Drinking behaviour in Flemish university and college students

1. 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

3. 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

4. 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?

5. 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?

6. 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

9. 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

10. 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

11. 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% Characteristics of the sample

12. 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

13. 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)‏

14. 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)‏

15. 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

16. 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.

17. 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

18. AUDIT • AUDIT – Self-report Version. Babor TF, Higgins-Biddle 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.

19. 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)

20. 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)

21. 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)

22. 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)

23. 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)

24. 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)

25. 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)

26. 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)

27. 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)

28. 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)

29. 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.

30. 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)‏ Alcohol: problematic use (AUDIT)‏

31. Binge drinking

32. 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…

33. Binge drinking: what’s in a name? • 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 drinkingin 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)

34. Frequency binge drinking 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% (² = 174.471; df = 4; p < 0.001)‏ Binge drinking: results • 0.3% means more or less 300 students

35. 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.

37. 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

38. 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%)‏.

39. 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: 14glasses per week vs. 6 glasses per week

40. 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).

41. Students living with peers and students living with their parents Hypotheses: => parental supervision => peer-influences => a common underlying characteristic (adventurous type)?

42. 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

44. Questions? I am all ears!