college bing drinking

college bing drinking - JDUHNAL GFAMEHtCAN CDLLEGE HEALTH....

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Unformatted text preview: JDUHNAL GFAMEHtCAN CDLLEGE HEALTH. VOL. 50. ND. 5 Trends in College Binge Drinking During a Period of Increased Prevention Efforts Findings From 4 Harvard School of Public Health College Alcohol Study Surveys: 1993—2001 Henry Weohsler, PhD; Jae Eun Lee, DrPH; Meiehun Kuo, SCD; Mark Seibring, BA. BS; Toben F. Nelson, MS; Hang Lee, PhD Abstract. the Boot Harvard School at l’uhtte Ilealth {‘ollege .s‘tleohol Studv surveved students at t [9 4-year eolleges that par- tieipated iii the lt't'E-‘Jl. IEIQ't. ttnd JQ‘H studies. Responses ill the 4 survey years were eotttparetl to determine trends in heavv aleohol use. aleoltol—related prohletrts. attd eneounters with eollege anti eomntunity prevention efforts. in 100]. apprositttately 2 iii 5 toast-t eollege studettts reported binge drinking. a rate altttost idetttieal to rates in the previous 3 surveys. Very little eltange in overall binge drinking oeeurred at the individual eollege level- The pereentt-tges of ahstainers and frequent hinge drinkers inereased. a polarisation of drinking hehavior first noted in 1997 A sharp rise in frequent hinge drinking was noted among students attending all-women‘s eolleges. thher signiiieanl ehanges ineloded inrreas- es in immoderate drinking and harm among drinkers. lvlore stu— dents lived in substanee-tree housing and eneountered eollege edueational efforts and sanetions resulting trom their alenhol use. Key Words: aleoltol. aleoltol—related problems. binge drinking. eollege students. seeondhattd elTeets oi aleoltol. prevention eavv episodie aieoltol use. or binge drinking. and the resulting prohlettts gaitted natitmal reeognitinn in the l‘il'S'ils as the ntttnher one puhlie health prob— lem affeeting eollege students- Sittee the release at the first l-larvard Seltool ot' Publie Health College .aleohol Study tCASl.' ittereased awareness of this prohlem has resulted in major governmental attd ttationai aetionsgl The Centers for Disease Control and Prevention [CDC] now provide tneas sures of hinge drinking in their state-hv—state repuorts.1 Both houses of |[Tittngress have passed resolutions asking enllege presidents to take steps to address this problem}: and the US Surgeon General established a national health goal ot'redueing eollege binge drinking hv sass h}; the sear r'tt'tr tfliil'rlte‘ authors are With the Uettttrttttettt rit'Hertltlt ortrt’ .‘t'or't'ot Bellini-tor ot tire Horror-rt St'ttoot oil'- Pttolit' Health to Boston. Hitting Lee is also iron the t'ltl'ttssttt'ttttvetts General Hospitttt in Boston. 203 Emil.“ The National Institute on Aleoholism and Aleohol Abuse tstssst formed a speeial task three to tttake ree- otttmendations to address the problem." Binge drinking has even reeeived glohal attention from the World Health I.'.'.'.|rgt-t— niration. whieh eonvetted a eonterenee to address the topie.” Several prominent organisations and key leaders have aeeepted this eall to aetion- Mothers Against Drunk Driving developed a new initiative to address eollege binge drinking and is eampaigning to open new ehapters on eollege eam- pusesf’ Tlte Rohert Wood .lohnson Foundation funded a multimillion—dollar grant program in It] eollege eommuni— ties to work on the prohlent.“-' ltt addition, The National Assoeiatittn of State Universities and Land—Grant Colleges sponsored a national media eampaign to draw attention to the issuefI and man}: loeal attd regional eoalitions have formed to develop interventions to reduee heavy drinking among eollege students. During the 1090s. the ittereasetl national attention paid to eollege hinge drinking prompted eolleges and universities to initiate or increase their prevention eil'IItIts.“2 The aetions taken to date. however. have foeused on eduealing or ehang— ing the pereeptions ot' the drinkers themselves, providing eounseling or shortsterm treatment. and imposing sattetions For the most severe ot'tettses.” Features of the environment that promote heavv aleohol use. stteh as eollege drinking traditions, Ias eollege or eommuttitv polieies attd enforce- ment, easy aeeessilailitv to elteap aleohol in high volume, attd gaps itt serviee networks have reeeived far less attention than other prevention et’i‘ortsJ-l ‘5 Several other studies that measure eollege studettt hinge drinking have shown that little or no elttutge in students“ heavy.r drinking patterns ltas oeeurred. The Monitoring the Future; Ntttt'ottrtt' Survey Results on flt'ttg t'_.-'se, tFJZ‘i—Etiltlltt reponed that the rate at eottsuming 5 or more drinks iii a row in the pttst 2 weeks for eollege students who are i to -t WECHSLEH ET At. years hcyend high scheel was 40.2% in 1993 and rentained at -'ilJ.l]‘ii.- in l‘?ir“9‘9.'f The ntnst recently pnhlishcd CDC sur- vey that leeked specifically at cnllege students tettnd that. in 1995. 41.5% ef cellege students aged 18 In 24 years had cnnsttmcd 5 er tttnrc drinks in a rew itt tlte preceding 30 days}? In tlte 1999 CAS. we t'eund that binge drinking was eften acctimpanied by cducatienal difficulties. psycheseclal preb— lems. antisecial behaviers. injuries. uverdnses. high-risk sex- ual behaviers. and ether risk taking. such as alcehel— impaired driving.ll A recent study'H indicated that. under existing patterns ef alcehel use. nearly 1 in '3 cnllege stu- dents (31139?) qualified fer a fermal diagnesis ef alcehel abuse and I 1H I? reset ceuld be diagnesed as ai’cnhel dependent. acenrding In criteria in the Dittgttnsttc and Stars terriers" Manned ntMentai th'serders. 4th editien [HEM—IV)” 't'he censequenees efcellege students” heavy drinking are ttet litttited tn the dt'iitkers themselves. Students whe attend- cd sehnnls with high rates nf heavy drinking experienced a greater number at secendhand effects. inclttding disruptien ef sleep er studies; prepeity damage; and verbal. physical. nr sexttal vinlencer'l-l In atltiitinn. residents nf neighhnrw heeds near cnlleges characterized as heavy-drinking scheels experienced higher rates nf neise disruptiens. prep— erty datnagc. and pnlice visits than pcnplc whn lived in neighberheeds sttrreunding scheels with tewer drinking rates and peeple whe did ttet live near a cnllege.” We had an eppertunity in 20-01 te resurvey the same cel- leges included in the previnus CA3 .samples tn determine the extent te which changes in alcehel preblems and use patterns ltad eccurred iii the preceding 1 years. In this repert. we present the EtlDI findings and a trend analysis exantining changes in rates frem the 1993. 1997'. 1999. and 111"” Etltll surveys. “- METHOD Sample The 21101 CAR surveyed students at tEll nf the cnlleges that participated in each ef the previeus three surveys. The participating scheels were lecated in 33 states and the Dis— trict nl' Cnlumhia. 1n the nriginal 1993 survey. we selected we scheels frem a list previded by the American Ceuncil en Educatien tn previde a representative sample ef accred— ited 4-year US cnlleges arid universities. The attrilinn nl' Ell seheels was primarily a result ef institutiens' inability tn previde a santple et' students and mailing addresses te meet the little cettstraittts ef the survey. .fltdtninistraters at each ptu'ticipatittg sclteel used the same precedurc as that used in cnnducting previntts CA5 surveys tn prnvide a list at 215 randently selected students frem all full—time undergraduate students enrelled during the EUUU EUUI scheei year. Details ef the previeus sam— In cnnducting the data analyses. we excluded 1 cnllege with a respense rate that was substantially lnwer than the ethers. leaving 119 schnels. The inclusien criteria differed 29st frem previeus survey years. We drew en results frem 113 schnnls that we had surveyed earlier atid reintreduced (i scheels that had been tirnppetl t'rnnt previnus analyses. Thus. rates fer earlier years cited in this repert are slightly differ- ent fre tn these repetted in ether articles that were based en CA5 data."'3-13 Hnwcvcr. when we cetttparcd the binge- drinking rates at the 119 scheels with the eerrespending rates ef all sclteels in each survey year. we feund they were identical. Drnpping the Inw-rcspttnsc schnnls did nnt change the results ef the survey- The santple ef 119 celleges represents a natinnal cress— sectinn nf students enrelled at 4-year cnlleges. Sixty-nine percent at the respenders attended public cnlleges and .1 st. attended private cnlleges. which apprnximates the US natinnal disttihutitnt el' full-time 4-year cnllege students. with 639:“:- attending public and saa- attending private scheels:13 Ferry-seven percent ef the respenders attended large cnlleges t2: 10.990 students}. 23% were at medium- sized cnlleges {iftfll—lflflflfl students}. and 9.9% were enrelled in small cnlleges ts: 511111 students}. The US natinnal distrihutintt is 37'9h. 14951. arid il-ll‘ii.-. respectively.“ Sixty—nine percent ef the respenders attended scheels in large er medium-steed cities. cempared with Tl‘ie ef stu- dents l'ltilltlltt‘tlr'1t1t:.33 Thirteen percent nf the students attend— ed scheels with a retigieus affiliatien. cempared with 169t- natienwidefl; and 5% percent ef the students attended all— wetnen‘s celleges. The 'ltltll sample censisted ef e4rs-.- wemen. a rate higher than the natienal rate et' undergraduate wemen. resulting in part ft'ettt the ittelusiett cf 5 wetnen's cnlleges. Aheut 3 ill 4 students (14%} were 1't‘v’hite. and l in 2 {59.2%} was under the legal drinking age tie. yeunger than 21 y]. We neted sig— nificant cltattges itt the dcrnngraphic characteristics nf the student satnples ever the 4 surveys- 'l'heret'ere. te cempare prevalence rates acress survey years. we weighted the data In the pepulatiett distributiett nf each schnnl in 1993 in terms nt' sextgender. age. and racetethnicity. We ttsed the weighted data in all analyses. Date Weighting and Binge-Hate Standardieatien 'l‘he demegraphic characteristics et' the student sample fer each sclteel tttay ttet he a perfect rellcctittn nf the true demngraphie characteristics fer the pepulatinn nf that scheel and may bias eur estimate ef binge drinking. Fer exantple. mere wemen than men rcspnndcd tn the survey. Hnwever. the hinge rate is higher fer men than fer wemen. and this can lead te selectien bias in the crude estimate ef the hinge rate. In additiett. bnth satttple and pepulatinn dentngraphic characteristics can change frnm year te year; and binge rates can appear te change when. in fact. the changes may reflect enly a given year's change ef respen- dents er scheel pepulatien fer a demegraphic greup. Te [tile eat attributing change itt hinge-drinking rates tn changes in dcmngraphie characteristics in each survey year. we based estimatinns ef the binge rates in each survey and the lengitudittal cetttparisens en a direct staridardixatiun pt'ecedure ever 3 strata tic. gender x '2 age gretlps [re 23 vs JDUHNAL 0F AMEHtCAN CDLLEGE HEALTH others] and 2 ethnic groups {White vs otherall that used each school‘s true demographic characteristic in I993 as the reference. For analyses that used individual student-level data. we weighted the individual student-level hinge-drink- ing response by using the weight structure that we had used for the standardization. We could then compare the hinge rate over time. given the assumption that demographic char— acteristics remained constant. and could also reduce the potential selection bias in the prevalence rate for each sur- vey year. The adjusted rates can. therefore. be reliably inter- preted over time. Ouestlonnalre The Etlfll survey questionnaire askcd respondents to art- swer a series of questions about their alcohol use and asso— ciated problems. as well as about their tobacco and other drug use. their lifestyles. and demographic and hackgrourtd characteristics. Additional questions asked students about their esperience with prevention programs and college alcohol policies. We repeated standard questions from questionnaires that were used in the 1993. 1997. and I999 surveys and that were adapted from previous large—scale. ttational studies. The questionnaire instructed participants to define a “drink” in equivalent amounts of alcohol: a lE—or. {Boll-mm bottle or cart of beer. a 4-oa tilfl-mLi glass of wine. a 12- oa [Soil-ml.) bottle or can of wine cooler. or a shot i |.21i or or BTmL} of liquor either straight or in a raised drink. Main Outcome Measures We employed the measure of hinge drinking or heavy episodic drinking as a printary outcome measure that is con- sistent with previous CA5 surveys. This measure of alcohol use is a standard metric in research on this taping-'14 We defined hinge drinking as the consumption of at least 5 drinks in a row for men or '4 drinks in a row for women dur- ing the 2 weeks before completion of the questionnaire. The CAS gender—specific measure of binge drinking was cons structed from responses to 4 questions ahout in] gender. thl most recent drinking experience. tcl drinking 5 or more drinks in a row during the past 2 weeks. and {d} drinking 4 drinks in a row during the past 2 weeks. Hinge drinking is strongly associated with adverse social consequences among college students.'-‘3-3'-33 An analysis of [993 CA3 data demonstrated that a gender-specific definition (“Sid”) of hinge drinking provides a measure of equivalent alcohol- retated problems for college men and women?5 We deleted respondents with missing data on these questions front the analysis {2.593 in I993. |.49iw. in I999. ass. in I999. and I.I9i< in Elllll l. ir'reqnnnr hinge drinkers were students who had hinged 3 or more times in the past 2 weeks. whereas nrsrnsinnni binge drinkers were those who had hinged | or 2 times in the same period. Non—hinge drinkers were students who had consumed alcohol in the past year but had not hinged in the previous 2 weeks. Abstainers were those students who had not consumed arty alcohol in the past year. We used the VOL 50. MARCH 2002 EiNGEDFHNKiNG TRENDS same 5M measure in defining high school hinge drinking as the usual amount of alcohol eonsumetl per occasion tinting the last year in high school. In addition to using the measure of binge drinking. we assessed student patterns of alcohol use by asking respon- dents who drank any alcohol in the past 3U days the follow- ing four questions: {a} how often they had a drink of alcohol in the past 3t] days [response categories were i to 2 or'rvi- sirnrs. :l to .5 or'r‘risirnis. ii to .9 occasions. it} to i9 occasions. 219 to J9 occasions. and dd or more occasionsi: [hi how many drinks they usually consumed on the t'iccasit'nls when they drank alcohol in the past month [response categories ranged from did not drink in post 30 days to 9 or more drinks]; tel how important getting drunk was as a reason to drink t response categories: very important. intpnrrnnr. some ti-‘irrd imprinted. and not in uii irrnrortunrj‘. and tdl how often they drank enough to get drunk in the past Till days {meaning unsteady dizzy. or sick to :t-Titil" stomach}. with response cat— egories identical to those in the first question. Students who drank alcohol in the previous year were asked a series of questions about their esperience of alcohol— related problems. including I1 health and behavioral conse- quences of their own drinking. The personal harms questions ranged from academic difficulties [such as missing a class or getting behind in schoolwork]. to physical and sesual vio- lence and serious utcdical prohlerns leg. alcohol overdose}. All students were asked a series of 3 questions about their experiences of the consequences of other students" drinking tsccortdhand effects} during the current school year. ‘We conducted analyses of the secondhand effects of alcohol use among non—hinge drinkers and residents of oil-campus res- idence halls and l'raternityisorority houses. Data on alcohol- related sesual assault and unwanted sesuai advances are presented for women only. We classified colleges as high hinge [with more than Eli‘s: of students binge drinking]; middle level {sass—sass; and low hinge [359t- or lower) on the basis of the aggregated hinge-drinking hehavior of their students. Mailing and Heeponee Hate Following the same practice as that used in the 3 prior sur- veys. we mailed questionnaires directly to students beginning in February and sent 3 separate mailings within a minimum span of 3 weeks. The initial rrtailirtg consisted of a letter of invitation to participate in the smdy and a questionnaire. We followed this mailing with a reminder postcard and a sepa- rater mailed seeoud questionnaire. Mailings were different for each school. anti we seherluled them to avoid the period immediately preceding and tollowing spring break to capture behavior that occurred on campus and to avoid responses that reflected behavior during spring vacation. Student responses to the survey were voluntary and anonymous. and students were told they did not have to answer any question that made them uncomfortable. As a result. the study received escrnpt status from the institu- tional review committee. To encourage responses. we offered cash pri r-tes. We entered into a drawing the names of 295 WECHSLEH ETAI. students who returned a separate postcard indicating that they had completed the survey. The prises were otte 31.51111 award to a student whose name was drawn from among stu- tlents responding within I week of tlte first mailing. and two $251} awards and five .‘EIILHJ awards to students selected from all those who responded. College response rates differed for eaclt of tlte 4 survey years: 5291 in 211111 trauge assesses; 59W in 1999 [range Era—3391s): 599% ill I997r {range 2991:--Ell%1. and 2119's in I993 [range stifle-11111921. However. the response rates at individttal colleges were not associated with the hinge rates. We used correlation analysis to esamine the potential bias tltat tttigltt have been introduced by nonresponders. First. we compared responses of students who responded early with these who responded late. We found no .statistically significant difference itt rates of binge drinking between students who responded before and after the second mailing in 2011] 1449i- vs 4391:}. x311. N 2 113.9134] 2 .9223: p : .3309. The Pearson correlation coefficient between a col- lege’s hinge rate and its response rate was ".1157 {p = .5315} in 1993: .1344 Ln = .6351 in 1997: 33112 {p = .9341 in 1999: and .1211 {p = .1164} in 211111. We included response rates as a continuous eovariate in tttultiple logistic regression mod- els in all of the analyses. in addition. we sent a short fornt of the questionnaire. including a question abottt drinking in 213111. to a sample of students who did not return the origi— nal questionnaire. and more than 51111 students responded. We found no significant differences in rates of past year alcohol use 129.3911 vs 311.9921. ft]. N = 111.9114] = .29; p = .59. for those who answered the short survey cotttpared with those who responded to the entire questionnaire- 'l'his pat— tern was consistent across tnajor demographic variables of age and gender and over surveys. Data Analysis To Iaeilitatc cotttparisotts with 1993. 199?. and 1999 data. we used only data from the I 19 schools that partici— pated in all 4 survey years. Thus. the 211111 findings tu‘e slightly {usually 191': or less} different from those previous- ly reported in articles that usetl data for 141] colleges in 1993. 116 in l992.and 119 in 19991.19”?j We conducted an overall trend analysis in binge-drinking rates among 119 schools with 4 time points. We used repeated measures in the longitudinal trend analysis to esamine the change of school—level binge-drinking rates over time. We used the generalised estimating equations {GEE} approach to fit the longitudinal models. In the model. we included a year variable [year = 1]. 4. t}. or 3 for I993. 199?. 1999. or 2001. respectively} to esarnine whether a linear tittte trend in binge-drinking rate was apparent from 1993 to 211131. We also included response rate and the interaction between response rate and the year vari— able in the model. We used chi-square tests to compare student characteris— tics anti outcomes of interest across the 4 survey years. Directly standardized binge rates were reported. We used chi—square analyses to perform comparisons of prevalence .5306 rates. We used the tttultiple logistic rcgressiott technique to assess the relationship between binge drinking anti its cor- relates. A test for linear trends of binge drinking over time was also performed within the logistic regression models. Adjusted odds ratios 10R] and 95% confidence intervals 11311 are reported. We used the 131213 approach to fitting the logistic regression models to account for clustered out- comes arising in our sampling schcmc'iihii; we used the SAS statistical software package in all analyses we conducted.1H RESULTS Composition of the Student Sample The characteristics of the samples from each of the 4 sur— vey years included in the present analysis differed in several ways. a majority of the sample participants in each survey year were women 15719.- in 1993. E19912 in 1991151912 in I999. and (Jr-19': itt 20011. but trend analysis indicated that the pro- portion of females in 211131 constituted a significant increase from 1993. ft 1 . N: 2o.1291= 131.9:p s: 111111]. In contrast. the percentage of White students was high each survey year—131191: in I993. T139} in I992. 2591s in I999. and 7493 in 21111] —but decreased throughout the survey years. whereas other racial groups increased in each year. 1:21 | . N = 25.31 I} = 1113.13: p :1: 1113111. We noted increases over time for students under the age. of 21 145% in 1993. 4991:: in 1997'. see in 1999. and see- in 2-301 1. ft 1. N = 26.1491 = 62.9: p 4': .Illltll; freshmen 121191: in I993. 249?- in I991 2391'. in 1999. and 239:: in 2111111. fit. N = 2o.ltl3} = 311.9: .9 e 1111111; and sophomores 1199’}. iii 1993. 21% iii 199?. 229? in 1999. attd 221321:- in 211111}. ft 1 . N = 213.1031: 19.9: p e 1113131. The percentages of older students and seniors decreased. We also found some significant shifts in residential chars acteristics of the sample. A higher proportion of students lived in on-campus residence halls [3291.- in 1993. 3139- in 1992. ass. in 1999. and ass. in soot 1. ft 1. .v = 20.0371 = (32.9: p s: .0001; itt substance-free housing 1129:} in I993. 211% in I997. 23% in I999. and 21:19? in 213111}. 3:31 I. N : 8.2921 2 1611.11. p at: 11131111: and in off—campus unatters with a spouse {111% iii I993. 19% in 199?. 13% in 1999. and lotii: in 2111111. x3111. N: 14.28151 = 127.315? c.0991. Fewer students lived off campus with their parents [3591' in 1993. 2891". in 1997. 259 in 1999. and 329 in 211111}. yitl. N: 14.21313} = 1?.2'. p -::. 1111131. We also found a significant decline in the percentages of respondents who belonged to fraternities or sororities 1 1691*: iii I993. 14% iii 1997'. 1491-. in 1999. and 1291: in 2111111. 31:311. N = 26.1312} = 60.3: p s: 1111-111: and in the percentages who lived in Greek houses 13.399 in 1993. 2.9911 in 1997'. 2391'- itt I999. and 2.5% in 21101 1. 31311. N = 26.032}: [13.2. p r: 1111111. College Binge-Drinking Hates fiver Time Fietween 1993 and 213131. we observed an increase in the binge—drinking rate at so (52%] of the l 19 participating col- lege-s. although the change was statistically significant at only 5 schools 139?]. Fly contrast. we observed a decrease in the hinge-drinking rate at 52 [sit-19H schools. but it was sta— JDUFI'NAL GF AMERICAN CGLLEGE HEALTH tistieally significant at nnly 5 sehunls {9%}. We edndueted an everall trend analysis in the seltdul-level binge-drinking rate amung l I? sehuuls at fnur time paints [Table | 1. These data shuwed nn linear trend in the sehnelulevel binge—drink- ing rate ever time. In additien. we ubserved nu signlfieaut differenees in binge drinking rates ever the. 4 survey years TABLE 1 Repeated Measu res Binge-Drinking Hate Ameng 119 Seheele [N = 4?5) Variable CeetT SE n ltltet'eept irate in 19513} 114333 [MILE a: .t‘lfltll 1t’ear ti}. 4. 6. St [Ltlil33 11111023 .2433 Respnnse rate High (3:: Til‘i'rttl Referenee — Middle tStl 'ltl‘i'ri [1.0239 tlflfilti .45Iti Lew te Stl‘iiwi 2-15254 liillfi .Efii'fi Year is an Respnnse Rate interaetinn [Lilli-4 HUI-239 -25 IE Nnre- "r’ear was ended as ll till-1H]. -'l [HUTL ii (“399). nntl ti {Mill l. HINGE rDFi'lNK av G TRENDS ameng the sehnels with high. middle. and law respense rates. as well as ne interaetiun between survey year and respnnse rate. Student Drinking Behavior Drinking patterns at" students river the 4- surveys are shnwn in Table '2. Remarkably similar prnpnrtinns df stu— dents were elassitied as binge drinkers in Ellill as in previ— nus survey years til-4.4%]. The prnpnrtinn til' binge drinkers. with l'ew eseeptinns. else did nnt ehange between 1993 and Efltll in must student and edllege subgreups {see Table 3]. The rate bf binge drinking arming students living with a sptiuse nIT eampus was significantly higher in BUD] than in earlier years. We neted signi’rieant deereases in binge drink— ing uniting Hispanie and Native Arueriean students and res- idents ul' fraternity nr snrnrity hnuses btlt nnted nn similar deerease in fraternity er serurity members everall. filthuuglt the overall rate ul' binge drinking did nnl ehange between |993 anti 2001. evidenee til a trend tnward pnltuiaatinn nf drinking behavior has enntinued sinee the seeend CAS survey. Abdul | in "l tlti‘iin students abstained frntn alenhnl during the past year anti l in ii {Emit} engaged in frequent binge drinking in [993. whereas 1 in 5 tl‘J'ibj TABLE 2 College Student Patterns 01 Aleehel Use: 1993, 199?, 1999, and 211111 is prevalenee in eaeh survey Etltlld DR Drinking pattern 1993‘ I‘M?“ 1999‘ Past year drinking 'l'ntal l9}! Female EELS Male Tilt} Binge dtinkers Tetal . ' 44.5 Female . 39.4 Male - . fitll nbstainers Tutal ' - ' [Elli Female 19.1 Male 20.5 Hen—binge drinkers 'l‘nta] Female Male Deeasienal binge drinkers Tntal Female Male Frequent binge drinkers Tntal IQ? Female l‘?.l Male 22-4 t-a— FED EH is: lsJ Is.- Lrl Ci [v.1 “and Lu Ch erl'f'. UH = edds ratin: CI = eenfidenee interval. “n = 5.232. “n — H.423. 'n = 11954.".42 ltl.9tl4. *p t: .Llfi‘. “n- «I. .ill: “in 1:: .tllll. VDL 50. MARCH EDGE Change nver time Ziltll vs WEB 9.5 '51" Cl Test l'ur linear time trend 1:- 83.? tl.i'tf:-. 0.39%“ s“. .tliltll 3 | -3 [18 I. [139* .flt'ld'ii T99 {Hit}. 034*” ' .Clflfll 44-4 I196. Lilli .4354 any Ltltl. l.|'ir .liliiEl 431‘: [1.39. It]? .Eltlltl lialh'l . |.l' IKE . Lil Elli l.l . 2i++ ..aeai . 4i .ae42 .ssrsr issn II I. 36.3 ' ' till 1. il.92*** .[lfl'lJl 4tl.4 i131]. titlst .lltlfll 3L3 U37". 093*” - .lltltll Elli: [Hit]. H.923” .tliltll Elli] . . tl.‘Jl"'-"* .t'liltlfi 23.4 - _ . “93*” .flflfl—“l- T31"; . . .. |.'_l[l*i”" gas: .2" . . L4H*** . L29*“* ED? WECHSL EH ET .41. TABLE 3 Patterns ef Cellege Student Binge Drinking Ameng Suhpepulatlena. 1993. 199?. 1999. and 2991 '11: prevalenee in eaeh survvffi 1C haraeteri stie 1993” I997111 I999L Gender Female 39.11 33.4 39.4 Male 49.2 43.5 511. Ethnicity Neu-Hispanie 44.3 43-1r 44.3 Hispanic 39-? 37-1 41-11 1|While 49.5 411.2 511.1 Blaekr'Afrieau Ameriean 115.2 111.5 12.5 AsiaiLI'Faeifie Islander 23.] 24.4 23.3 Native Anteriean indiaru' flther 39.3 32.9 42-15 flge 13’} e 21 45-5 4415 44-9 21—23 411.1 41.5 511-3 3? 24 211.5 211.3 29.1 1“fear in seheei Freshman 42.9 42.11 42.11 Sepheinere 4 .4 44.13 44.9 Junier 44.4 44-11 411.3 Senier 42.11 41.7 45.9 Resident-1: Hen—substanee—free residenee hall 41%.? 45-11 44.5 Suhstanee free residence hall 34.? 32-5 32.1 Fratemitw'sereritv 113.4 1.12-15 1111-3 12ft" earnpus. a1ene. er with a teammate 54.1 53-5 515-2 1.111 eanipils. with a speuse 111.5 211.11 22.9 1111' earnpus. with parents 29.? 211.3 29.11 lr'raternitjrfsereritv memher 111.4 111.4 115.2 .-"1’ete. 1111 = adds ratie: 1.".1 = eent'idenee interval. "n — 152112.111 — 14.4211. ‘rr — 12.954. "rt '— 111.9114. 1;: e .115: 11;: -e .111: “fir: s: 111111. students was an ahstainer in 211111 and l in 4 12391:) was a frequent binge drinker. The pereentage ef students whe repertetl retrespeetivelv that the}I had engaged in binge drinking during high seheel 13291 in 1993. 311% in 199?. 31193 in 1999. and 21191: in 211111 1. 11311. N = 25.411111 = 1211.3: p e 1111111. deelinetl sig- nifieantly. The rise in abstaining and frequent binge drinking between 1993 and 211111 was sigttii1eatit in ttiesi student and eellege suhgreups- with miner eseeptiens- We feuntl an inerease in abstentien hut net in frequent binge drinking ameng Hispanies 115911 in 1993 and 19% in 211111: (1R : 1.42; 95911 C1 = 1.09—4.34: iv = 111111191; Native Americans [1159? in 1993 and 22911 in 211111; 1111'. = 1.44; 9591: C1 = 1.13—1.83: p = 111131}: students whe lived in residenee halls 111191111 1993 and 2191"- in 211111: DR : 1.22: 9591 C1 = 1.112—1.33:p = 11112111: and fraternityr er sereritv heuses 1 191: in 1993 and 691: in 211111: OR = 5.32: 9591' C1 = 21113—13113: 2113 Change ever time 201“ 1'3 111113 Test fer linear 2111.11IJ DR 9591- C1 time trend te 411.9 1.118 1.1111. 1.17 -111211 43.11 11.91Ilr 11.39- 1.112 .9921} 45.2 1.114 12.92. 1.12 .26211 34.4 11.11111 11.65.11.921“ 21111} 511.2 1.11.1 11.911. 1.1 I 34111":- 21.1II 1-2111 11-92. 1-1111 .1455 215.2 1.111 11.1111. 1.52 .4334 11.11.11 11.211 11.115. 11.1.14?”it .1312 43.11 11.911 11.115. 1.111 .1 122 511.2 1.119 11.93. 1.211 11553 311.9 1.12 11.92. 1.32 .3325 42.4 0.93 11.35. 1.12 .11591 ' 2.3 [1.911 11.311. 1.111 .1211] 45.9 1.1115 11.94. 1.211 -2225 44.9 1.119 11-92- 1.21 11645 45.2: 11.94 11.115. 1.115 .1413- 252 1.1.1.1 11-1511. 1.1.1 .9912 25.4 11.151 11.42. 11.111111 112.12 54.5 1-112 11-1111. 1-1.11 -4451 211.5 1.1111 1.24. 2.115111”: .1111112 511.1 1.112 11.1111. 1.18 11111.11} 114.3 11.32 11.24. 1.113 .111311 p e- .11111111: these living with parents eff eampus 1229.5 in 1993 and 22911 in 211111: OR = 1.311: 9591*- C1 = 1119—1-55: 1n = 1111291: students attending seheels leeated in the Herth- east 11291: in 1993 and 15% in 20111: OR = 1.25: 959? CI = 1.115—1 .411: r: t .111 22.1: and rural areasi’srnail tewns 1 1491? in 1993 and 199:5 in 211111: 12R : 1.41: 9591: 1:1 : 1.211—1 .211: p «1 .11111111- 133' eentrast. a rise in frequent binge drinking hut net in absteniien was reperted arneng seniers {1991* in 1993 and 2-191. in 211111: 1:113]. : 1.22:9591:121= 1-115 1.42:1? =.1111311: students whe were hinge drinkers in high seheel {41199 in 1993 and 41191".1 in 211111: OR = 1.29: 9591” C1 = 1.174143: ,9 =: 1111111}: these living eff campus with a spetise 1351:- in 1993 and 391. in 211111: OR = 2.33:95‘2-C1=1.45 1.29:1: e 11111111; students attending eemmuter seheels 11 191: in 1993 and 15% in 211111: OR = 1.411: 9591: (“-1 = 1911—1911:}? = 11111111; these attending highly eempetitive seheels 11291.- in 1993 and 211% in 211111: 1211 : 1-23: 9591: C1 = 1.118 1.411: JGUHNAL 13F AMERICAN CDLLEGE HEALTH p : .9924}: and students in sehnnls lneated in the western regitin iii the 115 [1391'- in 1993 and 1591 in 2911]: UR = 1.113: 9591- C1 = 1.114 1.415; p = .9136]. The rate nf abstain- ing in all—wemen's enlleges deereased signifieantlg ever the 4 study years [25% in 1993 and 9.19%: in 21391; DR = [1-95: 959? C1 = 11.51—11.31”; p e .t][1[111: whereas frequent binge drinking inereased in these sehnnls [5% in 1993 and 1291". in 2991: {JR = 2.40; 959%- CI = 1.35—3.11;pe.f}flfl|1. The nuniher nf students whet reported an extreme drinking HINGE-DRINKING TRENDS style inereased signifieantiy between 1995 and 21101. A sig- nitieant increase in heavy drinking that was ennsistent with the nhseruatinn nf inereases in frequent binge drinking neeurred nn measures nt' 111 nr ninre drinking neeasinns in the past mnnth. ineluding drinking tn get drunk as a reasnn t'nr drinking and drunkenness 3 er mnre times in the past tnnnth {summarised in Table 41. The rate er" having 4 {51' mere drinks ran an eeeasinn alse inereased frntn 471% in 1993 tn519’a1112991 tOR=1.19;9591~C1=|.|1-|.Efi;p«:.99911. TABLE 4 Drinking Styles nf Students Whn Cnnsumed Alenhnl, 15193, 199?, 1999. and 2991 Change ever time 9&- preir'aienee in eaeh surge}r 1993” 199?" 1999“ 111111‘1 2991 vs 1993 _ _ Test fur linear 959‘"- CI Drinking style time trend p Drank en 11] nr inure neeasinns in the past 511 days Tntal . . 23.] anen - .. . 15.4 Men .. » 311.1 1|t't’as drunk 1-" .1 times in the past 511 days 'I'utal 39.1} 31.1.3 Wumen 1111.9 211d 25.1] Men 25.11 35.15 55.3 Drinks tn get drunki' Teutal 39.9 53.5 471-? Werner: 35.9 43.4 42.4 Men 4-1.4 59.1 511-1 1.35. |.-1ti'*‘”* 1.3.15. 1.559“ 1.22. |.5T"‘"‘* Nurt- filth,r students wltu drank alenhnl in the last year are included. 09. .-. ndds ratin; E1 = ennl‘ulenee inter-trail- tRepurt that drinking “tn get drunk" is an impenant reasnn Fnr drinking- 9r = 12.71.15. “a = 11.5915. "a : 19.511551 - H.793. ** fir: -: .1191. TABLE 5 changes in Binge-Drinking Hates Among anen at All-anen‘s and Ceeduenttnnal Cnllngee. 1993. 199?. 1999, 2091 “Variable 1993 1997 1999 2111.11 DR 95%- L'l'l' ss uf students in till-“'Ullltlti'h sehutils 2.3 Binge .-"t|1-wnmen's 24.5 9.99. 1.85 9.99. 1.1? feed tenlg weinent 39.3 Ahstttinfrs 9.1531. 9.931 1 1.111. 1115* .fitli-wnmen's 25-9 Lined tnnlg wnment “5.3 Frequent binge All-wumen's 5.3 1-1.9 Cured tnnly wentent 1?.4 19.3 1.151}. 2.99"“ 1.15. 1.4U*** Mirth HR = t'H‘ll'I‘. Latin; {"1 = eunl'idenee interval. 'i't‘uutmiled her age. raee. and response rate. “in e .95: “p «a: .111: “"1: «1.1191. 901. 519. MA HCH 2992 299 WECHSLEH ET Al. Most of the increase occurred between [993 and 199?. and the change was not strong between 1991[ and 20m . Drinking Behavior Among 1llit'omen (All-Women’s Schools ve Coeducetional Schools} To examine the changes in hinge drinking among strtdents at all-women’s colleges more closely. we separately exam— ined women‘s college students anti women who attended coeducational colleges over time {see 'l'ahle 5}. Frequent hinge drinking increased atttettg students at all—women's col— leges and among women attenting coeducational seltools. but the increase was not of the same magnitude as the change among students at all—women's colleges. Ahstaining from alcohol decreased among students at all-wortten's colleges. whereas we found a small but significant increase in the num- her of ahstairtets among women attending coed schools. We noted an increase in binge drinking among sturlents at all— women‘s colleges. although it did not reach statistical signif- icance. but there was no cltattge in hinge—drinking rates among women at {:tttltlLttlflllttl'litl colleges. Alcohol-Related Problems Prohlems related to alcohol use arttorig students who drartk alcohol during the past '31] days remained steady or increased slightly over the it years of the study {summarised itt Table I5). Artteng studertts whe censurtted aleoltel it] the past 30 days. we observed significant increases between 1993 and 20f}! in their having trouble with the police l4.fi% in [9'93 to £1599 in 211191} and getting hurt or injured {9.3% in 1993: to 12.899 in 2001}. We also noted significant. though slight. inereases in academic and interpersonal problems. although most of the changes in these rates occurred between I99}: and 1997. One iii 5 drinkers reported experiencing 5 or more problems related to their alcohol use. a rate that was consis— tent with previous results. In addition. we observed a significant increase among all students it] reports of ridirtg irt ntoter vehicles with drivers who were drunk or high t Iii-45's in [993 anti 23-29}. in 29f”: OR = 1.34:959H31 = 1.24— L44: p dill-{1111'}. Secondhand Effects of Alcohol Use The 2110] study found that high proportions of non—hinge drinkers and ahstainers who lived in on-eatttpus housing or in a fraternity or sorority house experienced negative effects from their peers‘ drinking. which was sintilar to our findings it] previous studies (Table Tl. The seeortdhand elTeets experi- enced tnost frequently were having studyfsleep interrupted [(19%). having to take care of a drunken student [-48%]. and being insulted or humiliated 112991}. Fifty—five percent of the students surveyed had experienced at least 2 secondhand effects. hut no clear pattern of change in the rate of second hand effects emerged over the 4 study years. TABLE 9 Alcohol-Related Problems Among Students Who Drank Alcohol. 1993. 199?. 1999. and 2991 Change ever tintc 2091 vs I993 95% Cl Prevalence in 9.5. .-"r|coho1--related problem 199':Irh 1999“ 2li-tlld Test for linear time trend p 21f] Miss a class Get behind in school work Do something you regret Forget where you were or what you did Argue with friends lingage in unplanned sexual activities Not use protection when you had sex [Jamage property Get into trouble with the campus or local police Get hurt or injUred Require medical treatment for an overdose Drove after drinking Have 2 different alcohol" related problems 4.15 9-5 11.5 2ft.ft the 29.9 ' - .l l .915. 2 “.99. L015. Ill? |.t'14 15.5 L25 I13 . 1.29 [1.3 . Li]? 2911 . - lflsl l2? isssss . l.l9 . L5H” . L95*** . Lsrrrr .2911“ .|.21** . l.39*** - .tiflfll .0904 ‘. .Uflfll .UUfl5 .{itifll .flflfl2 .lii4il .iilliil .i'll'lt'l | .flUfl l .03 34 ill] I ll .9in l Note. Analysis limited to only those who drank alcohol In the past year. 9? is the prevalence of those who had the problem one or more times since the beginning of the school year. {JR = odds ratio: CI = confidence interval. 'Jrr = 12.298. “a = 1 |.511o. or = H.325. "n = 3.235. *pr: .95: *t r: .fil'. “*p e .1191. JDUHNAL E'F AMERICAN COLLEGE HEALTH BtNGE—DHINKFNG TRENDS TABLE 1' Seeendhend Binge-Drinking Etieets en Hen—Binge Drinkers in Residence Hall or FreternitytSerertty Heuse 9r prevalenee in eaeh survey I999” Seeendhand ett'eet 1993* 1 997:- Been insulted er humiliated 29.5 23.9 Had a serieus argument and quanel Heen pushed. hit. er assaulted Had year preperty datnaged Had te take eare el' drunken studettl Had year studyingtsleeeing interrupted Experietteed an unwanted sexualadvanee Been a vieth ef sexual assault nr date rape+ . e 2'. seeendhand et't'eets 53,] let-l l9.tl 9.1": HH- ' lll't ii? 491‘: M9 13-? T 5 1. 55. 29.5 [9.2 Hill 13- | filll] tfhange ever time 'l'est fer linear time trend p Etltll vs I993 DR 95 9?- Cl ll.99 [Li-it]. H4 .9423 I .16 9-97". L39 .llTlltl' .1T93 .lifil {1115. l.ll4 Lilli. |.."tE ti.9t‘:-. Lin .9330 ill-:7". 1.16 lift l.ii4. 1.4m est test HES. 1193* {1.94. 1.26 Net-r. lneluded enly ahstainers and nen hinge drinkers 1TI derms er t'raternityt'sererity heuse. HR = raids iatiu; tL'I = eenlidenee interval. 'i‘Wemett tutly. '99 = i1.Ttitt. "tt = 1|.5tlt‘t. "n — litt-tEfi. "it = Hits] it: s: .95 We examined the seeendllattd elTeets ef' aleehel Lise aeress types ef living arrangements. The rate ef seeendhand et'l'eets was higher ameng residents itt fraternity er sm'nrity hettses than ameng these whe lived in residenee halls. Ameng students living itt residenee halls. these in sub- startee-lree living arrangements experienced fewer seeend- hand effeets than these living itt residenees where smelting and aleehel use were net explieitly restrieted. In sue]. a in it] t339t-t til the inhabitants ef fraternity er seret'ity lteuses and 't‘ in It] @995} ef the students whn lived in nttn~stlhd stance—free residenees experieneed at least 1 er mere see— undhand eliteets. eempared with a in [U t589tt ef students whe lived in suhstanee-t‘ree residenee halls. This pattern was eensistent ever the survey years. Drinking Ven ues Data fer seleet drinking venues aeress eaelt til the 4 sur- vey years are shewn itt Table 3. Student altendanee at resi— deuee hall events er parties did net Change ever the study pet-ind. The rate et" heavy drinking inereased at these venues. altheugh mest et‘ the ehange eeeurred between 1993 and 1997. Attendanee and heavy drinking at fraterni— ty and sernrity heuse parties eaeh significantly deereased between I993 and Ztitll. t—‘tt the same titne. we Fttund an inerease in heth attendauee and heavy drinking at eff—earn— pus parties. filtheugh the prevalenee nl' students whe went te eff—campus bars deereasetl between 1993 and EUU'l. llte rate el drinking 5 er mere drinks in the bars was higher in Elltll than in [993. VOL 50. MARCH 2992 Trends in Experience at Preventien Efforts Students were men: likely tu repun heing expesed te alee- hel edueatien ttrngrarns differing in heth fermat and eentent in Edit] enmpared with 1993. “they reperted that they were mine likely te attend leetures. meetings er wnrksheps. and speeial eellege etturses in Etltll than in 1993. but they were less likely tn see edtteatienal posters. signs. anneuneements. nr artieles. A signifieantly inereased prepertien et' students repened reeeiving all types ef infermatien item the eelleges between I99}: and EUUI {Table 9}. Natieually. mere than half ef all students repetted that their seheel previded them with int"an tnatitnt ahttut eellege rules geverning aleehul use. the penal— ties fer breaking these rules. and where in get help fer aIee- hut-related pt'tthletns. We nnted slight inereases in the pereentages ell students exposed in this infertnatinn ever the 4 CA5 studies. In l993. enly about i in 3 students reported that their seheel gave them inlermatien aheut hew te reeeg- nixe a preblem drinker. the hing—term health efi'eets el heavy alenhel use. and the dangers ef alenhel nverdese. We ehserved signifieant and suhslantial inereases in the percent- ages ef students whe reperted that they were previded with this int'ermatinn aeress the 4 surveys. attd mere than half et" all students reperted that their seheel tnld them aheut the dangers et' aleehel everdese. Further examinatien suggested that these students whe were hinge drinkers er had deme- graphie eltaraeteristies that plaeed them at greater n'sk fer heing hinge drinkers were previded with this infennatien. Students reperted that eelleges reel-z strenger aetiett te 2H WEGHSLEH ETAL TABLE 11 Attendance and Heavy Drlnlttng at Select tin-Campus and Diff-Campus 1.tt'enuea Change ever time 'l'est fnr 1-11: Prevalence in each survey 311111 ‘15 1993 1111131” 1iv’enne 111113" 11:11:11”3 1999" 211111IJ 115131: 121 time trend 1: Damn event nr party ‘31.- attending ' . .. - . . 11.91. 1.11 -5335 ‘31.: ennsnming .‘e 5 drinks . .' . .' . . 1.111. 116*” .flflDE 1iraternitvtsnrnrit}.t part3.r 111 attending . . . . [1-132. 11.111111‘1‘1‘ c 111.1111 1:1: ennsurrnng E 5 drinks . . . . - . _ 11.24. 11.111 .111112 fo-earnnus party 11’s attending . . . 1.12. 1.41 1”“1 r: .1111” ‘11:- ennstttning :E 5 drinks _, .. . . ..' 1.211. Litres c: 1111111 Giff—campus hat" 1311 attending _ ._ . 7111.11 11.31]. 11.95” .1111] 2 '11: cnnsnrning 13: 5 drinks . ' ' 23.111 32.5 . 1.41.1. 1.83111“?- :: 1111-111 hie-rs- Percentage is based nn the tntal students in the survey whn dranlt alcnhnl in the past 311 days. L111 = ndds lane: LII = etinfideriee Interval. “r? = 111.1311. ".11 = 11.41111.” = 11.117531“ 2 7.311141. “in s. .11]: *“p c.11111. TABLE 9 Eitpcsure tc Educaticnal Materlals Change ever time ‘11: prevalence in each survev 211111 vs 11:11:13 'l'est tint linear Educatinnal material 11-1113“ 111117“ 1111111" 211111‘1 951g. {fl ttnte trend .1) Direct educatinnal prngrams Lectures. meetings. nr wnrkshnps - 1.14. 141*“ n: .1111111 Special cnllege cnnrse -. 1.211. 1.111111“ 6: .1111111 1ndireet edtlentinnal prngrarns Mailings nr handnuts 11.85. 1.1111 .Et‘ifij Pnsters nr signs 1512.11 . [1.34 11.15. [1.941111 11253 Annnuncement nr articles 51.2 . . 11.111": 11.12. U.‘11’* .1211 1 were. L111 = ndds ratin‘. CI = cnnlidenee 1ntervul. :it = 15.2132. "n = 14.4211. “n = 13.954. in = 11.11.1114. *p c.1111: “‘11 a: .111: “1;? r: .1111]. address heavy drinking in 211111 than in 112193 fnr drinkers anti percentage nfsrudents whn mpnned that; the}. heel received a separately fnr frequent hinge drinkers. In an analysis limited tn warning did first significant”- changu. In 211111. 5% at stu- students whn drank alenhnl in the past year. students repeated dents whn drank alenhni in the past year espcrieneed at least increases between 11-1913 and 211111 in 5 selected ennsequenees ] ni' the 5 ennsequenees. whereas 411- did sn in 19113. We impnsetl h}: cnllege authnrities. pntential ennsequenees nnred a similar pattern. with minnr exceptinns. when we included being fined. attending a required edncatinnal prngrant. cnnsiclered frequent hinge drinkers enlv. Repnrts nt' receiv- perfnrnijng cnntmnnity service. being referred tn a treatment ing a warning decreased. hut reperts nf receiving nther dis- prngrant. and receiving ntherdiseipiinary actinn. [n enntrast. the eiplinary actinn did nnt change. Despite these increases in 212 JOURNAL DF AMEHJ‘CAN COLLEGE HEALTH various disciplinary actions. the overall percentage of stu— dents who experienced these imposed consequences for their drinking in 20-01 remained small [summarised in Table 10]. Student reports of the consequences imposed by a college for student drinking at residence hall or campus events also changed between 1993 and 20111. Students who lived in res— idence hails were less likely to be searched tor alcohoi when entering a residence hail [3.9% in 20111 and (1.093 in 1993; DR = [1.64: 95% CI = 0.46—0.33; p s: .Ufll’ll}. 1n arm]. stu- dents who attended any on -cantpus events were more likely in he at a campus party that was shut down because of alco- hol rseew in 2UUI and 22.3% in 1993; OR = 1.26; 959i:- [‘1] = l-1U—1.r-14;p = .UflflZ). Changes In Views of Alcohol—Control Policies In 21111. a majority of students supported a selected set of potential alcohol-control actions or policies that a college could enact. The most popular suggestions were clarifying the alcohol rules {9393-}. providing more alcohol-free recre- ational and cultural opportunities {89%i. and offering more EiNGE-DHWKWG TRENDS alcoholafree residences ($993.1. Policies such as holding hosts responsible for problems front alcohol use (55915-1. banning alcohol advertisements on campus i_559i-_'t. cracking down on drinking at sororities and fraternities {saw}. prohibiting kegs on campus tours}. and enforcing rules more strictly 163%] were also supported by a majority of students nationally. Among these. support for prohibiting kegs on campus (HR = 1.14: 959i: C] : Lilo 1.26; p «c .1191 J. offering alcohol-free residence ltmIs [OR = 1.72; 9591: C1 = 1.52—1.94: p s: 1111]}. arid banning alcohol advertisement on-campus {OR = 1.29; 95% C1 = 1.22—1.33; p s: .0011 increased significantly between 1993 and 20111 . Meanwhile. student support for pro— v iding more alcohol-free recreational and cultural opportuni- ties ifiR = [1.46: 95%: Cl : 1141—1152; p e .9111}. enforcing rules more strictly [OR = [1.76: 95% C1 : 9.22—9.81: p e: .0111}. and clarifying the alcohol rules (OR. = [1.152; 959% C1 = 1153—11126: p s: .1111} significantly decreased over the same period. Although the views of some policies increased and some decreased or stayed the same. more than half ofthe stu- dents supportetl each of these alcohol-control policies. TABLE 11] Exposure to Imposed Consequences for Drinking Prevalence in rii.- 1 99‘s}c 1 993'L 199'?“ Consequence Received warning 'l‘otai Frequent hinge Was fined Total Frequent hinge liir'as required to attend an alcohol education prograrrt Total Frequent binge Ilad to perform corntnurrity service 'i'otal Frequent hinge Was referred to an alcohol treatment program Total Frequent binge Received other disciplinary action Total Frequent hinge Any 1 of ahovet Total Frequent hinge 4.13- 3.2 3.9 9.2 5.1 31:: lEhange over time Test for linear time. trend p 21:11:11 vs 1993 DR 95'} {Ti 1123. 1.1 1 ans. 1195"" 1.96. 131*“ 211.5 1 as 2.5? 1.6? 4.711 2.2? 3.15. 1112*” 1.23. 4.113“ 1.21 1114 1.31. 223*” {1.23. 1.43 1.311 1.112 tor. tosses p.34. 1.3a More. Analysis lirnrtcd to only those who drank alcohol within the past year. Uri". = odds ratio: (".1 : confidence interval. “I‘Reeervmg a warning was escluded from the measure- “n = 12.21.13. "rr 2 11.53133”: lflJ'l-lfi. do = 3.233- “p e .Ufi: “p e: .iil'. *“p e .t’tfil. VGL 5:9. MARCH 2992 2'13 WECHSLEH ET AL Peer lnterventien in flthera’ Aleehel Use In 206]. 35% ef nen hinge drinkers asked semeene te step drinkittg. whereas 32% did se in 1993 (UR : 1.12: 95%- C‘l : LUZ—1.24:}: = .iilfi'i'}. Students reported that they eemv plained re a cellege effrcial er resident adviser sheet the beltavier ef intesicated students in Etitll at the same rate as they did in [993. Changes in Self—Fleeegnitinn ef Drinking Preblems in 'ltitll . 4.2% til‘ students whtr drank alcehel iii the past year described themselves as heavy er prehletn drinkers. lifti- hatl ever Lireuglrt they had a drinking prebleni. and 3% received cettnseling ttr treatment ftir an alcehel-related prehlein. These rates did net differ frem these in 1993. The prepertitin trf stu- dents whe seught help because ef alcehel preblettts signifi— cantly decreased t'retn 2.4% in 1993 te 1.5% it] ZWI [OR = flail: 95ft. Ci 2 il.48—i.l.8l; p a: .tlfllll l. When we censidered data en enly frequent binge drinkers in Etltll. lrt‘n: described themselves as heavy er preblem drinkers. 23"}?- tlteught they had ever had a drinking prtihlem. ’2'}? hatl ever sriught help. and an received ceunseling er treatment fer an alcehel—related prnhlcrrr. These rates did net differ frem these in 1993. Cfll’t‘lMENT A Cautienarv Nete Abeut Student Surveys The data presented in the current repert sheutd be inter— preted with eautitin. Resptnrses tn the CA3 survey are self- t‘eperts in a mail questiennaire- As srrch. they are suhject tn serrrces et' errer asseciated with this apprtiach, including irrtentienal er unintentienal respertse distertien and sample attrititin ttr failure ttt rcsptinti. Self-rcpnrts til' alcehel use are censidered te be reliable and valid. 1" i' The respense rate fer the CA8 has declined since the ini— tial survey in “993, antl this tlccline may affect the results til‘ the current survey. It is difficult te predict the directien ef the peterrtial bias that this increasing trend ef nenrespense may have prndtrcetl. Tn prritect against ntinrespense bias. we instituted several statistical eentrels and feund ne asse— ciatien between student respenses and binge—drinking rates. 'Wc ftiund nti difference in the respense rates ttl‘ early and late respenders te the survey. and between respenders and a sample ef nenrespenders whe were settt a shert versien ef the questierrttaire. The rate ef hinge drittkitrg i'eund iti this study was the same as that ebtained by ether tnajer natien- ai surveys ef cellege students. Mereever. the rate ef binge drinking acress the 4 survey years has remained remarkably censistent. and efferts te esamine the influence ef respense rate statistically have. revealed little effect. The same type ef students and celleges eshihit similar hinge—drinking rates each survey year. As a further preeautien. we used a weight- ing precedtrrc in the current study tti ctirrect fer ptitential differences in respense anteng demegt‘aphic stlbgreups in the sample. The CA5 is a natienal study with a very large sample sire. and the present analysis centains a large numher tif staw 21-4 tistical tests. Seme statistically significant differences may he ehservcd by chance ale-rte. Te pretect against this peten— tial prehlern. we cencentrateti en statistical significance at enly the .tll level and beyend. and we fecrrsed eur discus— sien err patterns ef results. We alse censidered the magni— tude t‘rf difference in ear discussirin tif the findings. Findings and COHEIUSIDHS The “lilill rates tii' hinge drittkittg at the l [9 CAS celleges were remarkably similar te these fettnd at the same institu- tiens in l993. WW. and l999.'~'-‘~33 Natienally. 2 cf 5 undergraduate ctillegc students were hinge drinkers. a rate that has net changed since [993. 1When we esamined changes acress the survey years at individual seheels. we l'ettnrl significant dreps in the nverall rate ef hinge tirinking tit enly a few celleges and significant increases trt an equal— ly small number. He pattern emerged that ceuld acceunt fer these changes. and the findings may have simply ticcurrcd by chance. We alse feund that the pelariaatien ef drinking behaviers tin campus. first repttrted in 19913" has ctintinucd. in 2fltll. tr higher percentage ef cellege students than in [993 repert- ed that they abstained frern aicehel. At the same time. a higher percentage trf .slutlcnls engaged in frequent hinge drinking. We feund that in Etltll mere drinkers ceuld be viewed as drinking te escess en such measures as frequen— cy tif drinking. frequency tif drunkenness. anti frequency ttl‘ drinking te get drunk. which is censistent with the finding that mere students are frequent hinge drinkers. This higher level tif immtiderate etinsrtmptitin prnhahly accnttnts fer the increase in the reptirted arneunt tit~ self—induced harm drinkers caused ever the study peri ed. Al the same time. i‘lt‘lliwhiflgfl drinkers whe live nn cant- prrs were net esperiencing an increased level ef secendhand effects ef alcehel. Previees findings frenr the CA3 survey rlata ntrtetl a streng relatienship betweert the rate ef binge drinking and the esperience ef secendhand effects ameng lien—binge drinkers.“ A clnser esaminatittn revealed that althertgh there were few changes in the rates ef secendhand effects ameng these whe lived in substance—free lieusing and attic-rig residetrts tlli ntin-suhstancc—i'rcc htiusing. the number tif students living in substance-free hetrsing natien— trlly increased significantly. Because substance-free heusing helps pretest students frern esperieneing secerrdharrd et'fects.-if placing mtire students in such settings might have helped keep the everalt rate frem rising at a titne when fre- quent binge drinking was increasing natienaily. Substance- l'rcc residence halls represent tine prnntising strategy fer reducing preblems with alcehel because these residences effer seme pretectien frem the seeendliand effects ef etltet's' drinking and [night pretcct these whe did l'ttlt hinge drink in high scheel I‘rtntt binge drinking in cttllcge- it is interesting that the everalt rise in frequent binge drinking eccurred sitnultaneeusly with a decrease in high scheel binge—drinking rates repeated by these students. in ear previeus studies. we friend a strung reiatitinship between high scheel and cellege hinge drinkingH and a JGUFI'NAL DF AMERICAN CDLLEGE HEALTH lnwered likelihtstd nt' binge drinking in cnllege if high sehnnl nun—binge drinkers were hnused itt substance—free living quarters.“ An increase in the use at such residences and a decrease in high schnnl binge drinking shnuld result in lnwered cnllege binge—drinking rates. That it did nut tin sn suggests that nther factnrs are keeping nverall binge- drinking rates it] cnllege at these high levels. Althnugh the nverall binge-drinking rates have ttnt changed. there have been shifts itt drinking hehavinr arnnng snme subgrnups. in 1993. students attending all-wnmen‘s cnlleges had much Inwer rates nf binge drinking. and atten- dance at these schnnls seemed tn prnteel wnmen frnm a heavy—drinking lifestyle.“ Since that time. students at these schnnls have repnrted significant increases in frequent hinge drinking. and they are new narrtrwing the gap in drinking behavinr between all—wnmen‘s cnlleges and cned- ucatinnai schnnls. We alsn nnted increases in bingeadrink- irtg rates amnng students living nff cantpns with a spnuse. which man frnm 1951? in 1993 tn ET'EFE in Hill]. The prnfile nf cnllege students is changing rapidly. Mnre wntttcn. mttre part—time. and meta nnn—traditinnal-age stu- tlents as well as mere students nf cnlnr are attending cnl- lege-“t these students tend tn he at the lnwest risk fnr engag- ittg iu hinge drinking.“ Hewever. the majnrity nt‘ cnllege students enntinue tn be these whn are aged IS tn '33 years. have never married. and live independently nf their parettts. In the 200] sample. we clnsely esantined the drinking behavinr nt' these traditinnal cnllege students and fnund high rates nf binge drinking. In this grnup. 51.5% were binge drinkers [55.5% nf the male students: 43115? nf the female students}- Amnng subgrnups nf students within this grnttp nf tra— ditinnai cnllege students. hfl.5‘}’t. nf White men and 54.3% nf White wnmen were binge drinkers. as were T5.|f‘rt:- nf fraternity members. ell-4‘}? nt' snrnrity members. 6351 cf tnale athletes. and 53.5% nf female athletes. Amnng tradi- tinnal cnllege students whn drank any alcnhnl in the past year. Till- as were binge drinkers {67.3% nf the wnmen and T315551 nf the nteni. The high rate nf binge drinking amnng these cnre grnups ttf cnllege students indicated that heavy drinking is nnrmative behavinr arnnng typical cnl- lege students. There is alsn sntttc gent! news frnm the EDUI findings. Fewer residents nf fraternity and snrnrity ltnuses engaged in binge drinking nver the 4 studies. Althnugh lhe rates fnr this student grnup remained very high. nur findings may reflect cnncerted effnrts nn snme campuses tn address the must estrente drinking behavinr by suspending nffenders nr insti— tuting alcnhnl bans at same chapters. The same. dnwnward trend was nnt nnted fnr all ntembers nt' fratemities and snrnrities. altltnugh the percentage at students whn were members ttf these nrganizatinns was significantly smaller in Edit] than it had been in the earlier studies. Significant declines in binge drinking were alsn nnted t'nr Hispanic and Native American students. ridditinnal pnsitive indicatnrs nt' change regarding drink- ittg nu cnllege campuses include the fnllnwing: VGL 50. MARCH 2002 HINGE-DRINKING TRENDS - An increase in repnrts nf students askng nther students tn cut back nt' stttp using alcnhnl. - An increase in the numbers nf students in Etlfil whn repnrted sttppnrt fer snnte strnrtg alcnhnl pnlicies. including prnhibiting kegs. banning advertisements. and nfferittg alcnhnl-free residences: a majnrity nf students natinnally suppnrted these pnlicies. The increase itt awareness nf heavy alcnhnl use as a majnr prtthlem amtmg cnllege students. whiclt may he ctmtribut— ing In these findings. Cnllege students may be well ahead nf cnllege administratnrs in suppnrting tnugher measures tn deal with this campus prnblem. The lack nt' change itt binge drinking arnnng cnllege stu— dents since 19‘3'3 is ntttahie. given the significant effnrts tn cnrttbat this prnhlem. The Edit] CA5 fnund that mnre stu- dents natinnally repnrted that they were espnsed ftl educa— tinnal materials abnut the risks anti cnnsequences nf drink— ing that their schnnls prnvided- A mainrity trf students repnrted that they were apprised nf their sehtml's rules regarding alcnhnl. the penalties fnr nnncnmpliance. where they cnuld get help fur alcnhnl-related prnblems. artd the dangers nf alcnhnl nverdnse. in additinn. student experi— ences nf strnng enfnrcement effnns have begun tn increase. Nthnugh the numbers are still relatively small. inure stu- dettts repttrted being fined. referred fnr alcnhnl educatien. required tn perfnrnt cnntmurtity service. and being subject— ed tn ntber disciplinary aetinns. fiverall. the repnrts nf these sanctinns remained tluite law. with fewer than [(1% nt‘ fre- quent binge drinkers experiencing arty disciplinary actinn as the result nf their drinking. It appears that these effnrts were nnt sufficient in intensi- ty nr estent tn he aecnmpanied by a change in hinge-drink— ittg levels. lt'nr preventinn effnrts tn he sttccessful. schnnls and cnmntunities must gn beynnd "nne—siae-tits-ali" appt‘naeltes.""'*-“‘ Heavy drinking behavinr differs accnrding tn ruany persnna] and envirnnmental characteristics. includ— ing gender: age; year it] schnnl; place nfresidence; lncatinn nt' schnnl: interest in athletics nr sncia] activities: member- ship itt a Greekdetter nrganiaatinn: and fecal. state. and fed— eral pelicies affecting students. These results strnngly sug- gest that segmenting and tailnring effnrts tn specific pnpulatinns are impnrtant fnr successful preventinn. Past preventinn effnrts have largely emphasized changing characteristics nf individual drinkers. such as their knnwl- edge. attitudes. and perceptinns.[-l3 Preventinn effnrts must estend beynnd these familiar apprnaehes nr use them strate~ gicttlly tn effect change in ether areas.“ Data frnm a variety nf snurces suggest effnrts that cnuld be made tn influence an eltvirnnntent that aggressively prnntntes alcnhnl use tn cnl- lege students ttnd ensures that it is easily accessible tn titetn. Recently. a panel nf esperts cnnvened by the Substance Abuse and Mental Health Serviees Administratinn [SAMH- SA} examined and summarised the literature dealing with envirnnmental apprnaches tn alcnhnl abuse.“ This panel fnund that envirnnmental interventinns were feasible and effective. In their repntt. they identified several evidence- 215 WECHSLEH ET Al. based interventinn areas that can help reduce alenhnl enns surnptinn and related prnblems. including the fnllnwing strategies: ' Decreasing the availability at" alcnhnl tn underage. drinkers - Raising alcnhnl tases and priees - Instituring respnnsible beverage service - Changing the cnttditinns nt' availability by limiting nut- lets ' Changing hnurs nf service and days nf sales These findings are in line with results fre-rn earlier CA3 research that has indicated that binge—drinking levels are assneiated with ease nf access In alcnhnl. price. special prn- n'tntinns. and nutlet density in cnllege enrnniuni- tiesdmmg They are alsn ennsistent with mere recent wnrk en the impact nf access tn alcnhnl an injury and ether neg— ative health nutenrnes3"”H Cnnnnmiity-based effnrts tn address these areas have been rignrnusly evaluated and have deninnstrated success in reducing bnth cnnsumptinn nf alcnhnl and assneiated harms-“3 These are prnmising apprnaches fer a cnllege settingdl“ Addressing envirtinniental preventinn will require that enlleges wnrk as partners with ether agencies and nrganiza— tinns in the cnmmunity. such as state and lneal lawmakers. regulatnry agencies. public and private service prnviders. and businesses. Unfnrtunately. activism in these areas nf'ten falls nutside the cnmfnrt level and espertise nf traditinnal cnllege alcnhnl—preventinn staff members. Given the unchanged nature it!" heavy drinking aninng cnllege students and the serinus health and sneial effects that result. the time has cnnte fnr mnre campuses and enmmunities tn try new and enrnprehensive apprnaehes. AC KHDWLEDGMENTS This study was suppnrted by a grant frnrn the Ruben Wand .lnhnsnn lr'nundatinn. We gratefully aekrtnwledge the assistance uf the Center fnr Survey Research nf the University nf Massachu— setts~Hnstnn. Dr Anthnny M. Rnrnan l'nr enrtdueting the mail sur— vey. Jeff Hansen fer the preparatian uf the data. and Lisa Travis fnr technical assistance. NDTE Fnr further infnrrnatinn. please address enmmunieatinns tn l-Ienry Weehsler. PhD. Harvard h‘chnnl nf Public Health. Depart- ment nf Health and Sncial Behavinr. 63'? Huntingtnn Avenue. antnn. MA [IE] IS tE-mail: hweehsle@hsptharvardedui. REFERENCES I. Weehsler H. Davenpnrt A. Duvvdal] G. Mneykens B. Castil— In 5. Health and belravinral euusequenees nfbinge drinking in cnl— lege; A natinnal survey (if students at 1de campuses. JAMA. lflfldzfl’ifitfil i: lnT’l—l 157?. E- Weehsler ll. Nelsen Tli. Binge drinking and the American cnllege student: What‘s five drinks“? Psyche! Addict Better. Eflflltlfiflhi-EQI. 3. Beiun'inrrd Risk fitt'tur Suri‘eiilunee System nniine prev-n- t'ent‘e dutu. Divisinn nf Adult and Cnnimunity Health. Hatinnal Center fnr C‘hrnnic Disease Preventinn and Health Prnmntinn. Cen- ters fnr Disease Cnntrnl and Preventinn {l QUE—l 999}. Available at: hrtp:ttwwwede-gnvtnccdphptbrfss. Accessed December a. 'llllll. 21E: 4. Higher Educatinn Aet Reaurhnriaatinn ed with. HR 32L lflfith Cnng “997%. 5. Higher Educatinn Aer Reanrhnrisatinn nt' Hall-l. Fl 1'92. Ill-5th Cnng “993). a. Hertitiry Penpie fifth“): Understanding rind imprinting Henna nnd Uhieen‘vevibr trnpnrving Henna. End ed. ‘v’ul. ’7'... final 2hr] l: Reduce the prnpnninn nl'persnns engaging in binge drink— ing nf alenhnlie beverages. Washingtun. DC: US Guvernntent Printing thiee: 200i]. 7". Marietta! Advising? Cnunt'ii nn Air'uind Abuse und Airti- itnfistrr Subt'nrntninee nn Cutie-gs Drinking. Natinnal Institute nn Aleehnl Abuse and Alcnhnlism; 1998. Available at; littpzttvvww .niaaa.nih.guvtabnuttenllegetdefaulthtm. Accessed September Ell. lflfll. 3. flet'lurtdinn uti lining Parade and Air'nitnf. Wnrld Health Drganiaatinn. Presented at the Wnrld Health Drganirarinn Tanni— pean Ministerial Cnnferenee nn ‘r'nung Penple and Alcnhnl. Steel-:- hnlm; EDfll. 9- Cnlfege Cnntrnissinn tn Address Airrniirn' 's t'inpurrr nn Amert'rsn's Cnitege Campuses. Mnrhers Against Drunk Driving. Etitl]. Available at: httpdtwww.maddnrgtl’rngrarnsicnllcge_ enmrnissinn_repnrt.pdf. Accessed March 1. Eflfll. It]. A matter nf degree: the natinnni efl‘nrr in reduce nigh-risk drinking nntnng cnllege students. Rnbert Wnnd Jnhnsnn Fnunda— tinn; 19%. Available at: http:itwwwrwjt‘.trrgiapptrw_abnut+ nur_granteestrw_gra_main_set.html. Aeeessed December In. lfl‘Jfi. l |. Natinnal Assnciatinn at State Universities and Land-Grant Cnlleges RUDD. hltp:fiwww.nasulgesirgt'initiativesialeultnl.ltlnt. Accessed Dctnber ET. 2000. IE. Weehsler H. Lee .1. Run M. Lee H. Cnllege binge drinking in the lflfifls: A cnntinuing prnblem. Results nf the Harvard Sehenl nf Public Health “5'99 Cnllege Alcnlinl Study. J Am Cali Henitii. EUUfltsflzlgfl Elf}. lfl. Weehsler ll. Kelly hi. Weitarnan E. SanGinvanni Jf’. Scib‘ ring M. What cnlleges are dning abnut binge drinking: A survey nf cnllege presidents. .i Ara Celt Health. EUU'IJ:4l:l:2lEl—22ti. 14. Weehsler H. Weitanian ER. lCnmrnunity snlutinns tn cum- munity prnblems: Preventing adnlescent alcnhnl use. Am J errata- H’enidi. tenderness—ass. l5. andall 13W. Weehsler H. Studying cnllege alcnhnl use: Widening the lens. sharpening the fneus. J StudAlrninn'. In press. lb. .ltthnsttrn LD. DiMalley PM. Euelnttarl JG. Mnnitrrring the Future nntirrnui survey resttits nn drug use. i915 EDDIE}. Did 2: Cm” iege students rind Fvnung uduits uges JQ-dfl [NIH Publicatinn DI 4925]- Bethesda- MD: blarinnal Institute nn Drug Abuse; 20m. l't'- CDC. Ynuth risk behavinr surveillance: Natinnal Cnllege Health Risk Behavinr Survey United States. MMWR. Illil'tzrlnt‘flfi- nl: 1—54. IE. Knight JR. Weehsler H. Run M. Seihring .‘vl. Weitrrrnan HR. Sehuekir MA- Alenhnl abuse and dependence amnng [its cnllege students. .i Stud Altrnnni. In press. If}. Diugnnstit' rind Statistit'ni Munurd by" Mentui Disnrdet's. Fnurth Editinn. Washingtnrt DC: American Psychiatric Assncia— nnn;1994. ll]. Weehsler H. Mneykens B. Davenpntt A. Castilln S. Hansen J- The adverse impact nf heavy episndic drinkers nn ntlier cnllege students. I StudAt’eniud. [assesses 634. El- Weehsler H. Lee JE. Hall J. Wagenaar AC. Lee H- Seennd- hand effects nf student alcnhnl use repnrted by neighhnrs nf enl- leges: 'l'he rnle nf alcnhnl nutlers. Erie .‘s'ei Med. In press. 2'2. Weehsler H. andall (3W. Macnncr Cl. GIedhill-Hnyt J. Lee H. Changes in binge drinking and related pt'nblenis arttnng American cnllege students between [993 and 199?. J' Am C‘nti Hardin. lass-.arzsr—ss. Cl}. Enrnllmenr in pnstsecnndary instirtninns. llltt't'. US Dept nf Htlueatinn. fli‘lice nt' Educatinnal Research and lrnprnvement. Available at: httpdtncesed.gnvtpubsitltltltltltllllhttpdt'. Accessed January ES. Eflfll JGUHNAL 0F AMERICAN CDLLEGE HEALTH 2-1. ‘t’seehslttr | l. Austin SB. Binge drinking: Tlte lisellour mea- sure. .i" Hind Alt'ut'ttil. |9lll~1jfltli:]22—~IE—l. '25. Woehsler ll. Don-drill E]. Davenport tit. Rinitn E. .t-‘tt fluonder- spot-int; measure of binge tlt'iitldni.1 among college students. Hint .l Fttltltt'He’tlllh. Iggiiflfirggd 9'35. as. Zeger .‘iL. Liang KY. :‘tlher't F5. Models for longitudinal tittttt: fit generalised estimating etioatiolt approtteh. Hitnnt-rr'rt's. ll-lHlit-l—l: Ill-lili— 1 non. 2?. Lion; KY. Zeaer 5| -. l ongitttdina] data analvsis using gen— eralised linear models. Hirll‘lle’l’l‘lr'i'. Willi-FEE 13—23. .33. He‘s SFSTJET User's (Erode. tarts-m tft. 4th ed. Cary. Nil: SEAS Institute- lot”. will EU. ICooper A ."v‘l- Sohel] Tit-IE. Sohel] l.t.'. Moist-.1 Sn... validity of ait'ttilolies' sell—rttrions: Dotation data. littet'rttttntnttl Jottr'nttl of sitt'tlit'tt'ott. IQH I '. l fit-“it'll dill}. fill- I'vlitlantk l.. Validity or sell' report aleohol use: ft literature revievt' and assessment. British .t'ont'ntrl oft- drt'ti't't'ttttn. I‘Jlil'i: 33.: Jill '{l— IUEt'l- 3|- Frier Mill. liell RM. ElliL'i-Lsttn 13L. UH It‘r’fls' it?” the .I’t't.‘l'."l."I The L‘ttt'rl-tt'rlt'r't' ol' sellvreporr ntltnt-t-t: use or t'lt't'ltttrlt’st'tifll's'. Santa :‘tr'ltlti- tert. E's-"it: R.-"tT-i[}'. 1991. HANFZI publication N—fil'll—FHF. 32. Weeltsler H. Lee Jii. Nelson TF. Lee H. Drinking levels. aleohol problems. and secondhand el'l'eets itt suhstanee—lree t‘ol- leee resitiettees: Results ol a national study. J h't‘nrl Alroltttl- It'Hllzt'tflflE—"il. 33. ‘t‘r'eehsler ll. Dowdall GW. Davenport .-"'t. Castillo S. {Torre— lates oI' eollege srttt‘lent hinge drinking. sltn J Pnlti't't' HE’Hl'l'll- 1995:8592 l—‘sl’lfi 34. Gerald I'll-L. llisser WJ. FrtlllL‘L'll-Lllin olerittt‘ation staltsttes to fill] l. US Dept of Ftittt'alion. National l'entt‘r l'or EIJUL'EILIUI'J- al Statisties. Hill-.5 Elllll ill-i}. 1'ir'v‘at-tlt'tnaton. Di": Elllll - Available at: I'ttttr:lt’ttees.ed.govlpnhslllfllloroilil. .i‘teeessetl Januatv 25. Eilill ."i‘i. 'Weeltsler H. Nelson T. Weitattiatt E. lr'rttnt knowledge to aetion: How Hat vard's L'ollege Aieohol Studs ean help votn' t-attt- C r tit." 11 l'll-"IIII suction and the support of the vaginal wall. protected intercourse- one at time of insertion. Less messv dtan the diaphragm. more aesthetic for the user. VDL 50. MARCH 2002 Advantages of the Cap * Can he left in plate the up to 43 hours. allowing spontaneous - Requires only one stttall applieatiott of spenttieide inside the Forfitrtlter information rotttttt'r: CERVICAL CAP LTD. 43!] lv’lonterev Avenue. Suite 13. Los Uatos. California ssosn I {4031 395-th1} - FAX tdflfil Sgfi—Eitls * tvtvt-v.eerveap.eotn ElNGE—DHWHWG THEMES nos design a entttpaign against student altioltol alruse. [Tortoise Ellillltlaanehfllim-fl. lo. Holder HD. Prevention ofaleohol problems in the 21st eett— tort." |Challentfites and opportunities. .tlm J.-ldtlit't. Elllll Lilli l i: l -- l 5. 3?. l’t't’t’f’mltll: Problems Related to all: 'ttlrol .r‘tt'tnltrbtlirt'.' J'fttt't- ronrttt-vrrttl Appli'tot'ltes. Suhstattee Ahttse and Mental Health Her- viees Administration. Center for Suhstantte Abuse Prevention. Division ol State and Community Svstems Development. Depart- tttettt of Health anti Human Services. I’uhlieation Ho- [St'v’lfitlll‘th i293 Available at: httpft'tvsvw.healllt.ortrt'govptthslPl'lDli'lflt'aar .htm. At‘eessed .lLtll-r iii. Ellill 33. L‘haloupka Fl. 1|It"t-'et.'lts1er H. Binge drinking itt eolleee: The itnpaet ol priee- availability. tutti aleohol t'ontrol polieies. Content- porary Er'tntontt't' Fr:t'ir‘_l'. 1996'. Isl-ti lE—l Eel. lull ‘Weeltsler H. Ktto H. Lee H. Dotvdall (i- Envirotntterttal eorreiates of underage alcohol use and related prohlemv of eolIt-ttt- stnt‘leltts. rittt J Fret‘ Med. Ellllll'. IQJEil—E‘J. 4i]. liorntttn DM. Speer I’W. Gntenen'ald FJ. 1..ahtn1vie EW. Spatial dvnanties of aleoho] availability. neighborhood strttt'tttre and violent erinte. J Sttttlsllt'oltol. Elllll :filt'fiitfiEE—Elo. -'l l. Treno Al. Gruenetvnld Pl. Johnson FW. Aleoltn] availabilh iv and injury: The role of loeal outlet densdies- Alt'ttltttl ens alt-p Hes. Ellfllflfit liltl-lt‘tT—l—l'll. 42. Holder no. Gi'tlt'illi‘tir'tiltl l’J. Ponieki "NE. et a1. ljfi'eet ttt' eonttttuniLv-hasetl interventions on high-risk drinking and aleohol- related injuries. .Mi'rl'd. 2illlilf234l Willi-'1 l—Elid't'. 4.1- Ktth GD. Tlte ittlluenee of college environments on student drinking. ltt: Gottaalea Li. Element v. eds. Reseotr'lt mini lntet 1-t-n- rt'ott: Preventing Sttlts'ttntt'e Abuse in Higher Education. Washing..— tttn. Di" fltliee or Educational Resear'eh and improvement: 45—?1. 44. Hinpson R. Hot-talent] .i. Comprehensive CUIlllliUl'tl'L}-' inter ventions to promote health intulieations for college age drinking problems. .i' .S'tntl di‘r'rtltttl. in press. Simply a Great Alternative! The Pt‘entif Cavity-Rim Cervical Cap is a hornet otttitraeeptive dint hltnlts the passage of spenrt front the vagina into the uterus. The deviet- is irritable-shaped and rustle of latea rubber. It has a firm vet pliant rim that fits snuglyf over the otnria and is held in plate by - As effective as the diaphragm. - Use of the cervical trap may assist in avoiding urinary trat‘t inl'eetioos associated with diaphragm use. (7 J9 ;—,le! “t: «if _ J"! 35%:— J(!r .-— 21? ...
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