effects of alcohol on students research paper pdf

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• v.4(10); 2013 Oct

Is Alcohol Consumption Associated with Poor Academic Achievement in University Students?

Walid el ansari.

School of Sport and Exercise, Faculty of Applied Sciences, University of Gloucestershire, Gloucester, United Kingdom

Christiane Stock

1 Unit for Health Promotion Research, Institute of Public Health, University of Southern Denmark, 6700 Esbjerg, Denmark

Claire Mills

Background:.

We assessed associations between educational achievement and alcohol consumption.

We employed five alcohol consumption measures (length of time of and amount consumed during most recent drinking occasion, frequency of alcohol consumption, heavy episodic drinking, problem drinking); and three educational achievement indicators (students’ subjective importance of achieving good grades, students’ appraisal of their academic performance in comparison with peers, students’ actual module mark).

Males were positively associated with all five alcohol consumption measures. Age was negatively associated with three alcohol consumption measures. While students´ importance of good grades was negatively associated with three alcohol consumption measures, academic performance in comparison with peers was negatively associated with heavy episodic drinking. Actual module mark was not associated with any alcohol consumption measure.

Conclusions:

Alcohol consumption showed negative associations with motivation for and subjectively achieved academic performance. University alcohol prevention activities might have positive impact on students’ academic success.

INTRODUCTION

The highest proportion of people with alcohol disorders are aged between 18 and 29 years,[ 1 ] an age bracket that includes the majority of enrolled university students.[ 2 , 3 ] Indeed, heavy alcohol use has been well documented among college students,[ 4 ] and many students embrace heavy-drinking habits for the first time during their 1 st year at university.[ 5 ] About 20-25% of college students had drinking problems,[ 6 ] or had experienced consequences related to drinking, as well as increased risk of heavy episodic drinking.[ 7 ] Given that university study per se represents a challenge to many students, an important feature related to students’ drinking is their academic performance.

The relationship between problematic alcohol consumption and academic performance is a concern for university administrators and officials.[ 8 ] Alcohol consumption has been negatively associated with academic performance,[ 6 ] and heavy drinking has been proposed as a probable contributor to student attrition from college.[ 9 ] Problems frequently experienced by university students due to drinking included missed classes and poor academic achievement.[ 10 ] Heavy episodic drinkers are much more likely than non-heavy drinkers to report that drinking caused them to miss class, fall behind in their schoolwork, and perform poorly on test/s or other academic project/s.[ 11 , 12 ] Similarly, others[ 13 ] found an apparently strong association between a composite variable of alcohol involvement of university freshmen (included queries about past-month frequency of drinking ≥5 drinks in one sitting) and a composite variable of the academic challenges that they faced (included an assessment of whether students failed to complete their degree after 6 years). Wood et al . found that alcohol involvement had a modest, negative association with educational attainment after controlling for background variables.[ 14 ] Unsurprisingly, heavy drinking and alcohol-related consequences in college students represent major challenges in some countries.[ 15 ] Such findings have suggested that, in higher education, a strong, negative correlation exists between undergraduate alcohol use and academic performance.[ 16 ] However, a point to note is that conversely, large-scale and well-controlled studies seem to have provided not much empirical support for the effect of heavy drinking on, e.g., attrition from college.[ 17 ] Indeed, findings from prospective research suggested that the association between alcohol use and undergraduate academic performance is negligible.[ 16 ]

Methodological challenges arise when attempting to understand the relationships between alcohol consumption and academic performance. Several of these challenges have to do with how alcohol consumption was measured (and number of indicators used); and how academic performance was measured (and number of indicators used).

In terms of the first methodological challenge, in appraising the links between alcohol consumption and academic performance, alcohol consumption has been measured using many approaches. For instance, some studies employed a single item to assess alcohol use.[ 13 ] Alternatively, in the USA, some studies[ 18 ] examined heavy alcohol use only, whilst others assessed three alcohol consumption variables (frequency of use, amount consumed, and frequency of heavy alcohol use).[ 19 ] Conversely, to assess university students’ typical and celebration drinking, some researchers[ 20 ] did not ask students to report the length of time that a typical drinking episode/celebratory occasion lasted, and recommended that future studies should consider this point as it has important implications for harmful outcomes associated with alcohol use. In order to bridge the range of the above shortcomings and capitalise on previous research recommendations, the current study measured alcohol consumption employing a wider approach to assess five aspects (including three types) of drinking. These included: Length of time (duration) that the last (i.e., most recent) drinking occasion lasted; amount consumed within the last (i.e., most recent) drinking occasion; frequency of alcohol consumption; heavy episodic drinking; and problem drinking.[ 21 ]

Similarly, in connection to the second methodological challenge, university students’ academic performance has also been measured in several ways. Indeed, studies could be categorized subject to the number of academic achievement indicators that were employed; and whether subjective (self-reported) or objective indicators were used. Some authors[ 18 ] used a single self-reported measure, where students reported their cumulative grade point average (GPA). Such use of self-reported GPA supported observations[ 13 ] that the appraisal of the links between academic performance and alcohol problems were based mostly on self-reported academic difficulties as a measure of academic performance. Other researchers[ 8 ] used a single objective measure – academic performance data of university students that were gathered from official university records. Moreover, other studies[ 19 , 22 ] employed two objective indicators (two measures of academic performance) obtained from the registrar (student's GPA during the survey's semester and cumulative GPA at that point). Much less research employed multiple subjective and objective measures simultaneously to appraise the links between academic performance and alcohol. To bridge such shortcomings, the current study conceptualized and measured academic performance using three approaches: (1) as students’ internal reflection on their academic achievement in terms of the importance they attach to achieving good grades in their studies; (2) as students’ subjective comparative appraisal of their overall academic performance in comparison with their peers; and (3) as an external objective teacher evaluation of students’ overall academic performance (final module marks or grades that students achieve in their course assessment/s). Such a tri-partite conceptualization of educational outcomes is supported by research in the achievement goal tradition. Two types of goals have been suggested: Performance goals (ego involvement or ability goals) that include the demonstration of competence relative to others; and mastery goals (task-involvement or learning goals) that deliberate the development of competence and task mastery.[ 23 ] As such, achievement goals are conceptualized as the purpose[ 24 ] or cognitive-dynamic focus[ 25 ] of task engagement.

Given the shortcomings highlighted above in relation to measuring alcohol consumption and measuring academic performance, the current study measured alcohol consumption employing a wider approach to assess five aspects (including three types) of drinking; and also conceptualized and measured three academic achievement indicators.

Aim of the study

This study assessed the associations between five alcohol consumption variables (length of time of last drinking occasion; number of drinks consumed during the last drinking occasion; frequency of alcohol consumption, heavy episodic drinking, and problem drinking as dependent variables) and three academic achievement indicators (importance of good grades, performance relative to peers, module mark as independent variables), whilst controlling for two socio-demographic variables (sex, age). Undergraduate students from University of Gloucestershire, UK completed a general health questionnaire, and their module grades were retrieved from the university computer systems. The specific objectives were to:

• Explore the alcohol consumption indicator/s (type of drinking) that were mostly associated with academic outcomes; and
• Explore the academic achievement measures that were mostly associated with alcohol consumption.

Data collection procedures

Ethical approval was provided by the university research ethics subcommittee after review of study design, tool, research material, and participant information sheet (included a letter of invitation highlighting that participation is voluntary). The population for this cross-sectional research design comprised undergraduate students enrolled for classes at the University of Gloucestershire, UK during the data collection period (2008-2009). Module teachers were also provided with information about the research (aims, objectives, voluntary nature of participation), and were approached for permission to collect data from students attending their module.

The study was a general student health survey[ 26 ] which also contained two questions about students’ views on their academic performance. The survey, usually administered toward the end of a lecture/class, required ≈ 15 min to complete. Each questionnaire had a participant information sheet attached. Students who remained in class to participate read the information sheet and if they wished to participate, removed and kept it for future reference. No monetary incentives nor course credit (as inducements) were provided to students for their participation. Once students completed the questionnaire, they brought it to the front of the room where it was placed in a large envelope. In the questionnaire, each participant provided her/his student registration number which was subsequently employed to import students’ actual grades that they accomplished from the university Strategic Information Technology System (SITS), and link the retrieved grades to students’ responses of the health survey. The students were assured that data protection and confidentiality were observed, and that their student registration numbers would be only used import students’ actual grades in an anonymous manner. The response rates were ≈ 80%, and for the analysis, we used data from 379 students.

The Health and Wellbeing Questionnaire, as employed in many student health studies,[ 26 , 27 , 28 , 29 , 30 , 31 , 32 ] included socio-demographic information (e.g., sex and age), as well as self-reported health behavior data (e.g., five alcohol consumption indicators):

Length of time of the last (most recent) drinking occasion (1 item): “The last time you ‘partied’/socialized, how many hours did you drink alcohol?” Participants provided the number of hours.

Amount (number of drinks) of alcohol consumed during the last (most recent) drinking occasion (1 item): “The last time you ‘partied’/socialized, how many alcoholic drinks did you have? (including alcoholic drinks you possibly had before going out).” Participants provided the number of drinks.

Frequency of alcohol consumption (1 item): “Over the past 3 months how often did you drink alcohol, for example, beer?” (six response options: “never,” “once a week or less,” “once a week,” “a few times each week,” “every day,” and “a few times each day”).

Heavy episodic drinking (1 item): “Think back again over the last 30 days. How many times (if any) have you had five or more drinks on one occasion?” (A “drink” is a glass/bottle/can of beer [≈50 cl], a glass/bottle/can of cider [≈50 cl], two glasses/bottles of alcopops [≈50 cl], a glass of wine [≈15 cl], a glass of spirits [≈5 cl] or a mixed drink). Response options were “never,” “once,” “twice,” “3-5 times,” “6-9 times,” and “10 or more times.”

Problem drinking (4 items): Data was gathered using an alcoholism-screening CAGE test,[ 21 ] a brief screening instrument consisting of four short questions [“Have you ever felt you should Cut down on your drinking?; Have people Annoyed you by criticizing your drinking?; Have you ever felt bad or Guilty about your drinking?; Have you ever had a drink in the morning to get rid of a hangover?” (Eye opener)]. Each question is answered either “yes” or “no”. Two or three affirmative answers suggest problem drinking, while four positive responses indicate serious suspicion of alcohol dependence.

Educational achievement was measured using three indicators.[ 27 ] The health questionnaire contained two items on students’ educational achievement; the third indicator (module mark) was retrieved from university computer systems.

• Students’ internal reflection on their academic achievement (importance they attach to achieving good grades) - “How important is it for you to have good grades at university?” (4 response categories, 1 = “not at all important,” 4 = “very important”);
• Students’ subjective comparative appraisal of their overall academic performance (in comparison with their peers) “How do you rate your performance in comparison with your fellow students?” (5 response categories, 1 = “much worse,” 5 = “much better”); and
• An external objective teacher evaluation of students’ overall academic performance in terms of the final module marks (in percent) accomplished by students in their course assessment/s). Similar to other studies,[ 28 ] each student's registration number was employed to import the student's module mark/grade (as percentages) from the university SITS,[ 33 ] which was then linked to the student's questionnaire responses.[ 27 ]

Statistical analysis

Analyses were performed using SPSS 14.0 (significance level set at P < 0.05). For demographic and other characteristics, frequencies were calculated separately for males and females in order to provide precise estimates. This is because sex is related to drinking and sex differences in alcohol consumption among undergraduates have been reported.[ 34 ] In addition, sex had a significant, direct relationship with academic problems;[ 13 ] and prospective results of young adults suggested that there might be some important sex differences as to how a lower response or low sensitivity to alcohol is related to alcohol outcomes and future drinking problems.[ 35 ] Sex comparisons were undertaken using Chi-square (χ 2 ) statistics for categorical variables and t -test statistics for continuous variables.

We then undertook five separate linear regression analyses to assess the relationship of each of the three academic achievement variables (importance of good grades, performance relative to peers, module mark), controlling for the demographic variables (age, sex), on each of the five alcohol consumption measures [length of time (duration) of last drinking occasion; amount (number of drinks) consumed during the last drinking occasion; frequency of consumption; heavy episodic drinking; and problem drinking]. For each regression analysis, in models 1-3, each of the three academic achievement variables was entered individually together with age and sex.

Alcohol consumption patterns

Male students spent more hours during the last (most recent) drinking occasion than females, and consumed more alcoholic drinks at that occasion [ Table 1 ]. Most students (74%) consumed alcohol at least once week, and only 3% reported no alcohol consumption. Males consumed alcohol more often than females ( P < 0.04). Half the sample (54%) testified heavy episodic drinking (≥5 drinks in a row) at least three times during the last month, and only 20% of respondents reported no heavy episodic drinking. The frequency of heavy episodic drinking was significantly higher among males than females ( P < 0.001). About 31% of the sample reported two or three affirmative answers in CAGE suggesting problem drinking, while 2.4% indicated four positive responses (serious suspicion of alcohol dependence). Again, males had more positive answers in CAGE than females ( P < 0.035).

Demographic and other selected characteristics of sample

Characteristics of academic achievement

Two-thirds of the sample (64%) felt that having good grades at university was very important for them [ Table 1 ], and ≈62% rated their own performance as being about the same as that of fellow students. The average module mark achieved by students was 55% (SD = 13). There were no significant differences between males and females across the three measures of academic achievement.

Are students’ duration of time of last drinking occasion or number of drinks consumed during last drinking occasion associated with academic achievement?

Neither the length (duration) of the last (most recent) drinking occasion nor the amount (number of drinks) consumed at the last occasion were significantly associated with any of the three academic achievement indicators (data not presented). However, age was consistently negatively associated with students’ length of time of last drinking occasion, and also with the number of drinks consumed during the last drinking occasion. Conversely, males were positively associated with these two alcohol consumption variables (data not presented).

Is students’ frequency of alcohol consumption associated with academic achievement?

When frequency of alcohol consumption was employed as the dependent variable in the regression analysis [ Table 2 ], males were consistently positively associated with the frequency of alcohol consumption, while age was not significantly associated. Independent of age and sex, the models show that the less the importance of good grades was to students (model 1), the higher the frequency of alcohol consumption ( P < 0.05). However, the associations between alcohol consumption frequency and the remaining two academic achievement variables (performance relative to peers-model 2; module mark-model 3) were not significant.

Regression models for three academic achievement indicators on frequency of alcohol consumption a as dependent variable

Is students’ heavy episodic drinking associated with academic achievement?

When heavy episodic drinking was selected as the dependent variable in the regression analysis [ Table 3 ], age was consistently negatively associated, whilst males were positively associated with heavy episodic drinking. Controlling for age and sex, the less the students rated the importance of good grades for them (model 1) and the lower they felt their academic performance was relative to their peers (model 2), the higher the frequency of heavy episodic drinking. However, the negative association with the third indicator of academic achievement (module mark) was minimal (model 3) and not significant. In addition, for heavy episodic drinking, a comparison of model 2 with model 3 showed that the importance of good grades explained more of the variation of heavy episodic drinking than performance relative to peers.

Regression models for three academic achievement indicators on heavy episodic drinking a as dependent variable

Is students’ problem drinking associated with academic achievement?

When problem drinking (measured as positive “Yes” answers in CAGE) was employed as the dependent variable in the regression analysis, males were consistently positively associated with problem drinking, while age was not significantly associated [ Table 4 ]. Controlling for age and sex, the less the students rated the importance of good grades (model 1), the higher the problem drinking ( P < 0.05). The associations between problem drinking and performance relative to peers (model 2) and with module mark (model 3) were both not significant. Table 5 provides a summary of the relationships between alcohol consumption variables and academic achievement and demographic variables.

Regression models for three academic achievement indicators on problem drinking a as dependent variable

Associations between alcohol consumption variables and academic achievement and demographic variables

Some studies suggested that in countries where alcohol can be consumed, college students were more likely to consume alcohol and drink more heavily than young adults not attending university,[ 36 , 37 , 38 ] and alcohol misuse/abuse is associated with negative academic achievement outcomes.[ 39 ] A recent study in England found that 21% of their sample of 770 undergraduate students (7 universities) displayed a likelihood of having a diagnosable alcohol use disorder.[ 40 ] Hence, university student alcohol use is a significant public health problem,[ 41 ] and alcohol consumption on university campuses and its negative consequences have become challenges for higher education institutions.[ 42 ] The current study assessed, in a university in the UK, the associations between five alcohol consumption variables (length of time of last drinking occasion; amount consumed during last drinking occasion, frequency of alcohol consumption, heavy episodic drinking, and problem drinking) and three academic achievement variables, whilst controlling for two socio-demographic variables (sex, age).

In the current study, males were significantly positively associated with the five measures of alcohol consumption. This is in agreement with, e.g., a study in the USA of 200 first-year college students[ 43 ] that reported that students increased their drinking on weekends, but this rise was more pronounced among men. Similarly, recent research of undergraduates from seven universities across England found that more men (65%) than women (58%) scored positive (8+) on the alcohol use disorders identification test (AUDIT), comprising 40% hazardous drinkers, 11% harmful drinkers, and 10% with probable dependence, although the difference in proportions between men and women categorised as AUDIT positive was not significant.[ 40 ] Our findings are also in line with an earlier study in the UK (3075 students from 10 universities) that reported more men (61%) than women (48%) exceeded “sensible” weekly drinking limits recommended by medical authorities and that 28% of the surveyed students reported binge drinking.[ 44 ]

Which alcohol consumption indicator/s (type of drinking) were mostly associated with academic outcomes?

As for objective one, Table 5 depicts an overview of the findings. We found relatively strong associations between heavy episodic drinking on the one hand, and the importance of good grades and the subjective academic performance relative to peers on the other, i.e., the more often students had ≥ 5 drinks on one occasion, the less they rated the importance of good grades was to them, and the lower they rated their own academic performance relative to their peers. Our current findings of negative significant relationships between heavy episodic drinking and two subjective academic achievement measures support previous research where more frequent heavy drinking was related to academic problems,[ 45 ] lower study hours,[ 46 ] and lower reported grades.[ 47 ] Our findings are also compatible with that heavy episodic alcohol use has been incriminated in acute in addition to the long-term health and social consequences.[ 48 , 49 ] An important point is that in the current study, in order to determine heavy episodic drinking frequency, we employed a cutoff of consuming ≥ 5 drinks on one occasion. Such cut-off value is in line with others.[ 50 ] However, some researchers[ 18 , 43 ] determined heavy alcohol use/heavy drinking days by computing a frequency based on the consumption of ≥5 consecutive drinks for men; or the consumption of ≥4 consecutive drinks for women. Hence, in terms of females, the current study employed a higher cut-off representing a more “relaxed” measure of heavy episodic drinking. Such cut-off could have resulted in a potential underestimation of the prevalence/number of heavy episodic drinking females; and a similar underestimation of the already significant associations between academic accomplishment variables and heavy episodic drinking.

In contrast to heavy episodic drinking, two of the other alcohol consumption measures we employed (frequency of alcohol consumption; and problem drinking estimated by number of affirmative answers in CAGE) showed fewer associations with academic outcomes. Frequency of alcohol consumption and problem drinking were both only associated with lower importance of achieving good grades, but not with ratings of one's academic performance relative to peers. The remaining two alcohol measures (length of time of last drinking occasion; amount consumed during the last drinking occasion) showed no association with the three academic achievement measures. This latter finding might be rather surprising given that the amount of drinks consumed at the last (most recent) drinking occasion could potentially be similar/parallel to heavy episodic drinking that measures the amount of alcohol consumed at one occasion. However, the questionnaire item asking only about the last drinking occasion reflects a more situational measure, in contrast to the heavy episodic drinking item that queried participant's drinking pattern over a period of time, and thus perhaps more likely to be associated with academic performance.

Direct comparisons of our findings with other studies are difficult, because of the diversity of approaches employed in the measurement of alcohol use/misuse (e.g., time period of recall; whether the number of drinks or actual alcohol units were employed in estimating the amount of alcohol consumed; cut-offs used for calculating heavy episodic drinking for men and for women, etc.). However, our associations between alcohol use and academic impairment were mostly demonstrated when measures of heavy episodic drinking or high risk drinking were used, as also shown in a review on the consequences of alcohol misuse in college populations.[ 15 ]

Which academic achievement measures were mostly associated with alcohol consumption?

For objective two, the current study found that alcohol consumption was related to impairments in subjectively reported academic achievement measures (importance of achieving good grades; one's academic achievement in comparison to one's peers). However, we did not find associations with the objective academic achievement indicator (actual module grade) [ Table 5 ]. Very few studies had been able to link alcohol use to students’ achieved grades that are retrieved from records/university computer systems (i.e., objective measure). For instance, one study found that the amount of alcohol consumed was a negative predictor of the cumulative GPA retrieved from students records.[ 19 ] Similarly, research in the Netherlands found a significant association between alcohol dependency and failing the 1 st year as reported from student registries.[ 8 ] Other studies used self-reported GPA and found significant negative associations between heavy alcohol use and GPA,[ 46 ] while in some research the association disappeared when controlling was undertaken for other factors.[ 13 , 18 ]

Several reasons are proposed for the lack of an association between alcohol consumption and module grade in the current study. Methodological limitations might account for this, including our limited sample size. In addition, the student's grade that was retrieved from the university SITS was that of a single module (the one that the student was attending when the questionnaire was completed) – this may not reflect the average (all year) final grades for any given student. It is also acknowledged that it is difficult to predict students’ grades generally, whether by using demographic and academic/educational variables;[ 51 ] or by using students’ educational satisfaction together with a range of health status (e.g., BMI, depressive symptoms, stress, etc.) and health behavior variables (e.g., health awareness/consciousness, self-rated health, physical activity, nutrition, etc.).[ 27 ] Hence to attempt to predict students’ grades specifically by alcohol consumption represents an even more formidable challenge.[ 13 , 18 ] Many other factors (e.g., age, social support, etc.) might play crucial roles and quite often alcohol drinking loses its initial significance when controlling is undertaken for such other factors.[ 27 ] It is also likely that heavy alcohol use might not lead to lower grades directly, but indirectly through impairments in bodily/mental functions: A path diagram from a prospective study showed that amount of alcohol consumed was associated with sleepiness and negatively associated with sleep duration, which in turn had effects on students’ achieved cumulative GPA.[ 19 ] Likewise, a recent longitudinal study demonstrated that binge drinkers experienced socio-emotional problems over time which seemed to be a mechanism for the academic risk posed by drinking.[ 52 ]

Whether the links between alcohol use and academic achievement are causal relationships remains unclear from the current cross-sectional study. It could be that straight forward cause-effect relationship exists, or that such links might be moderated by sleep, given that alcohol use is related to sleep habits where such habits and resultant daytime sleepiness could mediate alcohol's possible influence on academic performance.[ 19 ] In addition, heavy alcohol use was associated with lower GPA both directly and indirectly through its association with fewer study hours.[ 44 ] Bidirectional relationships might also exist, where alcohol use and academic performance impairments mutually influence each other in a vicious circle. On the one hand, the level of academic performance in high school children predicts their drinking problems as young adults independent of individual/family confounders.[ 53 ] At university, it is also plausible that performing poorly in coursework could lead to alcohol use.[ 19 ] On the other hand, bidirectional effects are supported by a longitudinal study showing that missing classes or falling behind schoolwork was a result of drinking during college, but the same study also showed that high school GPA was negatively associated with heavy alcohol use.[ 18 ] Given the uncertain time precedence among the variables, causal interpretations of the current study's data should be cautious.

This study has limitations. The study was undertaken at one university in one country, and whether results would be similar for university students of a wider socio-economic/cultural background is an empirical question. However, even prospective studies of the association between drinking and academic performance have often relied on data collected at single universities.[ 8 , 13 , 18 , 22 ] Besides the actual module grade (retrieved from the university SITS system), all data was self-reported (social desirability and sociability cannot be ruled out). For instance, we did not objectively measure drinking using biological measures (e.g., breath alcohol concentration).[ 16 ] However, self-reports from confidential and unidentified questionnaires is a commonly accepted procedure in substance use research of university students and provides data that are generally both valid and reliable.[ 54 ] The current survey was administered only once, but there might be a need to follow up undergraduates at “tighter” time intervals employing multiple measures of consumption within the context of a semester, as significant and abrupt changes occur frequently in the individual drinking trajectories of teenagers and young adults.[ 55 , 56 ] We did not find relationships between some alcohol consumption indicators and academic performance, where modest and non-significant associations were exhibited, although low statistical power may explain some of the null associations.[ 57 ] We did not measure achievement orientation established prior to entering university, and this might affect drinking behavior in university. Whilst the alcohol indicators we employed assessed drinking during different time periods (e.g., “most recent,” “30 days,” “3 months.”), yet, the “objective” academic measure is for a module undertaken usually in an entire academic term. Different time frames might hinder the possible linkage between specific drinking incidents and specific academic behaviors. It could also be argued that the “objective” academic measure we employed might not be 100% “objective”: Teacher evaluations of academic performance need to consider faculty grading practices that might be biased by discipline-specific norms and instructor-level variables. The current survey employed the final module marks of students who were attending a variety of different modules, but academic performance (final module marks) were not weighted to account for course difficulty, or in terms of variations in the rigor of grading practices across academic departments and among individual faculty within departments.[ 58 , 59 , 60 ]

In order to delineate cause and effect, prospective study designs are needed to examine the relation between drinking and academic performance. Such designs would need to collect baseline data on the relevant variables beginning many years before college. Given that achievement orientation and alcohol use are characteristics that are both formed prior to university, it is possible that the former might cause the latter.

In addition, to facilitate more valid comparisons, future research would benefit from some standardization, were possible, to the measures employed to estimate the various “facets” of alcohol consumption and/or types of drinking patterns. Further, periodic/regular estimation of alcohol risk and harm (along with a range of health and wellbeing variables) in nationally representative samples of university students would contribute to an evidence base that is critical for this important young adult population, a point that seems currently lacking in the UK. Furthermore, the examination of the pathway/s linking academic/educational performance and alcohol use/dependency in young adults may help identify opportunities for preventive interventions.

Our findings point to that alcohol misuse, especially heavy episodic drinking is very likely to have negative consequences on academic performance at University. Such findings echo with similar studies undertaken in secondary schools, where drinking predicted deteriorating socio-emotional functioning, with negative consequences for adolescents’ academic grades by the end of high school.[ 52 ] The findings also echo with research of college students, where heavy alcohol consumption (and resultant unhealthy sleep habits) have been associated with a range of behavioral challenges, including poor academic performance (Buboltz et al ., 2006; Perkins, 2002).[ 15 , 61 ] Indeed, alcohol use disrupts learning and memory in adults (Zeigler et al ., 2005).[ 62 ] Unsurprisingly, alcohol abuse is the single greatest public health hazard at American college and university campuses, and the alcohol drinking culture remains to be highly resistant to change.[ 63 ]

Therefore, alcohol policies on campus and educational and normative campaigns for students are highly relevant. Such programs and interventions should aim at prevention of alcohol abuse of college students and on college campuses as well as cessation programs. Hence universities might wish to pay attention to their alcohol policies and enforcement as these have been reported to be inversely associated with five outcomes related to student alcohol abuse or related consequences.[ 64 ] Likewise, campus and community coalitions/partnerships between campus leaders and senior college administrators and a range of community stakeholders can efficiently attend to the environment that may promote high-risk drinking, although few campuses work within such a structure.[ 65 ] For high-risk college students, brief intervention approaches with such students has been successful in reducing alcohol consumption and/or related consequences,[ 66 ] and although, many interventions for college students have traditionally been behavioral, pharmacological treatments could provide additional options.[ 67 ] Programs could involve creating motivation to change drinking; changing the drinker's expectancies about the effects of alcohol; clarifying norms through feedback on the drinker's alcohol use in comparison with other students; and making available cognitive-behavioral skills training, including how to monitor daily alcohol consumption and stress management.[ 67 ] The important point is that interventions that are selected need to be evidence-based.[ 67 , 68 ]

CONCLUSIONS

At University, alcohol misuse, especially heavy episodic drinking is very likely to have negative consequences on academic performance. Therefore, alcohol policies on campus and intervention educational and normative campaigns for students are highly relevant. In addition, future research should include prospective designs as well as objective and subjective measures for academic performance.

ACKNOWLEDGMENT

The authors thank the students and university where this research was undertaken; and acknowledge Leanne Raybould for participation in collection of some of the data on which this paper is based. In addition, we wish to acknowledge the UK Student Health Group.

Source of Support: Nil

Conflict of Interest: None declared.

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(March 2002 Supplement)

Journal of studies on alcohol  supplement.

Journal of Studies on Alcohol College Drinking, What It Is, and What To Do about It: A Review of the State of the Science

National Advisory Council on Alcohol Abuse and Alcoholism Task Force on College Drinking

Special Editors:  Mark S. Goldman, Ph.D., Gayle M. Boyd, Ph.D., Vivian Faden, Ph.D.

Supplement No:  14 Printed Date:  March 2002

Commissioned Papers

Panel 1 - contexts and consequences, studying college alcohol use: widening the lens, sharpening the focus.

Read the full Journal.

ABSTRACT Objective:  The study was designed to assess current trends in studying, and emerging approaches to furthering understanding of, college drinking. Method:  A literature review was conducted of findings and methods highlighting conceptual and methodological issues that need to be addressed. Results: Most studies address clinical, developmental and psychological variables and are conducted at single points in time on single campuses. Factors affecting college alcohol use and methods of studying them are discussed. Conclusions:  Most current studies of college drinking do not address the influence of the college and its alcohol environment. Our understanding of college drinking can be improved by expanding the scope of issues studied and choosing appropriate research designs. ( J. Stud. Alcohol,  Supplement No. 14: 14-22, 2002)

George W. Dowdall, Ph.D., Professor, Department of Sociology, St. Joseph’s University, and Henry Wechsler, Ph.D., Lecturer and Director of College Alcohol Studies, Department of Health and Social Behavior, Harvard School of Public Health

Epidemiology of Alcohol and Other Drug Use among American College Students

ABSTRACT Objective:  This article provides information on the extent of alcohol use and other drug use among American college students. Method:  Five different sources of data are examined for estimating recent levels of alcohol (and other drug) use among college students: Harvard School of Public Health College Alcohol Study (CAS), the Core Institute (CORE), Monitoring the Future (MTF), National College Health Risk Behavior Survey (NCHRBS) and National Household Survey on Drug Abuse (NHSDA). Results:  Alcohol use rates are very high among college students. Approximately two of five American college students were heavy drinkers, defined as having had five or more drinks in a row in the past 2 weeks. Alcohol use is higher among male than female students. White students are highest in heavy drinking, black students are lowest and Hispanic students are intermediate. Use of alcohol—but not cigarettes, marijuana and cocaine—is higher among college students than among noncollege age-mates. Longitudinal data show that, while in high school, students who go on to attend college have lower rates of heavy drinking than do those who will not attend college. Both groups increase their heavy drinking after high school graduation, but the college students increase distinctly more and actually surpass their nonstudent age-mates. Trend data from 1980 to 1999 show some slight improvement in recent years. Conclusions:  Despite improvements in the past 20 years, colleges need to do more to reduce heavy alcohol use among students. ( J. Stud. Alcohol , Supplement No. 14: 23- 39, 2002)

Patrick M. O’Malley, Ph.D., Senior Research Scientist, Institute for Social Research, University of Michigan, and Lloyd D. Johnston, Ph.D., Distinguished Research Scientist, Institute for Social Research, University of Michigan

Student Factors: Understanding Individual Variation in College Drinking

ABSTRACT Objective:  Research on individual differences in drinking rates and associated problems among college students is reviewed. Method:  Studies are included if completed within U.S. college and university samples and found in published scientific literature as identified by several searches of national databases. Results:  The resulting review suggests first that the extant literature is large and varied in quality, as most studies use questionnaire responses from samples of convenience in cross-sectional designs. Evidence from studies of college samples does consistently suggest that alcohol is consumed for several different purposes for different psychological effects in different contexts. A pattern of impulsivity/sensation seeking is strongly related to increased drinking among students. This pattern is supported by research into personality, drinking motives, alcohol expectancies and drinking contexts. A second pattern of drinking associated with negative emotional states is also documented. Some long-term consequences of this second pattern have been described. Social processes appear especially important for drinking in many college venues and may contribute to individual differences in drinking more than enduring personality differences. Conclusions:  Future research efforts should test interactive and mediating models of multiple risk factors and address developmental processes. ( J. Stud. Alcohol,  Supplement No. 14: 40-53, 2002)

John S. Baer, Ph.D., Research Associate Professor, Department of Psychology, University of Washington, and Coordinator of Education, Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System

A Developmental Perspective on Alcohol Use and Heavy Drinking during Adolescence and the Transition to Young Adulthood

ABSTRACT Objective:  This article offers a developmental perspective on college drinking by focusing on broad developmental themes during adolescence and the transition to young adulthood. Method:  A literature review was conducted. Results:  The transition to college involves major individual and contextual change in every domain of life; at the same time, heavy drinking and associated problems increase during this transition. A developmental contextual perspective encourages the examination of alcohol use and heavy drinking in relation to normative developmental tasks and transitions and in the context of students' changing lives, focusing on interindividual variation in the course and consequences of drinking and on a wide range of proximal and distal influences. Links between developmental transitions and alcohol use and other health risks are discussed in light of five conceptual models: Overload, Developmental Mismatch, Increased Heterogeneity, Transition Catalyst and Heightened Vulnerability to Chance Events. We review normative developmental transitions of adolescence and young adulthood, focusing on the domains of physical and cognitive development, identity, affiliation and achievement. Conclusions: As shown in a selective review of empirical studies, these transitions offer important vantage points for examining increasing (and decreasing) alcohol and other drug use during adolescence and young adulthood. We conclude with a consideration of research and intervention implications. ( J. Stud. Alcohol,  Supplement No. 14: 54-70, 2002)

John E. Schulenberg, Ph.D., Senior Research Scientist, Institute for Social Research, Professor, Department of Psychology, and Research Scientist, Center for Human Growth and Development, University of Michigan, and Jennifer L. Maggs, Ph.D., Associate Professor, Family Studies and Human Development, University of Arizona

The Adolescent Brain and the College Drinker: Biological Basis of Propensity to Use and Misuse Alcohol

ABSTRACT Objective:  This article reviews the literature on adolescent brain development and considers the impact of these neural alterations on the propensity to use and misuse alcohol. Method:  Neural, behavioral and hormonal characteristics of adolescents across a variety of species were examined, along with a review of the ontogeny of ethanol responsiveness, tolerance development and stress/alcohol interactions. Results:  The adolescent brain is a brain in transition. Prominent among the brain regions undergoing developmental change during adolescence in a variety of species are the prefrontal cortex and other forebrain dopamine projection regions, stressor-sensitive areas that form part of the neural circuitry modulating the motivational value of alcohol and other reinforcing stimuli. Along with these characteristic brain features, adolescents also exhibit increased stressor responsivity and an altered sensitivity to a variety of ethanol effects. Findings are mixed to date as to whether exposure to ethanol during this time of rapid brain development alters neurocognitive function and later propensity for problematic ethanol use. Conclusions:  Developmental transformations of the adolescent brain may have been evolutionarily advantageous in promoting behavioral adaptations to avoid inbreeding and to facilitate the transition to independence. These brain transformations may also alter sensitivity of adolescents to a number of alcohol effects, leading perhaps in some cases to higher intakes to attain reinforcing effects. These features of the adolescent brain may also increase the sensitivity of adolescents to stressors, further escalating their propensity to initiate alcohol use. Additional investigations are needed to resolve whether ethanol use during adolescence disrupts maturational processes in ethanol-sensitive brain regions. ( J. Stud. Alcohol,  Supplement No. 14: 71-81, 2002)

College Factors That Influence Drinking

ABSTRACT Objective:  The purpose of this article is to examine the aspects of collegiate environments, rather than student characteristics, that influence drinking. Unfortunately, the existing literature is scant on this topic. Method:  A literature review of articles primarily published within the last 10 years, along with some earlier "landmark" studies of collegiate drinking in the United States, was conducted to determine institutional factors that influence the consumption of alcohol. In addition, a demonstration analysis of Core Alcohol and Drug Survey research findings was conducted to further elucidate the issues. Results:  Several factors have been shown to relate to drinking: (1) organizational property variables of campuses, including affiliations (historically black institutions, women's institutions), presence of a Greek system, athletics and 2- or 4-year designation; (2) physical and behavioral property variables of campuses, including type of residence, institution size, location and quantity of heavy episodic drinking; and (3) campus community property variables, including pricing and availability and outlet density. Studies, however, tend to look at individual variables one at a time rather than in combination (multivariate analyses). Some new analyses, using Core Alcohol and Drug Survey data sets, are presented as examples of promising approaches to future research. Conclusions:  Given the complexities of campus environments, it continues to be a challenge to the field to firmly establish the most compelling institutional and environmental factors relating to high-risk collegiate drinking. ( J. Stud. Alcohol , Supplement No. 14: 82-90, 2002)

Cheryl A. Presley, Ph.D., Director, Student Health Programs and Assistant to the Vice Chancellor for Student Affairs for Research, Executive Director, Core Institute, Southern Illinois University; Philip W. Meilman, Ph.D., Director, Counseling and Psychological Services, Courtesy Professor of Human Development, Associate Professor of Psychology in Clinical Psychiatry, Cornell University; and Jami S. Leichliter, Ph.D., Behavioral Scientist, Division of STD Prevention, Centers for Disease Control and Preventiony

Surveying the Damage: A Review of Research on Consequences of Alcohol Misuse in College Populations

ABSTRACT This article provides a review and synthesis of professional research literature on the types, extent and patterns of negative consequences produced by student's misuse of alcohol in college populations based on survey research conducted during the last two decades. Considerable evidence is available documenting a wide range of damage by some student's drinking done to themselves as well as to other individuals, although some types of consequences remain speculative. Damage and costs to institutions are likely to be substantial, but this claim remains largely an inference based on current studies. Drinking by males compared with that of females produces more consequences for self and others that involve public deviance, whereas female's drinking contributes equally with males to consequences that are personal and relatively private. Research on racial/ethnic background, time trends and developmental stages reveals patterns in student data on consequences of drinking, but these data are very limited in the literature. Evidence suggests there is only a modest correlation between student's self-perception of having a drinking problem and the many negative consequences of drinking that are reported.  (J. Stud. Alcohol,  Supplement No. 14: 91-100, 2002)

H. Wesley Perkins, Ph.D., Professor of Sociology, Department of Anthropology and Sociology, Hobart and William Smith Colleges

Alcohol Use and Risky Sexual Behavior Among College Students and Youth: Evaluating the Evidence

ABSTRACT Objective:  To evaluate the empirical associations between alcohol use and risky sex at two levels of analysis. Global associations test whether individuals who engage in one behavior are more likely to engage in the other, whereas event-specific associations test whether the likelihood of engaging in one behavior on a given occasion varies as a function of engaging in the other on that same occasion. Method:  Studies examining the association between drinking and risky sex in samples of college students and youth were reviewed. Those published in the past 10 years and using event-level methodology or random sampling were emphasized. Results:  Findings were generally consistent across levels of analysis, but differed across types of risky behaviors. Drinking was strongly related to the decision to have sex and to indiscriminate forms of risky sex (e.g., having multiple or casual sex partners), but was inconsistently related to protective behaviors (e.g., condom use). Moreover, the links among alcohol use, the decision to have sex and indiscriminate behaviors were found in both between-persons and within-persons analyses, suggesting that these relationships cannot be adequately explained by stable individual differences between people who do and do not drink. Analysis of event characteristics showed that drinking was more strongly associated with decreased protective behaviors among younger individuals, on first intercourse experiences and for events that occurred on average longer ago. Conclusions: Future efforts aimed at reducing alcohol use in potentially sexual situations may decrease some forms of risky sex, but are less likely to affect protective behaviors directly. ( J. Stud. Alcohol , Supplement No. 14: 101-117, 2002)

M. Lynne Cooper, Ph.D., Professor of Psychology, Department of Psychology, University of Missouri at Columbia

Alcohol-Related Sexual Assault: A Common Problem Among College Students

ABSTRACT Objective:  This article summarizes research on the role of alcohol in college students' sexual assault experiences. Sexual assault is extremely common among college students. At least half of these sexual assaults involve alcohol consumption by the perpetrator, the victim or both. Method:  Two research literatures were reviewed: the sexual assault literature and the literature that examines alcohol's effects on aggressive and sexual behavior. Results:  Research suggests that alcohol consumption by the perpetrator and/or the victim increases the likelihood of acquaintance sexual assault occurring through multiple pathways. Alcohol's psychological, cognitive and motor effects contribute to sexual assault. Conclusions:  Although existing research addresses some important questions, there are many gaps. Methodological limitations of past research are noted, and suggestions are made for future research. In addition, recommendations are made for college prevention programs and policy initiatives. ( J. Stud. Alcohol,  Supplement No. 14: 118-128, 2002)

Antonia Abbey, Ph.D., Associate Professor, Department of Community Medicine, Wayne State University

Alcohol-Related Aggression during the College Years: Theories, Risk Factors, and Policy Implications

ABSTRACT Objective:  The purpose of this article is to present an overview of the research literature on alcohol-related aggression with a focus on college students. Method:  Data from both survey studies and experimental laboratory investigations conducted on college students are reviewed. Various methodological approaches to studying the alcoholaggression relation, and their associated limitations, are then presented and discussed. Results:  The literature indicates that alcohol consumption facilitates aggressive behavior and increases the risk of being the victim of a violent act, particularly in heavy drinkers. Results from these studies are then placed into a context by reviewing 12 influential theories of aggression and alcohol-related aggression. On the basis of these theories and empirical data, a preliminary risk profile is presented to help identify which factors are likely to be important in predicting who will and who will not become aggressive after drinking alcohol. Conclusions:  Although much research is still needed to elucidate the intricate causes of alcohol-related aggression, current prevention efforts might focus on modifying key risk factors such as poor cognitive functioning and inaccurate expectations about the effects of alcohol. Other prevention efforts directed specifically at college students might focus on helping them to identify risky situations that might facilitate the expression of intoxicated aggression. ( J. Stud. Alcohol , Supplement No. 14: 129-139, 2002)

Peter R. Giancola, Ph.D., Assistant Professor of Psychology, University of Kentucky

Today's First-Year Students and Alcohol  (Not part of Supplement) M. Lee Upcraft, Ph.D., Senior Scientist, Center for the Study of Higher Education, Professor Emeritus of Higher Education and Assistant Vice President Emeritus for Student Affairs, The Pennsylvania State University

So What Is an Administrator to Do?  (Not part of Supplement) Susan Murphy, Ph.D., Vice President, Student and Academic Services, Cornell University

Panel 2 - PREVENTION AND TREATMENT

A Typology for Campus-Based Alcohol Prevention: Moving toward Environmental Management Strategies

ABSTRACT Objective:  This article outlines a typology of programs and policies for preventing and treating campus-based alcohol-related problems, reviews recent case studies showing the promise of campusbased environmental management strategies and reports findings from a national survey of U.S. colleges and universities about available resources for pursuing environmentally focused prevention. Method:  The typology is grounded in a social ecological framework, which recognizes that health-related behaviors are affected through multiple levels of influence: intrapersonal (individual) factors, interpersonal (group) processes, institutional factors, community factors and public policy. The survey on prevention resources and activities was mailed to senior administrators responsible for their school's institutional response to substance use problems. The study sample was an equal probability sample of 365 2- and 4-year U.S. campuses. The response rate was 76.9%. Results:  Recent case studies suggest the value of environmentally focused alcohol prevention approaches on campus, but more rigorous research is needed to establish their effectiveness. The administrators' survey showed that most U.S. colleges have not yet installed the basic infrastructure required for developing, implementing and evaluating environmental management strategies. Conclusions:  The typology of campus-based prevention options can be used to categorize current efforts and to inform strategic planning of multilevel interventions. Additional colleges and universities should establish a permanent campus task force that reports directly to the president, participate actively in a campus-community coalition that seeks to change the availability of alcohol in the local community and join a state-level association that speaks out on state and federal policy issues. ( J. Stud. Alcohol,  Supplement No. 14: 140-147, 2002)

William DeJong, Ph.D., Professor, Boston University School of Public Health, and Director, U.S. Department of Education's Higher Education Center for Alcohol and Other Drug Prevention, and Linda Langford, Sc.D., Associate Director of Evaluation and Assessment, U.S. Department of Education's Higher Education Center for Alcohol and Other Drug Prevention

Identification, Prevention, and Treatment: A Review of Individual-Focused Strategies to Reduce Problematic Alcohol Consumption by College Students

ABSTRACT Objective:  The purpose of this article is to review and assess the existing body of literature on individually focused prevention and treatment approaches for college student drinking. Method:  Studies that evaluate the overall efficacy of an approach by measuring behavioral outcomes such as reductions in alcohol use and associated negative consequences were included. All studies discussed utilized at least one outcome measure focused on behavioral change and included a control or comparison condition; however, not all trials were randomized. Results:  Consistent with the results of previous reviews, little evidence exists for the utility of educational or awareness programs. Cognitive-behavioral skills-based interventions and brief motivational feedback (including mailed graphic feedback) have consistently yielded greater support for their efficacy than have informational interventions. Conclusions:  There is mixed support for values clarification and normative reeducation approaches. Much of the research suffers from serious methodological limitations. The evidence from this review suggests that campuses would best serve the student population by implementing brief, motivational or skills-based interventions, targeting high-risk students identified either through brief screening in health care centers or other campus settings or through membership in an identified risk group (e.g., freshmen, Greek organization members, athletes, mandated students). More research is needed to determine effective strategies for identifying, recruiting and retaining students in efficacious individually focused prevention services, and research on mandated student prevention services is an urgent priority. Integration between campus policies and individually oriented prevention approaches is recommended. ( J. Stud. Alcohol,  Supplement No. 14: 148-163, 2002)

Mary Larimer, Ph.D., Assistant Professor of Psychiatry and Behavioral Sciences, Adjunct Assistant Professor of Psychology, Associate Director, Addictive Behaviors Research Center, University of Washington, and Jessica M. Cronce, B.S., Research Coordinator, Addictive Behaviors Research Center, Department of Psychology, University of Washington

Social Norms and the Prevention of Alcohol Misuse in Collegiate Contexts

ABSTRACT Objective:  This article provides a review of conceptual and empirical studies on the role of social norms in college student alcohol use and in prevention strategies to counter misuse. The normative influences of various constituencies serving as reference groups for students are examined as possible factors influencing students' drinking behavior. Method:  A review of English language studies was conducted. Results:  Parental norms have only modest impact on students once they enter college beyond the residual effects of previously instilled drinking attitudes and religious traditions. Faculty could theoretically provide a positive influence on student drinking behavior, but there is little evidence in the literature that faculty norms and expectations about avoiding alcohol misuse are effectively communicated to students. Although the norms of resident advisers (RAs) should ideally provide a restraint on student alcohol misuse, the positive influence of RAs is limited by their negotiated compromises with students whom they oversee and by their misperceptions of student norms. Research reveals student peer norms to be the strongest influence on students' personal drinking behavior, with the more socially integrated students typically drinking most heavily. The widespread prevalence among students of dramatic misperceptions of peer norms regarding drinking attitudes and behaviors is also a consistent finding. Permissiveness and problem behaviors among peers are overestimated, even in environments where problem drinking rates are relatively high in actuality. These misperceived norms, in turn, have a significant negative effect promoting and exacerbating problem drinking. Conclusions:  Interventions to reduce these misperceptions have revealed a substantial positive effect in several pilot studies and campus experiments. ( J. Stud. Alcohol,  Supplement No. 14: 164- 172, 2002)

Alcohol Advertising and Youth

ABSTRACT Objective:  The question addressed in this review is whether aggregate alcohol advertising increases alcohol consumption among college students. Both the level of alcohol-related problems on college campuses and the level of alcohol advertising are high. Some researchers have concluded that the cultural myths and symbols used in alcohol advertisements have powerful meanings for college students and affect intentions to drink. There is, however, very little empirical evidence that alcohol advertising has any effect on actual alcohol consumption. Method:  The methods used in this review include a theoretical framework for evaluating the effects of advertising. This theory suggests that the marginal effect of advertising diminishes at high levels of advertising. Many prior empirical studies measured the effect of advertising at high levels of advertising and found no effect. Those studies that measure advertising at lower, more disaggregated levels have found an effect on consumption. Results:  The results of this review suggest that advertising does increase consumption. However, advertising cannot be reduced with limited bans, which are likely to result in substitution to other available media. Comprehensive bans on all forms of advertising and promotion can eliminate options for substitution and be potentially more effective in reducing consumption. In addition, there is an increasing body of literature that suggests that alcohol counteradvertising is effective in reducing the alcohol consumption of teenagers and young adults. Conclusions:  These findings indicate that increased counteradvertising, rather than new advertising bans, appears to be the better choice for public policy. It is doubtful that the comprehensive advertising bans required to reduce advertising would ever receive much public support. New limited bans on alcohol advertising might also result in less alcohol counteradvertising. An important topic for future research is to identify the counteradvertising themes that are most effective with youth. ( J. Stud. Alcohol,  Supplement No. 14: 173-181, 2002)

Henry Saffer, Ph.D., Professor of Economics, Kean University, and Research Associate, National Bureau of Economic Research

The Role of Mass Media Campaigns in Reducing High-Risk Drinking among College Students

ABSTRACT Objective:  This article categorizes and describes current media campaigns to reduce college student drinking, reviews key principles of campaign design and outlines recommendations for future campaigns. Method:  The article describes three types of media campaigns on student drinking: information, social norms marketing, and advocacy. Key principles of campaign design are derived from work in commercial marketing, advertising, and public relations and from evaluations of past public health campaigns. Results:  Information campaigns on the dangers of high-risk drinking are common, but none has been rigorously evaluated. Quasi-experimental studies suggest that social norms marketing campaigns, which correct misperceptions of campus drinking norms, may be effective, but more rigorous research is needed. As of this writing, only one major media campaign has focused on policy advocacy to reduce college student drinking, but it is still being evaluated. Lessons for campaign design are organized as a series of steps for campaign development, implementation and assessment: launch a strategic planning process, select a strategic objective, select the target audience, develop a staged approach, define the key promise, avoid fear appeals, select the right message source, select a mix of media channels, maximize media exposure, conduct formative research, and conduct process and outcome evaluations. Conclusions:  Future campaigns should integrate information, social norms marketing, and advocacy approaches to create a climate of support for institutional, community and policy changes that will alter the environment in which students make decisions about their alcohol consumption. ( J. Stud. Alcohol,  Supplement No. 14: 182-192, 2002)

William DeJong, Ph.D., Professor, Boston University School of Public Health, and Director, U.S. Department of Education's Higher Education Center for Alcohol and Other Drug Prevention

Environmental Policies to Reduce College Drinking: Options and Research Findings

ABSTRACT Objective:  The goal of this article is to provide an overview of environmental strategies that may reduce college drinking. Drinking behavior is influenced by many environmental factors, including messages in the media, community norms and attitudes, public and institutional policies and practices and economic factors. College student drinking may be influenced by environmental factors on and off campus. Method:  A comprehensive search of MEDLINE, ETOH, Current Contents and Social Science Abstracts databases was conducted to identify research studies evaluating effects of environmental strategies on college and general populations. Results:  The identified environmental strategies fall into four categories: (1) increasing compliance with minimum legal drinking age laws, (2) reducing consumption and risky alcohol use, (3) decreasing specific types of alcohol-related problems and (4) deemphasizing the role of alcohol on campus and promoting academics and citizenship. Although the extant research indicates that many environmental strategies are promising for reducing alcohol-related problems among the general population, few of these strategies have been evaluated for effects on the college population. Conclusions:  Further research is needed to evaluate effects of alcohol control policies on alcohol consumption and its related problems among college students. ( J. Stud. Alcohol,  Supplement No. 14: 193-205, 2002)

Traci L. Toomey, Ph.D., Assistant Professor, School of Public Health, Division of Epidemiology, University of Minnesota, and Alexander C. Wagenaar, Ph.D., Professor and Director, Alcohol Epidemiology Program, School of Public Health, Division of Epidemiology, University of Minnesota

Effects of Minimum Drinking Age Laws: Review and Analyses of the Literature from 1960 to 2000

ABSTRACT Objective:  The goal of this article is to review critically the extant minimum legal drinking age (MLDA) research literature and summarize the current state of knowledge regarding the effectiveness of this policy. Method:  Comprehensive searches of four databases were conducted to identify empirical studies of the MLDA published from 1960 to 1999. Three variables were coded for each study regarding methodological quality: (1) sampling design, (2) study design and (3) presence or absence of comparison group. Results:  We identified 241 empirical analyses of the MLDA. Fifty-six percent of the analyses met our criteria for high methodological quality. Of the 33 higher quality studies of MLDA and alcohol consumption, 11 (33%) found an inverse relationship; only 1 found the opposite. Similarly, of the 79 higher quality analyses of MLDA and traffic crashes, 46 (58%) found a higher MLDA related to decreased traffic crashes; none found the opposite. Eight of the 23 analyses of other problems found a higher MLDA associated with reduced problems; none found the opposite. Only 6 of the 64 college-specific studies (9%) were of high quality; none found a significant relationship between the MLDA and outcome measures. Conclusions:  The preponderance of evidence indicates there is an inverse relationship between the MLDA and two outcome measures: alcohol consumption and traffic crashes. The quality of the studies of specific populations such as college students is poor, preventing any conclusions that the effects of MLDA might differ for such special populations. ( J. Stud. Alcohol,  Supplement No. 14: 206-225, 2002)

Alexander C. Wagenaar, Ph.D., Professor and Director, Alcohol Epidemiology Program, School of Public Health, Division of Epidemiology, University of Minnesota, and Traci L. Toomey, Ph.D., Assistant Professor, School of Public Health, Division of Epidemiology, University of Minnesota

Comprehensive Community Interventions to Promote Health: Implications for College-Age Drinking Problems

ABSTRACT Objective:  This article reviews comprehensive community interventions that sought to reduce (1) cardiovascular disease risks; (2) smoking; (3) alcohol use disorders, alcohol-related injury and illicit drug use; or (4) sexual risk taking that could lead to HIV infection, sexually transmitted disease and pregnancy. Method:  Comprehensive community programs typically involve multiple city government agencies as well as private citizens and organizations and use multiple intervention strategies such as school-based and public education programs, media advocacy, community organizing, environmental policy changes and heightened enforcement of existing policies. This review focused on English-language papers published over the past several decades. Results:  Some programs in each of the four problem areas achieved their behavioral and health goals. The most consistent benefits were found in programs targeting behaviors with immediate health consequences such as alcohol misuse or sexual risk taking. Results were less consistent when consequences of targeted behaviors were more distant in time such as cardiovascular risks and smoking. Also, programs that targeted youth to prevent them from starting new health-compromising behaviors tended to be more successful than programs aimed at modifying preexisting habits among adults. Programs that combined environmental and institutional policy change with theory-based education programs were the most likely to be successful. Finally, programs tailored to local conditions by the communities themselves tended to achieve more behavior change than programs imported from the outside. Conclusions: Comprehensive community intervention approaches may have considerable potential to reduce college-age drinking problems, especially given the success of these programs in reducing alcohol-related problems and in preventing health-compromising behaviors among youth. ( J. Stud. Alcohol,  Supplement No. 14: 226-240, 2002)

Ralph Hingson, Sc.D., Professor and Chair, Social and Behavioral Sciences Department, Boston University School of Public Health, and Jonathan Howland, Ph.D., M.P.H., Professor and Chair, Social and Behavioral Sciences Department, Boston University School of Public Health

The Role of Evaluation in Prevention of College Student Drinking Problems  (Not part of Supplement) Robert F. Saltz, Ph.D., Associate Director and Senior Research Scientist, Prevention Research Center, Berkeley, CA

View from the President's Office: The Leadership of Change  (Not part of Supplement) Joy R. Mara, M.A., Mara Communications

JOINT PANEL PAPER

The Student Perspective on College Drinking  (Not part of Supplement) Peggy Eastman, Author and Journalist

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• Published: 10 December 2013

Alcohol marketing and drunkenness among students in the Philippines: findings from the nationally representative Global School-based Student Health Survey

• Monica H Swahn 1 ,
• Jane B Palmier 1 ,
• Agnes Benegas-Segarra 2 &
• Fe A Sinson 2  

BMC Public Health volume  13 , Article number:  1159 ( 2013 ) Cite this article

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A largely unaddressed issue in lower income countries and the Philippines, in particular, is the role of alcohol marketing and its potential link to early alcohol use among youth. This study examines the associations between exposures to alcohol marketing and Filipino youths’ drinking prevalence and drunkenness.

Cross-sectional analyses were used to examine the Global School-based Student Health Survey (GSHS) conducted in Philippines (2011). The self-administered questionnaires were completed by students primarily 13 to 16 years of age (N = 5290). Three statistical models were computed to test the associations between alcohol marketing and alcohol use, while controlling for possible confounding factors.

Alcohol marketing, specifically through providing free alcohol through a company representative, was associated with drunkenness (AOR: 1.84; 95% CI = 1.06–3.21) among youths after controlling for demographic and psychosocial characteristics, peer environment, and risky behaviors. In addition, seeing alcohol ads in newspapers and magazines (AOR: 1.65, 95% CI = 1.05–2.58) and seeing ads at sports events, concerts or fairs (AOR: 1.50, 95% CI = 1.06–2.12) were significantly associated with increased reports of drunkenness.

Conclusions

There are significant associations between alcohol marketing exposure and increased alcohol use and drunkenness among youth in the Philippines. These findings highlight the need to put policies into effect that restrict alcohol marketing practices as an important prevention strategy for reducing alcohol use and its dire consequences among vulnerable youth.

Peer Review reports

Alcohol use is the most commonly used psychoactive substance in the world and is one of the leading causes of death and disability [ 1 ]. Alcohol abuse causes 3.2% of all deaths worldwide annually and also accounts for 4.0% of the global disease burden each year [ 2 ]. Research has shown that alcohol use is associated with alcohol addiction [ 3 ], other drug use [ 4 ], unintentional injuries [ 3 , 5 ], physical fighting [ 6 ], criminal activity [ 4 ], suicidal ideation and attempts [ 7 – 9 ], and increased risk of HIV/AIDS [ 10 , 11 ].

In order to address this global public health issue, the World Health Organization (WHO) recently prioritized the global reduction of the harmful use of alcohol [ 12 ]. Even with limited data, it is still evident that low and middle-income countries bear a disproportionate public health burden due to increasing alcohol consumption and limited or non-existent prevention policies and programs [ 1 ].

Alcohol use among youth is affected by a range of psychosocial and environmental factors. Relatively recent research has increasingly focused on the role of exposure to alcohol marketing broadly defined and its influences on youth drinking in particular. However, such research has been largely limited to high income countries, with a few exceptions [ 13 – 17 ].

Intriguingly, research on the predictors of alcohol use and its adverse outcomes among youth is scarce in the Philippines. Data from the WHO indicates that almost 9% of the Philippines population who are 15 years of age and older (estimated at 86 million) have an alcohol use disorder [ 18 ]. In addition, 25% of males and 8.3% of females (15-85+ years) are heavy episodic drinkers [ 18 ]. A related and also largely unaddressed issue in the broader Western Pacific region, and the Philippines in particular, is the role of alcohol marketing and its potential link to early alcohol use among youth. Since the 1990s, concern has grown about heavy drinking and alcohol-related harm, and the link with the growth in alcohol marketing that targets young people [ 19 , 20 ]. In the Philippines, new marketing strategies for beer and spirits are now being used to target youth and women, particularly by the large local companies, Asia Brewery and San Miguel Corporation [ 20 ]. Although the Philippines has a national legal minimum age for off and on premises sales of alcoholic beverages [ 18 ] and a recently enacted drunk driving law [ 21 ], there are no restrictions on the marketing of such alcoholic beverages to youth and minors. A high proportion of marketing expenditures are on non-media forms of promotion [ 20 ]. Alcohol company sponsorship of sports and cultural events is a major marketing strategy, which is under-researched and rarely addressed by policy makers [ 20 ]. Sponsorships at sports events in particular (which attract more young people) provide promotional opportunities that imprint brand names and products on young consumers and potential consumers [ 20 ]. Direct marketing includes brand promotions at venues or retail outlets at which drinkers can be approached directly, or creating the brand’s own events at which the public or invited customers attend. New brands and products, such as ready-to-drinks (RTDs) are often launched in this way to give people an opportunity to sample the product [ 20 ].

Analysts of the Asian alcohol markets describe RTDs as a starting point for young consumers moving from non-alcoholic beverages to alcoholic drinks. Growth in RTDs is anticipated in the Philippines among women and new young drinkers [ 22 ]. Marketing of RTDs in the Philippines began on a small scale but volume sales increased markedly as local companies began to compete with the imported brands led by Diageo Philippines Inc. [ 22 ]. There is intense competition between global alcohol companies such as Diageo, Heineken, Carlsberg, Anheuser Busch, SABMiller and Kirin to position themselves to get a share of the emerging markets in the Western Pacific region. Review of recent corporate reports of global alcohol companies shows that the strategy is to target growing countries with high youth populations [ 20 ].

In two of the few studies conducted on exposure to alcohol marketing among youth in a low income country, findings demonstrate that alcohol marketing, specifically through the provision of free alcohol to school-attending youth (ages 13–16), is relatively common in Zambia (30%) [ 23 ] and among vulnerable service seeking youth in Uganda (27.0%) [ 24 ] and that this form of marketing is associated with problem drinking and drunkenness [ 23 , 24 ]. Previous research conducted primarily in North America and Europe shows that exposure to alcohol advertising and ownership of alcohol promotional items has been found to increase the risk of alcohol use among adolescents [ 14 , 25 ]. Moreover, based on extensive research, it is clear that alcohol marketing also influences youths’ attitudes and perceptions about alcohol, which are related to expectancies and intentions to consume alcohol beverages [ 26 , 27 ]. In addition, youth who report liking alcohol advertisements are also more likely to use alcohol [ 28 – 30 ]. More troubling is the issue of the long-lasting effect of alcohol marketing exposure. As an example, research shows that exposure to alcohol advertising in youth predicts youth’s intentions of alcohol consumption up to two years later [ 31 ].

The totality of previous research indicate that alcohol marketing to youth is a growing public health concern and that this problem may be exacerbated among youth living in countries with limited alcohol policies and self-regulation by the alcohol industry [ 32 , 33 ]. This may be the case because of the resources available to the alcohol industry to promote their marketing efforts. Alcohol Justice (formerly the Marin Institute) is a group dedicated to respond to the alcohol industry and their marketing practices primarily in the U.S. They report that the alcohol industry spends more than $6 billion each year on marketing its products [ 34 ]. Unfortunately, many alcohol marketing practices are aimed directly at youth and those that are outside of the home (e.g., billboards, advertisements at sports events and concerts, buildings, newspapers and magazines, and on the internet) pose particular concerns because parents cannot typically shield their children from those exposures [ 35 ]. However, spending on these forms of marketing, labeled “out-of-home advertising” have increased by billions in recent years [ 35 ]. Alcohol advertising and marketing of alcohol products clearly increase intent to use as well as actual alcohol use among adolescents [ 26 , 27 , 29 , 30 ]. Additionally, recent research shows that youth are more exposed to alcohol marketing than adults and need stronger protections [ 36 ]. The increased use of digital media is set to make matters worse. Alcohol marketers are rapidly using social networking for their campaigns, and such media is used more heavily by young people which will likely exacerbate their exposure to alcohol marketing [ 36 ].

The purpose of this study is to examine the prevalence of alcohol marketing exposure in a nationally representative sample of youth in Philippines and to examine if there are significant associations between alcohol marketing and drunkenness among Filipino youth. Findings from this study will be important for prevention and intervention efforts that seek to reduce alcohol use and adverse health consequences among youth.

The current study is based on the Global School-based Student Health Survey, conducted in Philippines in 2011 among students in grades 1 st -4 th (N = 5290). The GSHS was developed and supported by the World Health Organization in collaboration with the United Nations Children’s Fund, the United Nations Educational, Scientific, and Cultural Organization, the Joint United Nations Programme on HIV/AIDS, and with technical assistance from the Centers for Disease Control and Prevention [ 37 ]. The goal of the GSHS is to provide data on health behaviors and relevant risk and protective factors among students across all regions served by the United Nations. Country specific questionnaires, fact sheets, public-use data files, documentation and reports are publicly available from the Centers for Disease Control and Prevention and the World Health Organization [ 37 ].

The GSHS is comprised of a self-administered questionnaire, administered to students primarily 11–16 years of age. The survey uses a standardized scientific sample selection process, common school-based methodology, and a combination of core questionnaire modules, core-expanded questions, and country-specific questions. The Philippines GSHS employed a two-stage cluster sample design to produce a representative sample of students in 2nd-4 th year levels of Secondary Education or High School. The first-stage sampling frame consisted of all schools containing any of 2nd-4 th year levels. Schools were selected with probability proportional to school enrollment size. The second stage of sampling consisted of randomly selecting intact classrooms (using a random start) from each school to participate. All classrooms in each selected school were included in the sampling frame. All students in the sampled class rooms were eligible to participate in the GSHS [ 37 ].

Survey procedures were designed to protect students’ privacy by allowing for anonymous and voluntary participation. Students completed the self-administered questionnaire during one class period and recorded their responses directly on computer-scannable questionnaire answer sheet [ 37 ].

The current analyses are based on the restricted data file that includes an expanded list of questions. The school response rate was 97%, the student response rate was 84%, and the overall response rate was 82%. A total of 5290 students participated in the Philippine survey [ 37 ]. The sample consisted of 2,279 males and 2,986 females, and of the following age groups: 11 years old or younger (n = 20), 12 years old (n = 205), 13 years old (n = 980), 14 years old (n = 1,350) 15 years old (n = 1310) and 16 years old or older (n = 1384).

The alcohol marketing factors examined were seeing alcohol advertisements at sports and public events, during sports on TV, on billboards, in newspapers and magazines, seeing actors drink, possessing alcohol brand logo and being offered alcohol from an alcohol company representative. Responses to these questions were dichotomized to indicate any exposure versus none for each of the seven marketing variables (Table  1 ). The analyses controlled for the following potential confounders (all dichotomized): current alcohol use, bullying victimization, lack of friends, missing school, and illicit drug use (Table  1 ). Drunkenness, the outcome measure, was assessed through students’ reports of the number of times they had gotten drunk during their lifetime on a 4-item scale ranging from 0 times to 10 or more times. Responses to the outcome measure were dichotomized to reflect none versus at least one episode of drunkenness during lifetime.

Logistic regression analyses were computed to determine the associations between alcohol marketing exposures and drunkenness using a 3-step model-building strategy. Model 1 included sex, age, alcohol use in the past 30 days, and usual amount of alcohol use. Model 2 included variables from Model 1 along with bully victimization, lack of friends, missing school, and illicit drug use. Model 3 included variables from Model 1 and Model 2, in addition to factors relating to alcohol marketing, such as seeing alcohol ads at sports events, fairs or concerts, or on TV, seeing actors drink, alcohol advertisements on billboards, and in newspapers and magazines, being offered alcohol from an alcohol company representative and having a brand logo item.

Analyses were conducted with the SAS 9.1 and SUDAAN 10 statistical software packages to accommodate the sampling design, and produce weighted estimates. IRB approval was obtained from the Georgia State University to conduct these analyses.

The prevalence for each variable examined in this study is outlined in Table  1 . Among participants, 23.3% reported current alcohol use and 20.7% reported drunkenness. The bivariate associations between sex, age, and alcohol marketing with current alcohol use, and drunkenness are presented in Table  2 . Boys were more likely than girls to report current alcohol use or drunkenness. Youth 16 years of age or older were also more likely to report alcohol use or drunkenness. Exposures to alcohol marketing through seeing actors drinking alcohol on TV, alcohol brand advertising during sports on TV, on billboards, possessing items with an alcohol brand logo and being offered alcohol from an alcohol company representative were associated with increased reports of current alcohol use. All forms of alcohol marketing exposures significantly increased risk for reports of drunkenness, except for newspapers/magazines. Seeing actors drinking on TV significantly increased reports of current alcohol use (OR: 1.48, 95% CI = 1.17–1.87), and drunkenness (OR: 1.25, 95% CI = 1.05–1.49). Seeing alcohol ads on billboards also significantly increased reports of current alcohol use (OR: 1.32, 95% CI = 1.09–1.59), and drunkenness (OR: 1.21, 95% CI = 1.09–1.36). Seeing alcohol ads at sports events, fairs or concerts significantly increased reports of drunkenness (OR: 1.71; 95% CI = 1.27–2.30). In addition, being offered free drinks through an alcohol company representative significantly increased reports of current alcohol use (OR: 2.22, 95% CI = 1.57–3.13), and drunkenness (OR: 2.17, 95% CI = 1.47–3.22). Alcohol marketing through receipt of brand logo items significantly increased reports of current alcohol use (OR: 1.86; 95% CI = 1.53–2.27), and drunkenness (OR: 1.43; 95% CI = 1.23–1.67).

Multivariate analyses presented in Table  3 , show that current alcohol use was the strongest correlate of drunkenness across the three models computed. In Models 2 and 3, having missed school and other drug use were also associated with increased reports of drunkenness. In Model 3, which examined the potential role of alcohol marketing factors, having received free alcohol from a company representative was significantly associated with drunkenness after controlling for demographic characteristics, personal competencies and peer environment (AOR: 1.84, 95% CI = 1.06–3.21). In addition, seeing alcohol ads in newspapers and magazines (AOR: 1.65, 95% CI = 1.05–2.58) and seeing ads at sports events, concerts or fairs (AOR: 1.50, 95% CI = 1.06–2.12) were significantly associated with increased reports of drunkenness.

This study examined the prevalence of exposure to alcohol marketing practices among nationally representative school-attending youth in the Philippines, and whether exposure to alcohol marketing is associated with drunkenness. The findings show that there is a high prevalence of exposure to different forms of alcohol marketing strategies. The most commonly reported exposures were seeing alcohol use by actors, seeing alcohol name brands at sport events or on TV and seeing billboards with an alcohol advertisement. However, the form of alcohol marketing that appears particularly troubling is provision of free drinks by alcohol companies directly to youth which was reported by 10% of the students. Moreover, receiving free alcohol from alcohol companies remained associated with drunkenness in multivariate analyses indicating that it appears to be a relatively robust risk factor for alcohol misuse. This issue regarding providing free drinks to youth has been observed in other countries [ 23 ] and warrants attention by researchers and policy makers.

It is clear from previous research that direct marketing of alcohol products increases alcohol use and problems among youths and those findings are corroborated by the findings in the current study. The results of this study indicate a high prevalence of current alcohol use (23.2%) and drunkenness (20.7%) among the school-attending youth in the Philippines., in addition to a very strong association between current drinking and drunkenness. Our findings are also supported by research in the U.S. that shows that distributing alcohol merchandise to youth predicts their alcohol use [ 38 ]. In this study, nearly 15% of youth reported owning an item with an alcohol logo on it. However, owning an item with an alcohol brand logo on it was not associated with drunkenness.

The findings of this study show that alcohol marketing strategies in the Philippines through providing free alcohol to youth and through print and television media appear to reach a relatively large population of youth. These findings regarding the association between provision of free alcohol to youth and self-reports of drunkenness, mirror those conducted in Sub-Saharan Africa [ 23 ]. These alcohol marketing practices, aimed directly to children, have been banned in other countries and have important policy implications for countries where such bans do not exist. The implications of the empirical findings from the current study clearly indicate that stricter policies to prevent underage alcohol advertisements are needed. Such measures need to be urgently considered and applied given the frequency and levels of exposure to alcohol marketing, in particular, the free distribution of alcohol to youths, as observed in the current study.

The timing is critical for new policy initiatives and prevention strategies aimed to reduce alcohol use among adults and youth [ 39 ]. Recent reports by the alcohol industry indicate that they will produce and sell cheaper alcohol to Asia and African markets in order to increase its consumer market [ 20 ]. The goal of targeting low-income consumers and creating affordable brews will be achieved through using local ingredients, and also utilizing inexpensive individual-sized packaging to make purchasing alcohol more affordable [ 20 ]. Previous research clearly highlights that affordability of alcohol is strongly linked to alcohol use [ 40 ], and that these new industry strategies are likely to have a negative impact on alcohol use and alcohol-related adverse outcomes among youth in the Philippines and the Western Pacific region.

Policy and intervention suggestions for agencies provided by the World Health Organization to counteract alcohol marketing and reduce harmful effects of alcohol use include regulating alcohol marketing content and the volume of marketing, regulating marketing in media and sponsorship activities of alcohol industry, restricting or banning alcohol promotions targeting young people, regulating alcohol marketing techniques like social media, developing effective surveillance systems to monitor alcohol marketing, and enforcing marketing restrictions [ 12 ]. More research is necessary regarding the exposure of youth to alcohol advertising and levels of consumption to gain formative information needed to counteract these marketing influences and inform policy makers to support and implement such strategies.

The WHO has taken an important leadership role related to underage drinking prevention in their Report on the Seventh Meeting of the Regional Advisory Panel on Impacts of Drug Abuse: Technical consultation on the global strategy to reduce the harmful use of alcohol [ 12 ]. Per the Report, mandatory as well as voluntary regulations of marketing of alcohol products need to be considered and included in a comprehensive strategy to reduce the harmful use of alcohol. The Report also underscores that these measures need to be urgently considered and applied given the frequency and levels of exposure to alcohol marketing, in particular, the free distribution of alcohol to youths, as observed in the current study.

Although regulation of alcohol marketing to youth has been scarce in low and middle income countries, some progress is currently underway to enact policy in this area. [ 39 ]. In Zambia, bans have recently been implemented against the manufacturing and sale of strong liquor individual- sized sachets sold at very low prices, often in unlicensed bars and to minors [ 41 ]. Moreover, a recent commentary recommends that there should be a total ban on alcohol advertising in South Africa [ 42 , 43 ]. Additionally, the South African Minister for Social Development, Bathabile Dlamini, has stressed the need for restricting alcohol advertising in the country, in order to reduce the burden of social and health consequences of binge drinking among South Africans [ 44 ]. Researchers who have modeled the effectiveness of a ban on alcohol advertising on youth drinking in the U.S. found that among interventions shown to be successful in reducing youthful drinking prevalence, advertising bans appear to have the greatest potential for premature mortality reduction [ 45 ]. Another study performed an econometric analysis using data from the National Longitudinal Survey of Youth and estimated that a 28% reduction in alcohol advertising would reduce adolescent monthly alcohol use from 25% to between 24% and 21%, and would reduce adolescent binge drinking from 12% to between 11% and 8% [ 46 ]. This study also concluded that a total ban on all forms of alcohol marketing would results in further decreases in alcohol use and binge drinking among youth [ 47 ].

These same economists performed a study of 20 countries over 26 years and showed that a ban on all alcohol advertising could reduce underage monthly alcohol participation by about 24% (almost as much as a 100% increase in alcohol prices) and would reduce binge drinking by about 42% [ 47 ].

There are several limitations that should be considered when interpreting the findings of this study. First, the study is based on self-reported data of students in the Philippines. Accordingly, the findings may not be generalized to other populations or to youth who are no longer in school. Second, while our findings show statistically significant associations between marketing practices, other correlates, and drunkenness, more specific temporal ordering cannot be determined, nor can causality be inferred. Finally, the study did not include specific measures of other marketing strategies and educational experiences or other factors that may influence or confound the associations observed between alcohol marketing and drunkenness.

This study demonstrated that there are significant exposure to alcohol marketing and that this exposure is associated with alcohol use and drunkenness among school-attending youth in the Philippines. These findings highlight the need for leaders to prioritize implementation of policies that limit alcohol exposure and that restrict alcohol marketing practices as important prevention strategies for reducing alcohol use and its adverse health consequences among youth in the Philippines.

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Acknowledgment

The authors thank Huang Yao M.A., M.S. for her contribution to the analyses of this manuscript. We greatly appreciate her dedication and assistance in the data management and analysis for this study as Dr. Swahn’s Graduate Research Assistant while a graduate student at Georgia State University.

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MHS conceptualized the study, guided the analyses and drafted sections of the manuscript. JBP conducted the literature review and drafted sections of the manuscript. ABS led the acquisition of the data and provided contextual information. FAS led the acquisition of the data, and interpreted and reviewed analyses. All authors reviewed multiple versions of the manuscript and read and approved the final manuscript.

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Swahn, M.H., Palmier, J.B., Benegas-Segarra, A. et al. Alcohol marketing and drunkenness among students in the Philippines: findings from the nationally representative Global School-based Student Health Survey. BMC Public Health 13 , 1159 (2013). https://doi.org/10.1186/1471-2458-13-1159

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Received : 24 June 2013

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DOI : https://doi.org/10.1186/1471-2458-13-1159

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