Research articles
Environmental correlates of underage alcohol use and related problems of college students

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Abstract

Background: Underage alcohol use is a major contributor to morbidity and mortality in adolescents and young adults. This study examined drinking levels and ensuing problems among college students and factors associated with binge drinking.

Method: The Harvard School of Public Health College Alcohol Study conducted a self-administered survey. The participants include a random sample of 7061 students aged <21 years (defined as underage drinkers), and 4989 between ages 21 and 23 in 1997 at 116 nationally representative 4-year colleges in 39 states. The outcomes of the study include self-reports of alcohol use, binge drinking (defined as five or more drinks in a row for men and four or more for women at least once in a 2-week period), alcohol-related problems, preferred type of drink, access to alcohol, and price paid per drink.

Results: Underage students drink less often but have more drinks per occasion, are more likely to drink in private settings (off-campus, dormitory, and fraternity parties), and pay less per drink than do of-age students. Correlates of underage binge drinking include residence in a fraternity or sorority (odds ratio [OR]=6.2), very easy access to alcohol (OR=3.3), obtaining drinks at lower prices (OR=2.1, for under $1 each or a set fee for unlimited drinks), and drinking beer (OR=9.5).

Conclusions: Effective controls on price, access, and fraternity and off-campus parties, and reinforcing minimum drinking age laws are needed to reduce the high levels of binge drinking and related health and behavioral problems of underage students.

Introduction

Alcohol abuse is arguably the nation’s number one public health problem,1 and has an especially powerful impact on youth.2 Underage drinking is connected to immediate and long-term health and behavioral consequences. Driving after drinking is the single strongest contributor to morbidity and mortality for adolescents and young adults,1 and most alcohol control measures aimed at youth focus on this behavior.3 Youth alcohol use has also been tied to morbidity and mortality from burns, drowning, falls, acute alcohol poisoning, suicide, and violent crime.4 Overall, annual costs associated with underage drinking are estimated at $58 billion.5

Nowhere are the effects of heavy episodic drinking evidenced more than at American colleges. College students binge drink more often than their former high school classmates who do not attend college.6 In these settings, where about one half of students are under age 21,7 regular use and abuse of alcohol is part of many students’ environment. At the average college, two in five students had at least one episode of binge drinking in the 2 weeks before being surveyed.8, 9

This pattern of heavy, episodic drinking exists despite a national minimum legal drinking age (MLDA) of 21, in effect since 1984, and the requirement by the Safe and Drug Free Schools Act of 1989 that colleges publish information about laws regulating drug and alcohol use (including the MLDA), spell out the penalties, and periodically evaluate the effectiveness of the institution’s policy. The 21-year minimum drinking age is credited with reducing motor vehicle fatalities involving drivers between 18 and 20 by about 800 per year, and drinking among youth by an estimated 10% to 15%.10, 11 Despite these laws, underage drinking on college campuses is widespread and heavy.8, 9, 12, 13, 14

Risk factors associated with heavy, episodic, or binge drinking have entailed primarily personal characteristics of students and residence on campus. Caucasian students, males, and students aged ≤23 are more likely to binge drink,8, 9, 12, 13, 14 as are fraternity or sorority house residents.15

Contextual or environmental variables have been associated with binge drinking in general population studies. The use of beer as the alcoholic beverage of choice is related to heavy or hazardous alcohol use.16, 17 Environmental factors such as access to alcohol and price have been associated with drinking, heavy drinking, and associated harms.18, 19 In the case of college students, location of a bar within a mile of campus and the price of alcohol in the adjoining community are associated with binge drinking.9 The association with price is generally weaker among college students than among high school students and is limited to women and moderate drinkers.19, 20 However, these studies did not examine the way established prices are discounted in college communities where special promotions, free drinks for women, and a set price for an unlimited supply of drinks are available. Furthermore, because access is generally reported as easy for college students, degree of ease of access has not been considered as an important factor in binge drinking.

This paper examines the nature of underage drinking among college students and how it differs from the drinking of students who are of legal drinking age. We seek to determine what factors are associated with heavy, episodic, or binge drinking among underage college students. Understanding the relationship of environmental factors, such as access and price, to risky alcohol use may provide insights for forming prevention strategies to counter alcohol abuse and related problems among college students.

Section snippets

Sample

This report is based on the 1997 Harvard School of Public Health College Alcohol Study (CAS) survey. Its methods are described elsewhere in detail.8, 9, 21 The 1997 survey involved 130 of the 140 colleges and universities first surveyed in 1993, a representative sample of 4-year accredited institutions of higher education. The ten colleges not participating in 1997 were unable to provide random samples of student names in time for inclusion. Of the 130 participating institutions, 14 had low

Characteristics of the study sample

The respondents included 7061 students <21 years, and 4989 students aged 21–23. Students <21 years of age are labeled “underage,” and students 21 to 23 years of age as “of-age.” The two groups differed significantly by gender. One third (37%) of the underage students were male compared with 43% of the of-age group (χ(1)2=52.8, p<0.0001). Because of the difference in gender between these two groups, we adjusted gender in all of the multiple logistics regression models. We found no significant

Discussion

College students under the minimum legal drinking age report some important differences in their alcohol use compared with their legal-age peers. Although most underage college students drank alcohol, they were less likely to drink than were students of legal drinking age and they reported drinking on fewer occasions. However, among those who drank, underage students consumed more alcohol per occasion and, perhaps as a result, experienced more alcohol-related problems.

Almost all underage

Acknowledgements

This study was supported by the Robert Wood Johnson Foundation. We gratefully acknowledged the assistance of Jeff Hansen for the preparation of the data and Toben Nelson for carefully reviewing drafts of this manuscript.

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