Transcript Joint Action (JA) “European Partnership for Action against

Drinking behaviour in Flemish university
and college students
Prof. dr. Guido Van Hal
Research Group Medical Sociology and Health Policy, University of
Antwerp, Flanders, Belgium
8th of November 2013, Binge Drinking
in Belgian Minors: An innocent problem?
Palace of the Academies, Brussels
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Previous history
• Need for an alcohol and drug policy for the Antwerp
university and Colleges
=> Collaboration initiated by SODA (Antwerp Platform
for consultation on drug problems) towards an
alcohol and drug policy in the Antwerp university and
colleges
• Difficult to reach a consensus on the strategy and
approach
• => first “evidence” is needed by means of a large-scale
survey in the involved students
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Methodology: research questions
•
10 research questions:
- What is the state of the art of the substance use in
Antwerp students?
- To what extent do so called typical manifestations
of substance use in students occur (binge drinking,
medication use during exams, …)?
- Where and when does the substance use take
place?
- Which are the motives for substance use?
- To what extent do problematic substance use
and/or negative consequences of substance use
occur?
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Methodology: research questions
- Is there a relationship between leisure time activities
and substance use?
- Is there a relationship between the state of mind and
substance use?
- Is there a relationship between personal
characteristics (sex, living situation, …) and
substance use?
- To what extent are social services (as well inside as
outside the setting of the university or college)
known and are they used in case of questions and
problems?
- To what extent is the theme of alcohol- and drugs a
part of the study curriculum?
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Methodology: used instruments
•
Questionnaire elaborated by means of:
- validated instruments (AUDIT, CORE, DAST, GHQ, …)
- own questions, based on questions from other studies (for
example leisure time activities)
•
•
•
Pretest questionnaire in 10 students
Final questionnaire distributed among all Antwerp
students by intranet (BlackBoard)
A lot of attention was given to the announcement and
promotion
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Methodology: sampling
• Questionnaire 6 weeks “on line” – February – March
2005
• 27,210 Antwerp students (2004-2005)
=>7,813 students opened the questionnaire (28.7%)
=> 5,530 filled it out (20.3%)
• Representative sample (n=1,501) taking into account:
- sex
- age
- university/college
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Characteristics of the sample
• 75.1%  22 years
• 53.1% female; 46.9% male
• 61.4% not working; 26.5% temporary jobs;
11.6% working student
• 71.0% living at home; 20.0% living with peers
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Characteristics of the sample
Institute
Student
population
% in
population
Students in
sample
% in sample
Nautical college
480
1.8%
43
2.9%
Artesis college
6,891
25.3%
374
24.9%
Karel de Grote college
7,182
26.4%
393
26.2%
Plantijn college
3,171
11.7%
173
11.5%
University of Antwerp
9,486
34.9%
518
34.5%
Total
27,210
100.0%
1,501
100.0%
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Antwerp – Ghent - 2009
•
•
•
•
Ghent 2008-2009: 55,461 students
Antwerp 2008-2009: 29,210 students
Filled out questionnaires: 18,543 (21.9%)
Representative sample: 3,537
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Students and alcohol: do they go hand in hand with
one another?
“The university student generally has the reputation that he does not
scorn alcohol. (…) Some even go that far to label the combination of
beer and student as being fundamental.” (W. Prové - 1965)
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Students and alcohol: do they go hand in hand with one
another?
“College students drink. No matter how you slice it, most people
would agree with some version of that statement.” (Walters & Baer,
2006)
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Alcohol: prevalence
• Prevalence 2009:
– 96.8% has ever drunk alcohol (beer, wine, liquors, aperitif)
– 92.4% has drunk alcohol during the last year
– for each of the alcoholic drinks, there is an ever-use between
84.0% en 92.5%
– For each of the alcoholic drinks the last year use was between
74.8% en 83.9%
 Alcohol use is very current in students
… but these figures do not say anything concerning the
possible problematic character of the alcohol use =>
frequencies of use and instruments to trace problematic
use are needed
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Alcohol: frequency
 Strikingly more frequent use during the academic year
and during holidays than during examination periods
 >50% frequent beer users during academic year and
holidays
 Low frequencies of daily users during examination
periods, which can be an indication of a small number
of students with alcohol dependency (0.9% for beer).
User frequencies give indications but no clear picture of a
possible problematic use.
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Alcohol: problematic use measured
Two validated instruments:
• Alcohol Use Disorder Identification Test (AUDIT)
– self report-questionnaire
– 10 questions on drinking pattern and experienced
consequences of alcohol use
– Usefulness in adolescents and students is proven
• Quantitative norms British Medical Association
– self report-question on the mean number of glasses of alcohol
drunk per week
– risk-assessment of physical harm due to alcohol use:
• women: >14 glasses alcohol/week
• men: >21 glasses alcohol/week
• How many drinks containing alcohol do you usually drink weekly?
…………drinks
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AUDIT
• AUDIT – Self-report Version. Babor TF, HigginsBiddle JC, Saunders JB, Monteiro MG. AUDIT. The
Alcohol Use Disorders Identification Test. Second
Edition. World Health Organization, Department of
Mental Health and Substance Dependence, 2001.
• Fleming MF, Barry KL, McDonald R. The alcohol use
disorders identification test (AUDIT) in a college
sample. Int J Addictions 1991;26:1173-85.
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AUDIT (1)
•
How often do you have a drink containing
alcohol?
-
Never (0)
Monthly or less (1)
2-4 times a month (2)
2-3 times a week (3)
4 or more times a week (4)
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AUDIT (2)
•
How many drinks containing alcohol do you
have on a typical day when you are
drinking?
-
1 or 2 (0)
3 or 4 (1)
5 or 6 (2)
7 to 9 (3)
10 or more (4)
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AUDIT (3)
•
How often do you have six or more drinks on
one occasion?
-
Never (0)
Less than monthly (1)
Monthly (2)
Weekly (3)
Daily or almost daily (4)
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AUDIT (4)
•
How often during the last year have you
found that you were not able to stop
drinking once you had started?
-
Never (0)
Less than monthly (1)
Monthly (2)
Weekly (3)
Daily or almost daily (4)
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AUDIT (5)
•
How often during the last year have you
failed to do what was normally expected of
you because of drinking?
-
Never (0)
Less than monthly (1)
Monthly (2)
Weekly (3)
Daily or almost daily (4)
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AUDIT (6)
•
How often during the last year have you
needed a first drink in the morning to get
yourself going after a heavy drinking
session?
-
Never (0)
Less than monthly (1)
Monthly (2)
Weekly (3)
Daily or almost daily (4)
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AUDIT (7)
•
How often during the last year have you had
a feeling of guilt or remorse after drinking?
-
Never (0)
Less than monthly (1)
Monthly (2)
Weekly (3)
Daily or almost daily (4)
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AUDIT (8)
•
How often during the last year have you
been unable to remember what happened
the night before because of your drinking?
-
Never (0)
Less than monthly (1)
Monthly (2)
Weekly (3)
Daily or almost daily (4)
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AUDIT (9)
•
Have you or someone else been injured
because of your drinking?
-
No (0)
Yes, but not in the last year (2)
Yes, during the last year (4)
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AUDIT (10)
•
Has a relative, friend, doctor, or other health
care worker been concerned about your
drinking or suggested you to cut down?
-
No (0)
Yes, but not in the last year (2)
Yes, during the last year (4)
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AUDIT – How to interpret?
• Total scores of 8 or more are recommended as
indicators of hazardous and harmful alcohol use,
as well as possible alcohol dependence.
(Applicable to women and elderly people from a
total score of more than 5)
• AUDIT-scores in the range of 8-15 represent a
medium level of possible alcohol problems,
whereas scores of 16 and above represent a
high level of possible alcohol problems.
• Total scores of 20 or above represent a high
level of possible dependence.
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Alcohol: problematic use (AUDIT)
AUDIT-score
Male students
Female students
0-7
48.1%
80.7%
8-15
40.9%
17.6%
16-19
7.1%
1.1%
20-40
4.0%
0.6%
(²=388.467; df=3; p<0.001)
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Binge drinking
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Alcohol: binge drinking
• Hot item in the media, but what is binge drinking?
• Binge drinking means drinking several glasses of
alcohol in a short time with the intention to get drunk
quickly.
On that point, there is a consensus, but unfortunately, there
are many more differences concerning the definition…
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Binge drinking: what’s in a name?
1. Number of glasses per occasion?
USA: 4+ (♀) / 5+ (♂)
Europe: tendency to use higher numbers (6+/8+?)
2. What is an occasion?
Strongly culturally determined: closing hour pubs, drinking habits
(for example dinner during hours with wine),…
It is important to come to a universal definition of binge drinking in the
near future, with the BAC as a basis.
In our study: at least 4 standard glasses in 2 hours (women) and at
least 6 standard glasses in 2 hours (men)
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Binge drinking: results
Percentage
students
Percentage
students (♂)
Percentage
students (♀)
Never
43.6%
34.0%
51.6%
Less than monthly
35.7%
35.1%
36.4%
Monthly
13.0%
16.8%
9.8%
Weekly
7.4%
12.2%
3.5%
Daily or almost daily
0.3%
0.6%
0.1%
Frequency binge
drinking
(² = 174.471; df = 4; p < 0.001)
• 0.3% means more or less 300 students
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Binge drinking: results
• The more frequent binge drinking, the higher the risk
of problematic use, measured by the AUDIT (rs =
0.72; p<0.001); approximately evenly strong in
women and men.
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Alcohol: other results
• No relationship between age and alcohol use…
• but between starting age and alcohol use: the lower the
starting age, the higher the risk to end up with problematic
alcohol use
• Places where alcohol is used: pub, restaurant, parties and
own place of residence.
– Positive relation between frequency of visiting parties and pubs and
frequency of drinking beer
– Positive relation between frequency of visiting parties and pubs and
frequency of drinking liquors
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Alcohol: other results (2)
• Motives for alcohol use: sociability with friends
(95.6%), to have fun (58.2%), because it is
pleasant (57.1%), to relax (55.8%), to create a
good atmosphere (50.0%), to get a good
feeling (30.7%), to let off steam in case of
stress (30.7%).
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Alcohol: other results (3)
• Relationship between board membership of a
student organisation and a higher frequency of
alcohol use (beer and liquors)…
• Relationship between board membership of a
student organisation and consumed quantity of
alcohol: 14 glasses per week vs. 6 glasses per
week
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Alcohol: other results (4)
• Students who are board member of a student
organisation have a 3 times higher risk of
becoming problematic alcohol users
• Students living with peers have a higher alcohol
use than students living with their parents
(study in Antwerp and Amsterdam – Boot CRL,
Rosiers JFM, Meijman FJ, Van Hal GFG,
2010).
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Students living with peers and
students living with their parents
Hypotheses:
=> parental supervision
=> peer-influences
=> a common underlying characteristic (adventurous
type)?
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Some conclusions
• The bulk of students in Antwerp and Ghent do not
show characteristics of risky or problematic use
• Though, problematic use is not that far away:
– 1/9 ♂ students shows signs of problematic alcohol use
– Widespread binge drinking is risk-increasing
An information and sensibilisation campaign could
be useful for all students
A minority of students needs advice and/or help
!!! 3/10 students want more attention for the alcohol
and drugs theme in the study curriculum
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Questions? I am all ears!