Introduction to the Special Issue on College Drinking Games

Drinking games are high-risk, social drinking activities comprised of rules that promote participants’ intoxication and determine when and how much alcohol should be consumed. Despite the negative consequences associated with drinking games, this high-risk activity is common among college students, with participation rates reported at nearly 50% in some studies. Empirical research examining drinking games participation in college student populations has increased (i.e. over 40 peer-reviewed articles were published in the past decade) in response to the health risks associated with gaming and its prevalence among college students. This Special Issue of The American Journal of Drug and Alcohol Abuse seeks to advance the college drinking games literature even further by addressing understudied, innovative factors associated with the study of drinking games, including the negative consequences associated with drinking games participation; contextual, cultural, and psychological factors that may influence gaming; methodological concerns in drinking games research; and recommendations for intervention strategies. This Prologue introduces readers to each article topic-by-topic and underscores the importance of the continued study of drinking games participation among college students.     

Assessing the Relationship Between Mental Health Symptoms and Alcohol Consequences in College Drinkers

College drinking is a public health dilemma affecting the nation’s institutions of higher education. This article assesses the relationship between mental health symptoms and alcohol consequences experienced by college drinkers. It is a secondary data analysis of the American College Health Association-National College Health Assessment (ACHA-NCHA II) Spring 2011 Executive Summary Data Set. The ACHA-NCHA II is a nationally recognized survey that supports colleges and universities in the data collection of their students’ mental, physical, and sexual health habits, behaviors, and perceptions of the campus wellness. A linear regression analysis test was used to test the relationship between the number of mental health symptoms and alcohol consequences. This article assesses whether male college students have more mental health symptoms when they experience alcohol consequences when compared to female college students. This study found female college students experience more mental health problem symptoms associated with alcohol consequences.     

Alcohol,Tobacco, and Nonmedical Drug Use in Older U.S. Adults: Data from the 2001/02 National Epidemiologic Survey of Alcohol and Related Conditions

OBJECTIVES: To examine the prevalence and sociodemographic and health‐related correlates of substance use, including alcohol, tobacco, and nonmedical drug use, in adults aged 65 and older. DESIGN: Cross‐sectional, retrospective survey of a population‐based sample, the 2001/02 National Epidemiologic Survey on Alcohol and Related Conditions. SETTING: United States. PARTICIPANTS: Eight thousand two hundred five U.S. adults aged 65 and older. MEASUREMENTS: Prevalence of lifetime and previous‐12‐month alcohol, tobacco, and nonmedical drug use and associations between substance use and sociodemographic and health‐related factors. RESULTS: Almost 80% of older adults had used any of the three substances over their lifetimes, and more than 50% reported such use over the previous 12 months. Alcohol was the most commonly used substance over the lifetime (74%) and in the previous 12 months (45%), followed by tobacco (52% lifetime; 14% previous 12 months); far fewer reported nonmedical use of drugs (5% lifetime; 1% previous 12 months). In general, being younger, male, and divorced or separated were factors consistently associated with use of any of the three substances. CONCLUSION: Most older adults had used substances over their lifetimes and in the previous 12 months. Alcohol is the substance of choice for this age group, followed by tobacco; few report nonmedical drug use.     

Measuring Liability for Substance Use Disorder among College Students: Implications for Screening and Early Intervention

Background: Heavy drinking and illicit drug use among college students has been a longstanding public health concern. Current methods to screen and identify college students at-risk for the development of substance use disorders (SUD) are somewhat limited. Objectives: This study aimed to cross-validate the work by Kirisci et al. (), who developed the Transmissible Liability Index (TLI), by deriving a set of items that would be potentially useful for characterizing SUD risk across multiple dimensions among college students. We examined: 1) variations in the TLI-College Version (TLI-CV) by race, sex, SES, religiosity, and family history of substance use problems; 2) the association between the TLI-CV and alcohol and/or marijuana dependence, both cross-sectionally and prospectively, by race and sex; and, 3) the sensitivity and specificity of the TLI-CV for identifying cases of marijuana and/or alcohol dependence. Methods: Data from an ongoing longitudinal study of college students (n = 1,253) was used to conduct item response theory (IRT) analyses; the resulting TLI-CV consisted of 33 items. Results: The TLI-CV was significantly associated with baseline dependence and significantly higher for non-dependent individuals who later became dependent during the subsequent three years of college. These associations were observed for both sexes, Whites, Blacks/African-Americans, Asians, and other racial minorities. The sensitivity and specificity were suboptimal. Conclusions and Scientific Significance: The TLI-CV advances prior research to identify college students at risk for SUD. This approach holds potential promise to identify and ultimately modify the trajectories of college students who may be at risk for the development of SUD.     

Alcohol and Other Drug Use among College Students: Intimate Partner Violence and Health-Compromising Behaviors

A survey was conducted with 400 male and female college students to examine the relationships among intimate partner violence (IPV), alcohol and other drug use, and health-compromising behaviors. The results indicated that IPV was directly related to alcohol use. The results further indicated that alcohol and drug use are directly and IPV is indirectly associated with risky sexual behaviors. Victimized male and female students had higher rates of alcohol and drug use and other health-compromising behaviors compared to nonvictimized male and female students. Implications are suggested for collegiate prevention programs.     

Drinking game play among first-year college student drinkers: An event-specific analysis of the risk for alcohol use and problems

Background: College students who play drinking games (DGs) more frequently report higher levels of alcohol use and experience more alcohol-related harm. However, the extent to which they are at risk for increased consumption and harm as a result of DG play on a given event after accounting for their typical DG participation, and typical and event drinking, is unclear. Objectives: We examined whether first-year students consumed more alcohol and were more likely to experience consequences on drinking occasions when they played DGs. Methods: Participants (n?=?336) completed up to six web-based surveys following weekend drinking events in their first semester. Alcohol use, DG play, and consequences were reported for the Friday and Saturday prior to each survey. Typical DG tendencies were controlled in all models. Typical and event alcohol use were controlled in models predicting risk for consequences. Results: Participants consumed more alcohol on DG versus non-DG events. All students were more likely to experience blackout drinking consequences when they played DGs. Women were more likely to experience social-interpersonal consequences when they played DGs. Conclusion: DG play is an event-specific risk factor for increased alcohol use among first-year students, regardless of individual DG play tendencies. Further, event DG play signals increased risk for blackout drinking consequences for all students, and social-interpersonal consequences for women, aside from the amount of alcohol consumed on those occasions as well as typical drinking behaviors. Prevention efforts to reduce high-risk drinking may be strengthened by highlighting both event- and person-specific risks of DG play.     

Alcohol use among Hispanic college students along the US/Mexico border

Background: The trend of alcohol use among college students has been shown to vary by ethnicity and has been linked to acculturation among Hispanics. Consistent findings indicate that males consume alcohol more frequently and in greater quantities compared to females. Objectives: This study investigated the drinking habits of Hispanic college students living in the border region of South Texas. The study evaluated the influence of acculturation on alcohol consumption among Hispanic males and females. Methods: Two hundred and ninety-six Hispanic students participated in this study. The participants reported their drinking behaviors over the past 30 days and completed a measure of acculturation. Results: Fifty-nine percent of the participants reported consuming alcohol in the past 30 days with more males than females reporting alcohol consumption. Logistic regression analysis indicated that age and gender, and not acculturation or enculturation, predicted drinking in the last 30 days. Among drinkers, the regression analyses indicated that gender and lower levels of Anglo orientation were linked to increased alcohol consumption, suggesting that Hispanics who were less oriented toward the Anglo culture consumed more alcohol than those more oriented toward the Anglo culture. Among drinkers, males and females did not differ in frequency or binge drinking, but males consumed more alcohol than females. Conclusion: Previous research indicates that greater acculturation is linked to greater consumption of alcohol; however, we found it to be associated with less consumption. The findings regarding gender represent some consistencies with previous research but there are some inconsistencies as well. These results suggest that less acculturated Hispanic male college students residing in the border region may be at a higher risk of alcohol abuse than Hispanic female students and more acculturated male students.     

Failure of College Students to Complete an Online Alcohol Education Course as a Predictor of High-Risk Drinking That Requires Medical Attention

Background: AlcoholEdu® for College and other computer-based education programs have been developed to reduce alcohol use and related problems among students. Objectives: This study investigated whether the failure of incoming first-year students to complete AlcoholEdu predicts future high-risk drinking that requires medical attention. Methods: A review of clinical records kept by a single university’s health service identified 684 undergraduates (classes of 2007–2011) who had presented for an alcohol event (September 2003 through June 2008). We used survival analysis to determine whether students who partially completed the course or failed to take it were disproportionately represented among student patients who presented with elevated blood alcohol concentration (BAC). Results: Students who failed to take the online course were 4.64 times more likely than those who completed it to experience an alcohol event (p < .0001), while those students who had partially completed the course were 1.52 times more likely (p < .0001). Amount of online alcohol education and gender were not significantly related to students’ measured BAC level. Conclusion: Students who had completed AlcoholEdu were less likely to present for an alcohol event than were students who partially completed or failed to take the course. Campus administrators should consider whether students who fail to complete an online alcohol course should be flagged for more focused interventions (e.g., brief motivational interview, mandatory education classes). Scientific Significance: This is the first study to show a relationship between first-year college students’ non-completion of an online alcohol course and subsequent high-risk drinking that requires medical attention.     

Adolescent Self-Reported Alcohol/Other Drug Use Consequences: Moderators of Self- and Parent Agreement

Although the reliability of assessment instruments designed for use with adults is well established, much less is known about the adequacy of these instruments for adolescent substance abusers. As part of a comprehensive intake evaluation, the Inventory of Drug Use Consequences (InDUC) was administered to 40 adolescents assigned to a probationary substance abuse treatment program and to one of their parents. The correlation was statistically significant between parent and adolescent InDUC score(s), but the interrater reliability was relatively low. IQ scores and level of substance use were considered as moderator variables, but neither showed a significant effect. History of head injury, however, significantly moderated this relationship; those adolescents reporting no history of head injury showed little correspondence with parent InDUC score(s), whereas those adolescents with a history of head injury showed significant correlations with parent InDUC scores. This suggests that a history of head injury may affect the way in which adolescents perceive substance-related consequences.     

Predictors of College Student Support for Alcohol Control Policies and Stricter Enforcement Strategies

Objectives: With alcohol-related problems remaining a concern on college campuses, prevention efforts are increasingly directed to addressing the environmental factors that encourage consumption. This study examined students' support for alcohol control policies, correlates of that support, and actual vs. perceived peer support. Methods: Telephone interviews were conducted with a random sample of 510 college students. We conducted a three-step hierarchical regression analysis to examine predictors of policy support. Levels of personal and perceived peer support for alcohol control policies were compared. Results: Findings revealed a high level of policy support among students, with variability in support by gender, alcohol consumption levels, and drinking and driving tendencies. Additionally, compared to the percentage of students who supported each policy, a smaller percentage thought other students were supportive. Conclusions: Results provide valuable insights to inform the development of media campaigns and other environmental management initiatives.     

Alcohol Use and Sexual Risk Behavior among College Students: Understanding Gender and Ethnic Differences

Objectives: The purpose of the current study was to assess the role of gender and ethnicity in the relationship between alcohol use and risky sexual behavior. Method: Sexually active college students (n = 425) reported on alcohol expectancies, perceived risk of HIV, and drinking and sexual behavior in the context of a larger health behavior survey. Results: Approximately one-third of participants reported binge drinking 3 or more times in the past two weeks. African-American women reported less drinking and less positive alcohol expectancies than other women. Older men engaged more often than younger men in binge drinking and reported more sexual partners in the past year. Younger age and greater perceived risk for HIV were positively associated with condom use for both women and men. Conclusion: Collectively, these findings suggest that alcohol abuse and HIV prevention efforts among young adults need to consider gender, ethnicity, and age.