Emmanuel Kuntsche

Drinking at European universities? A review of students' alcohol use.

BACKGROUNDnHigh volumes of alcohol consumption and risky single occasion drinking (RSOD) among university students have been shown to be associated with considerable harm to both those who consume alcohol and their fellow students. The vast majority of these studies are based on US and Canadian samples.nnnAIMnThe present article provides an overview of the characteristics of alcohol-consuming university students in Europe.nnnMETHODn65 relevant articles published within the last 20years using European student populations could be identified.nnnRESULTSnSociodemographic, individual, social, and university-related characteristics associated with alcohol consumption patterns could be identified. Male students, in particular, tended to consume alcohol more often and in higher quantities, including RSOD. Students consumed alcohol chiefly during social gatherings and for social and enhancement motives. Those without family obligations and those living alone, with roommates or in areas with a high density of students were more likely to consume alcohol in higher quantities, and to engage in RSOD. Students tend to overestimate the extent of their fellow students alcohol consumption.nnnCONCLUSIONSnHealth promotion and prevention efforts which focus on these characteristics (i.e., gender, drinking motives, living conditions and social norms), and which have been successful and evaluated among university students in the US and Canada, may also be very promising for their European counterparts.

Cross national study of injury and social determinants in adolescents

Objectives: To compare estimates of the prevalence of injury among adolescents in 35 countries, and to examine the consistency of associations cross nationally between socioeconomic status then drunkenness and the occurrence of adolescent injury. Design: Cross sectional surveys were obtained from national samples of students in 35 countries. Eight countries asked supplemental questions about injury. Setting: Surveys administered in classrooms. Subjects: Consenting students (nu200a=u200a146 440; average ages 11–15 years) in sampled classrooms. 37 878 students (eight countries) provided supplemental injury data. Exposure measures: Socioeconomic status (material wealth, poverty) and social risk taking (drunkenness). Outcome measures: Specific types and locations of medically treated injury. Results: By country, reports of medically treated injuries ranged from 33% (1060/3173) to 64% (1811/2833) of boys and 23% (740/3172) to 51% (1485/2929) of girls, annually. Sports and recreation were the most common activities associated with injury. High material wealth was positively (OR>1.0; p<0.05) and consistently (6/8 countries) associated with medically treated and sports related injuries. Poverty was positively associated with fighting injuries (6/8 countries). Drunkenness (social risk taking) was positively (p<0.01) and consistently (8/8 countries) associated with medically treated, street, and fighting injuries, but not school and sports related injuries. Conclusion: The high prevalence of adolescent injury confirms its importance as a health problem. Social gradients in risk for adolescent injury were illustrated cross nationally for some but not all types of adolescent injury. These gradients were most evident when the etiologies of specific types of adolescent injury were examined. Prevention initiatives should focus upon the etiologies of specific injury types, as well as risk oriented social contexts.

Cultural and Gender Convergence in Adolescent Drunkenness: Evidence From 23 European and North American Countries

OBJECTIVEnTo investigate time-trend changes in the frequency of drunkenness among European and North American adolescents.nnnDESIGNnCross-sectional surveys in the 1997/1998 and 2005/2006 Health Behaviour in School-Aged Children Study (HBSC).nnnSETTINGnHigh schools in 23 countries.nnnPARTICIPANTSnA sample of 77 586 adolescents aged 15 years was analyzed by means of hierarchical linear modeling.nnnMAIN OUTCOME MEASUREnThe frequency of drunkenness.nnnRESULTSnWe observed a significant increase of about 40% in the mean frequency of drunkenness in all 7 participating Eastern European countries. This increase was evident among both genders, but most consistently among girls. Meanwhile, it declined in 13 of 16 Western countries, about 25% on average. Declines in Western countries were particularly notable among boys and in North America, Scandinavia, the United Kingdom, and Ireland. Despite this gender convergence, with few exceptions (Greenland, Norway, United Kingdom) boys continued to have a higher frequency of drunkenness in 2005/2006 than girls.nnnCONCLUSIONSnThe confirmed cultural convergence implies that adoption and implementation of evidence-based measures to mitigate the frequency of adolescent drunkenness such as tax increases and restricting alcohol access and advertisement should get the same priority in Eastern European countries as in Western countries. Policy measures that might facilitate decreases in drunkenness such as server training and the promotion of alcohol-free leisure-time activities should be reinforced in Western countries. The gender convergence implies that prevention policy should be less exclusively focused on male adolescents.

Development and Validation of the Drinking Motive Questionnaire Revised Short Form (DMQ-R SF).

A short form of the Drinking Motive Questionnaire Revised (DMQ–R; Cooper, 1994) was developed, using different item selection strategies based on a national representative sample of 5,617 12- to 18-year-old students in Switzerland. To confirm the concurrent validity of the short-form questionnaire, or DMQ–R SF, data from a second national sample of 2,398 12- to 17-year-old students were analyzed by means of structural equation modeling. The results confirmed the four-dimensional factor structure of the DMQ–R SF both in general and among subpopulations. The mean values as well as the links with alcohol use and related problems were similar to those obtained with the original DMQ–R. These results support the potential use of the DMQ–R SF in a wide range of international studies that measure drinking motives.

Alcohol outlet density, perceived availability and adolescent alcohol use: a multilevel structural equation model

Objectives: Perceived availability is commonly associated with adolescent alcohol use. Little is known about the factors which shape this perceived availability. The present study investigates (1) whether perceived alcohol availability is related to the characteristics of the adolescents’ social environment and the per capita outlet density in the community and (2) whether adolescent alcohol use is related to perceived availability, social environment characteristics and outlet density. Methods: Multilevel structural equation models were estimated based on data from a national representative sample of 6183 adolescents in the 8th and 9th grades of school (mean age 14.8 years) in 254 communities in Switzerland. Findings: Social environment characteristics, that is, having peers and siblings who drink, going out without parental knowledge of the adolescents’ whereabouts, drinking in public settings and the density of on-premises but not off-premises alcohol outlets, were related to perceived availability. Adolescent alcohol use increased with the permissiveness of social environment characteristics and with increasing perceived availability. Community-level perceived availability and the density of on-premises but not off-premises outlets were related to volume drinking but not to the frequency of risky drinking occasions. Conclusions: Perceived availability and drinking volume appear to be shaped by the adolescents’ social and physical environments. Adolescents who have a variety of opportunities to obtain alcohol might develop the impression that underage drinking is common and socially endorsed. Consequently, preventive actions to curb adolescent alcohol consumption should take into account the social acceptance of drinking and the physical availability of alcohol in the community.

Drinking to have fun and to get drunk: motives as predictors of weekend drinking over and above usual drinking habits.

Most evidence on the motives-alcohol use link has come from cross-sectional research using retrospective assessments. It remains also to be demonstrated whether motives predict drinking in particular circumstances. In the present study, drinking motives assessed 2 weeks prior to a diary study were used to predict the number of drinks on weekend days as reported via short message service (SMS). Multilevel regression models were estimated based on 391 reports from 55 participants (mean age 22.7). The results revealed that enhancement motives but not gender, age, or social, coping, or conformity motives predicted weekend drinking over and above usual consumption. Consumption and motives together explained more than three-quarters of the inter-individual variance in weekend drinking. To conclude, this study points to a heavy episodic weekend drinking culture of young people who drink large quantities on Friday and Saturday nights apparently because they are seeking fun and excitement. Preventive measures should aim to counteract young peoples drinking at peak times and in high-risk situations.

Short Message Service (SMS) Technology in Alcohol Research-A Feasibility Study

AIMnThe aim of this study was to describe the feasibility, advantages and limitations of the combined use of Internet and SMS technology to assess alcohol use, and to test whether an SMS sent in the evening (i.e. prior to a possible drinking event) changed the respondents assessment, made on the following day, of the number of drinks consumed.nnnPARTICIPANTSnSeventy young adults (mean age 22.7) were recruited through face-to-face contacts, e-mails and Internet advertisements.nnnDESIGN AND SETTINGnParticipants completed a baseline assessment via Internet and were randomly assigned to two conditions (with and without evening SMS). Over four weekends, both Friday and Saturday night, drinking was assessed via SMS questions sent the next day to the participants cell phones.nnnRESULTSnA high retention rate (75% in total) was obtained across all three recruitment conditions. The number of drinks indicated in the SMS survey was strongly correlated with the usual quantity assessed via Internet and did not differ depending on whether an additional SMS question was sent in the evening or not.nnnCONCLUSIONnThe new method shares some of the advantages of conventional diaries but overcomes most of the limitations: it is easy to use, cost-effective and suitable for large-scale surveys. Application restrictions and further developments are discussed.

What is Worse? A Hierarchy of Family-Related Risk Factors Predicting Alcohol Use in Adolescence

The aim of the present study was to determine if family structure, perception of excessive drinking in the family, and family bonding hold a graduated importance in predicting adolescent alcohol use and their association with peers who drink excessively. Three nested linear structural models were calculated separately for frequent and excessive drinking, based on a sample of 3,127 eighth and ninth graders in Switzerland (mean age 15.3, SD 0.8) surveyed in spring 2002 in the context of the “Health Behavior in School-Aged Children (HBSC)” study. The results confirm that the perception of excessive drinking in the family is more closely related to both frequent and excessive drinking than family structure, and family bonding is more closely related than drinking perception. Adjusting for both socio-demographic variables and the association with peers who drink excessively only slightly changed the results. To predict an association with the latter, family structure was more important than the perception of drinking, but family bonding remained the predominant predictor. The results stress the graduated importance of family-related risk factors: by listening to their childrens worries, by spending their free time with them, and by providing help when needed, parents might have the possibility to actively minimize the risk of frequent and excessive drinking regardless of whether they are frequent excessive drinkers or live without a partner.

Alcohol consumption in late adolescence and early adulthood - where is the problem?

Risky single-occasion drinking (RSOD) is more common in late adolescence and early adulthood (approximately between the ages of 16 and 30) than in any other period in life. This is also the age when young people in Switzerland and many other European countries are legally allowed to buy and drink alcohol, but they usually do not yet have adult responsibilities. This paper reviews evidence from the international literature and provides examples of studies conducted in Switzerland demonstrating that (a) RSOD is by far most prevalent on Saturday evenings followed by Friday evenings, usually because young people go out and do not have any work or study responsibilities the next day; (b) RSOD results from drinking in private before going out (predrinking) and accelerating the pace of drinking (i.e. increasing the number of drinks consumed per hour); (c) RSOD is often not accidental but purposeful,. to seek excitement, to have fun and to feel the effects of alcohol; (d) RSOD occurs predominantly outside the home, mostly in bars, pubs, discos or at special events and festivals; (e) RSOD often results in intended and unintended injuries and other acute consequences, which are leading risk factors for mortality and morbidity in this age group. Effective prevention strategies should include attempts to reduce opportunities to engage in heavy drinking as well as strategies to reduce its harmful consequences.

Do we act upon what we see? Direct effects of alcohol cues in movies on young adults’ alcohol drinking

AIMSnAmple survey research has shown that alcohol portrayals in movies affect the development of alcohol consumption in youth. Hence, there is preliminary evidence that alcohol portrayals in movies also directly influence viewers drinking of alcohol while watching movies. One process that might account for these direct effects is imitation. The present study therefore examined whether young people imitate actors sipping alcohol on screen.nnnMETHODSnWe observed sipping behaviours of 79 young adults (ages 18-25) watching a 60-min movie clip, What Happens in Vegas, in a semi-naturalistic home setting. Each of the 79 participants was exposed to 25 alcohol cues. Two-level logistic regression analyses were used to analyse whether participants in general imitated actors sipping during this clip. In addition, we applied proportional hazard models in a survival analysis framework (Cox regression) to test whether there was a difference in imitation of the cues between male and female participants, and to test whether the timing of the actors sipping throughout the movie played a role.nnnRESULTSnThe findings showed that participants were more likely to sip in accordance with the actors sipping than without such a cue. Further, we found that men were more likely to imitate actors sipping than females and that participants tended to respond to actors sipping at the beginning of the movie rather than at the end.nnnCONCLUSIONnExposure to actors sipping alcohol in a movie seems to have an immediate impact on the drinking behaviour of viewers, via the mechanism of imitation.