Addressing College Drinking as a Statewide Public Health Problem: Key Findings From the Maryland Collaborative

State Alcohol Policy Environments of U.S. Colleges: Predictors of Sexual Assault and Alcohol-Related Arrest and Disciplinary Action

INTRODUCTION

Binge drinking and sexual assault are serious inter-related public health problems faced by college students. State-level alcohol policy restrictiveness has been found to decrease binge drinking among college students and, therefore, may also reduce occurrences of alcohol-related criminal offenses. It was hypothesized that more restrictive state alcohol policy environments would be associated with fewer liquor law violations and sexual assault offenses on U.S. college campuses.

METHODS

Data were aggregated across 3 academic years (2016-2017, 2017-2018, and 2018-2019) and represented n=1,290 institutions. Zero-inflated negative binomial regression modeling was performed in 2022-2023 to evaluate associations of state-level young adult binge drinking and the Alcohol Policy Scale (APS) with the numbers of campus-level alcohol-related arrests, alcohol-related disciplinary actions, rape offenses, and fondling offenses reported in national Campus Safety and Security data.

RESULTS

Higher APS scores had direct associations with fewer alcohol-related arrests (1.79% decrease per one-unit increase in APS, p=0.05), alcohol-related disciplinary actions (2.27% decrease per one-unit increase in APS, p=0.027), and rape offenses (0.85% decrease per one-unit increase in APS, p=0.021). The associations APS scores had with disciplinary actions and rape offenses were partially and fully mediated, respectively, by state-level young adult binge drinking. No associations were found between APS and fondling offenses.

CONCLUSIONS

This cross-sectional study presents evidence that more restrictive state alcohol policies are associated with fewer alcohol-related arrests and disciplinary actions, and rape offenses on college campuses. Future research should identify the alcohol policy domains that are most protective against these outcomes.

Alcohol and cannabis co-use: Receptiveness to treatments and application to intervention planning

Given the prevalence of alcohol and cannabis co-use among college students, prevention for co-use is crucial. We examined hypothetical receptiveness to substance-specific interventions among students who reported co-use. Students who use alcohol and cannabis were more receptive to alcohol interventions than cannabis interventions. Campus prevention experts should consider offering evidence-based alcohol-focused interventions as a potential pathway for decreasing substance use among college students who engage in co-use.

The Health Belief Model in the Context of Alcohol Protective Behavioral Strategies

Objective: Alcohol use continues to be prevalent and problematic among young adult samples. Protective behavioral strategies (PBS), which are harm reduction strategies utilized while drinking, have been linked to decreased alcohol use and subsequent alcohol-related problems. An individual's likelihood of adopting PBS and other health behaviors, according to The Health Belief Model (HBM), is dependent on perceived susceptibility to and severity of adverse health outcomes, as well as perceived benefits and barriers related to implementing those behaviors. The present study examined whether the perceived effectiveness of PBS in the context of the HBM leads to an increase in PBS use. Method: The analytic sample (n =694 college students, M_age =20.21, SD =4.37, 63.26% female, 72.05% Caucasian) self-reported demographics, weekly alcohol consumption (i.e., frequency, intensity, and quantity), alcohol-related problems, use of PBS, and perceived effectiveness of PBS use. A latent variable model was used to test the effect of perceived PBS effectiveness on PBS use, alcohol consumption, and alcohol-related problems. Results: Perceived PBS effectiveness was associated with a higher likelihood of using PBS subtypes (Manner of Drinking, Stopping/Limiting Drinking, and Serious Harm Reduction), which in turn was associated with reductions in alcohol consumption and problems. Conclusions: These findings suggest that increasing perceptions of PBS effectiveness may lead to more PBS use, decreased alcohol consumption, and fewer alcohol-related problems. Future research could implement longitudinal methodology to assess attempts to increase perceived effectiveness of PBS use and potentially establish a causal link between these perceptions, PBS use, and alcohol-related outcomes.

Forming Cardi-OH: A Statewide Collaborative to Improve Cardiovascular Health in Ohio

Background

Cardiovascular risk factor control is challenging, especially in disadvantaged populations. However, few statewide efforts exist to tackle this challenge. Therefore, our objective is to describe the formation of a unique statewide cardiovascular health collaborative so others may learn from this approach.

Methodology

With funding from the Ohio Department of Medicaid’s Ohio Medicaid Technical Assistance and Policy Program, we used a collective impact model to link the seven medical schools in Ohio, primary care clinics across the state, the Ohio Department of Medicaid, and Ohio’s Medicaid Managed Care Plans in a statewide health improvement collaborative for expanding primary care capacity to improve cardiovascular health in Ohio.

Results

Initial dissemination activities for primary care teams included a virtual case-based learning series focused on hypertension and social determinants of health, website resources, a monthly newsletter with clinical tips, webinars, and in-person conferences. The collaborative is aligned with a separately funded hypertension quality improvement project for paired implementation.

Conclusions

The collective impact model is a useful framework for developing a statewide collaborative focused on the dissemination and implementation of evidence-based best practices for cardiovascular health improvement and disparity reduction. Statewide collaboratives bringing payers, clinicians, and academic partners together have the potential to substantially impact cardiovascular health.

Individual and Contextual Characteristics Associated With Alcohol Use Among Brazilian Adolescents

Objective: To analyze the association between individual and contextual characteristics with alcohol indicators of experimentation, use in the last 30 days and drunkenness in Brazilian adolescents.

Methods: Cross-sectional study based on data from 100,914 student attending 9^th grade from the 2015 National School Health Survey. Multilevel logistic regression models were performed for the outcomes: alcohol experimentation; use in the last 30 days and drunkenness; and exposures, adjusted for adolescents’ sociodemographic characteristics.

Results: Girls were more likely to experiment alcohol (OR = 1.09; 95% CI = 1.05–1.12), use it in the last 30 days (OR = 1.09; 95% CI = 1.00–1.13) and less prone to drunkenness (OR = 0.90; 95% CI = 0.87–0.93). A higher proportion of public-school students reported drinking. There was a positive association of substance use by parents, peers and the adolescents themselves with the outcomes. Having a policy of banning alcohol consumption at school was associated with a greater chance of alcohol experimentation in public schools.

Conclusion: Exposure to legal and illegal substances by friends, family members and a prohibitive school environment favored the outcomes.

College students' receptiveness to intervention approaches for alcohol and cannabis use

OBJECTIVE

Addressing high-risk alcohol and cannabis use represent major challenges to institutions of higher education. A range of evidence-based treatment approaches are available, but little is known concerning students' receptiveness to such approaches. Prior work identified that students were most open to individual therapy and self-help options for reducing alcohol use, but less open to medication. The current study examines student receptiveness to intervention approaches across a wider range of intervention approaches (e.g., remote/telehealth), and extends to evaluate cannabis intervention receptiveness.

METHOD

Undergraduate students reported on alcohol and cannabis use, motives for and reasons against use, and openness to an array of interventions for reducing alcohol and cannabis use.

RESULTS

Informal options (self-help, talking with family/friends), individual therapy, and appointments with a primary care provider (PCP) were endorsed most frequently. Group therapy and medication were less commonly endorsed, though medication was endorsed at a higher prevalence than in prior studies. Women generally expressed higher receptiveness than men. Lower alcohol consumption was associated with increased receptiveness to some approaches. Students at high risk for alcohol and/or cannabis dependence were less receptive to many treatment options.

CONCLUSIONS

College students were open to a wide variety of approaches for reducing their alcohol and cannabis use. These results can inform selection, implementation, and availability of campus-wide services, especially as low-cost technological-based approaches are expanding. Further attention to existing services (e.g., PCP) for addressing alcohol and cannabis use may be considered, given students' receptiveness to such approaches. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A mixed-method evaluation of the adoption and implementation of the College Alcohol Intervention Matrix among prevention experts: a study protocol

Background

Risky drinking among college campuses has been a long-standing concern and there have been dedicated efforts to develop evidence-based prevention and treatment strategies (EBSs) to decrease alcohol use and increase healthy behaviors among college students. Further, the College Alcohol Intervention Matrix (CollegeAIM) was developed as a tool with accompanying resources, to assist institutions of higher education in selecting EBSs that are appropriate and a good fit for their campuses. However, the CollegeAIM tool and selection of prevention strategies from stakeholders’ perspectives has yet to be evaluated. This study protocol describes the methodology for a research project evaluating CollegeAIM from an implementation science perspective using the Exploration, Preparation, Implementation, and Sustainment framework.

Methods

The aims of this study will be accomplished with a mixed-method design comprised of reviews of strategic planning documents, quantitative surveys and interviews with prevention experts, and focus groups to identify key components of a decision-support program for prevention experts to support the use of CollegeAIM. Participants are members of the multi-site Missouri Partners in Prevention coalition to reduce risky substance use on college campuses across the state.

Discussion

The results of this study will provide key information to support the development of additional supportive tools for campuses that can improve their selection and implementation of EBSs that fit the needs of their respective campuses. This work is important to further advance the implementation and sustainment of extant EBSs for risky college alcohol use.

Self-reported campus alcohol policy and college alcohol consumption: a multilevel analysis of 4592 Korean students from 82 colleges

BACKGROUND

Campus alcohol policy has been associated with student alcohol consumption in numerous studies. However, more information is required to assess the extent to which school policy affects student drinking behavior; especially when both individual-level sociodemographic characteristics of students and area-level characteristics of college campuses are controlled for. Thus, this paper explores the association between campus alcohol policy and student alcohol consumption among a nationally representative sample of college students in South Korea, while controlling for both individual and area-level characteristics.

METHODS

We surveyed and analyzed the data of 4592 students from 82 colleges. Multilevel (hierarchical) linear modeling was used to identify the association between campus alcohol policy and alcohol consumption levels, measured via the AUDIT-C (Alcohol Use Disorders Identification Test - Consumption). Controlled individual-level characteristics included sex, year level, major, GPA (grade point average), pocket money, smoking status, stress level, depressive thoughts, suicidal thoughts, and number of clubs/organizations. Controlled area-level characteristics included college type, number of students, number of faculty members, number of workers/administrators, and region.

RESULTS

Compared to students unaware of their school's campus alcohol policy, students who self-reported that their campuses allow drinking in outdoor spaces (β = 0.755 p = 0.010) or in all areas (β = 0.820, p = 0.044) had higher AUDIT-C scores. Students attending schools with a large number of students, males, freshmen, students with low GPA, students with high amounts of pocket money, and smokers also had higher alcohol consumption scores relative to their peers. Alcohol education experience in the form of lectures, mail, and/or campaigns were not associated with student alcohol consumption levels.

CONCLUSION

Our results suggest an association between self-reported campus alcohol policy and student alcohol consumption. College educators and administrators must be aware that relative to students unaware of their school's campus alcohol policy, students at colleges that allow drinking in outdoor spaces or all areas consume higher amounts of alcohol than their peers; even when area-level factors are controlled for.

TRIAL REGISTRATION

Yonsei IRB (IRB number: Y-2017-0084). https://irb.yonsei.ac.kr Date of registration: 01/2017. Date of enrolment of first participant to trial: 03/01/2017. Y-2017-0084.

Risks associated with alcohol and marijuana use among college student athletes: The case for involving athletic personnel in prevention and intervention

The purpose of this study was to describe alcohol and marijuana use patterns and related consequences among student athletes. A total of 12,510 students (n=1,233 athletes) completed four cross-sectional online annual surveys as part of a multi-site campus initiative. Chi-square tests of independence, t-tests, and regression models evaluated differences in alcohol and marijuana use between athletes and non-athletes. The prevalence of binge drinking and high intensity drinking was significantly higher among student athletes than non-athletes, even after controlling for demographic characteristics. Thirteen percent of student athletes experienced an alcohol-related injury during the past year; this was more common among binge drinkers than non-binge drinkers (20.5% and 2.6%, respectively). Among student athletes, past-month binge drinking and past-year marijuana use were significantly associated with lowered GPA (ps<.01). Skipping class was twice as prevalent among student athletes who used marijuana as compared with athletes who did not use marijuana, but no differences were found related to binge drinking. Components for a training for athletic personnel to reduce risks for alcohol-related injury and academic consequences that are associated with alcohol and marijuana use among student athletes are described. Involving athletic personnel might be an important strategy to identify and intervene with high-risk student athletes.

Assessing Campus Alcohol Policies: Measuring Accessibility, Clarity, and Effectiveness

BACKGROUND

Excessive alcohol consumption poses significant hazards to health and safety on college campuses. While substantial research exists regarding effective policies for preventing alcohol-related problems in the communities surrounding campuses, on-campus alcohol policies have received far less attention.

METHODS

Official campus alcohol policies (CAPs) were retrieved from the websites of the 15 member schools of the Maryland Collaborative to Reduce College Drinking and Related Problems, a voluntary statewide collaborative. CAPs were assessed for accessibility, clarity, and effectiveness. In addition to assessing whether campuses were in compliance with federal regulations for comprehensiveness of policies, a measure of likely policy effectiveness was developed through the use of 2 Delphi panels drawing on alcohol policy researchers and on-campus and community practitioners, respectively. The panels rated 35 potential policies and 13 possible sanctions; lists of policies and sanctions were compiled primarily from what was already in existence at 1 or more member schools.

RESULTS

For most campuses, the CAPs could be located within 30 seconds, but tended to be spread across multiple web pages. Language used to communicate the policies tended to be complex and above the reading level of someone with a high school education. At least half of the schools had less than half of the possible policies rated most or somewhat effective by the Delphi panels. Schools were more likely to employ the most effective sanctions, but somewhat and ineffective sanctions were also not uncommon.

CONCLUSIONS

CAPs are an important element in reducing negative consequences of alcohol consumption on college campuses. A higher level of research scrutiny is warranted to understand the extent to which CAPs are associated with excessive drinking, but this research describes an evidence- and expert-informed assessment approach that colleges can use to regularly analyze and update their CAPS.

Continuity of drunk and drugged driving behaviors four years post-college

BACKGROUND

Driving under the influence of alcohol is a leading cause of injury and premature death among young adults, and college-educated individuals are at particularly high risk. Less is known about driving under the influence of other drugs, which is on the rise.

METHOD

This study describes prospective seven-year trends in alcohol and other drug (AOD)-involved driving among a young-adult sample beginning with their second year of college (i.e., Years 2-8), and documents the extent of continuity in such behaviors across time. Originally recruited as incoming first-year students at one large public university, participants (n=1194) were interviewed annually about how frequently they drove while drunk/intoxicated (DWI), after drinking any alcohol (DAD), and/or while under the influence of other drugs (DD). Follow-up rates were high (>75% annually).

RESULTS

Among participants with access to drive a car, annual prevalence peaked in Year 4 (modal age 21) for both DWI (24.3%_wt) and DD (19.1%_wt) and declined significantly thereafter through Year 8 (both ps<0.05). DAD was far more prevalent than DWI or DD, increasing from 40.5%_wt in Year 2 to 66.9%_wt in Year 5, and plateauing thereafter. Among marijuana-using participants, likelihood of DD was consistently greater than the likelihood of DWI among Heavy Episodic and Light-to-Moderate drinkers, and it declined significantly during Years 5-8 (p<0.05).

CONCLUSION

Post-college declines in heavy drinking and DWI prevalence were encouraging but did not necessarily translate to reductions in likelihood of engaging in DWI, depending on drinking pattern. College-educated individuals represent an important target for AOD-involved driving prevention.