhand effects from others' drinking. SETTING: United States, 119 four year colleges. PARTICIPANTS: Representative samples of youth ages 18-24 surveyed in 1997 and 1999 using an anonymous mailed questionnaire (total n = 27 687). MAIN RESULTS: Students from colleges with higher levels of social capital reported reduced risks for binge drinking (adjusted OR 0.38, 95% CI 0.20 to 0.69, p = 0.002), frequent drunkenness (adjusted OR 0.58, 95% CI 0.34 to 0.98, p = 0.04), acquisition of binge drinking in college (adjusted OR 0.48, 95% CI 0.24 to 0.95, p = 0.03), and alcohol abuse (adjusted OR 0.55, 95% CI 0.34 to 0.91, p = 0.02) in multilevel multivariate analyses that controlled for individual volunteering, the measure on which social capital was based. Higher levels of social capital protected against multiple drinking related harms (adjusted OR 0.51, 95% CI 0.29 to 0.90, p = 0.02) and secondhand drinking effects (adjusted OR, 0.30, 95% CI 0.16 to 0.58, p = 0.0003). Significant cross level interactions exist between fraternity/sorority membership and social capital for measures of risky drinking. Harm reduction primarily reflects consumption modification. CONCLUSIONS: Social capital exerts strong protective effects on alcohol abuse and harm in college including among high risk students.     

Alcohol Outlets,Neighborhood Characteristics,and Intimate Partner Violence: Ecological Analysis of a California City

Neighborhood indicators of social disadvantage, such as poverty and unemployment, are associated with intimate partner violence (IPV). Despite the well-established link between heavy drinking and IPV, few studies have analyzed the contribution of alcohol outlet density to the occurrence of IPV. Greater numbers of alcohol outlets in a community may be a sign of loosened normative constraints against violence, promote problem drinking among at-risk couples, and provide environments where groups of persons at risk for IPV may form and mutually reinforce IPV-related attitudes, norms, and problem behaviors. This study used ecological data to determine if alcohol outlet density (number of bars, restaurants serving alcohol, and off-premise outlets per unit area) is related to rates of IPV-related police calls and IPV-related crime reports in Sacramento, California. Separate analyses for IPV calls and crime reports were conducted using Bayesian space–time models adjusted for area characteristics (poverty rate, unemployment rate, racial/ethnic composition). The results showed that each additional off-premise alcohol outlet is associated with an approximate 4% increase in IPV-related police calls and an approximate 3% increase in IPV-related crime reports. Bars and restaurants were not associated with either outcome. The findings suggest that alcohol outlet density, especially off-premise outlets, appear to be related to IPV events. Further research is needed to understand the mechanisms by which neighborhood factors, such as alcohol outlet density, affect IPV behaviors. Understanding these mechanisms is of public health importance for developing environmental IPV prevention strategies, such as changes in zoning, community action, education, and enforcement activities.