Screening for high-risk drinking in a college student health center: characterizing students based on quantity, frequency, and harms

Autor: Natalie Mullett, Mary Lou Sole, Jennifer Bolden, Thomas P. McCoy, James F Schaus, Janani Sivasithamparam, Mary Claire O'Brien
Rok vydání: 2009
Předmět:
Zdroj: Journal of studies on alcohol and drugs. Supplement. (16)
ISSN: 1946-584X
Popis: Heavy episodic drinking by college students is the most serious public health problem on college campuses (Office of Disease Prevention and Health Promotion, Department of Health and Human Services, 2000). Traditionally, heavy episodic drinking is defined as the consumption of five or more drinks in a row for men, or four or more drinks in a row for women, at least once in the past 2 weeks (“5/4 definition”; Wechsler et al., 1994). The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines heavy episodic (or “binge”) drinking as a pattern of drinking that brings the blood alcohol concentration (BAC) to .08 grams percent or above. For the typical 150 pound adult, this corresponds to 5/4 consumption in about 2 hours (Task Force of the National Advisory Council on Alcohol Abuse and Alcoholism, 2002). High-risk drinking is reported by 44% of college students, a number that is essentially unchanged from earlier studies, despite vigorous attempts at environmental and individual interventions (Wechsler et al., 2002). High-risk drinking is associated with substantial consequences and harms, and is a leading cause of morbidity and mortality among college students. It is estimated that each year more than 500,000 college students ages 18-24 are unintentionally injured while under the influence of alcohol, and approximately 1,700 students die from alcohol-related causes (Araujo and Wong, 2005; Hingson et al., 2005). The proportion of college students reporting driving under the influence increased from 26.5% to 31.4% from 1998 to 2001 (Hingson et al., 2005). Academic consequences of drinking include missed classes, falling behind in schoolwork, and poor grades (Perkins, 2002). The U.S. Preventive Services Task Force (2006) recommends screening all adolescent and adult patients for problem drinking. The NIAAA (Task Force of the National Advisory Council on Alcohol Abuse and Alcoholism; 2002) recommends incorporating alcohol screening into standard practice at college student health centers. Screening for high-risk drinking in a student health center meets the preventive health standard of screening for a condition that is prevalent, harmful, and treatable (Gordon, 2006). The student health center provides an ideal opportunity to intervene with students who are identified as high-risk drinkers and who are experiencing alcohol-related harms. Without a systematic approach to routine alcohol screening, student health centers must rely on episodic alcohol-history information, often obtained after a significant harm has occurred, thereby missing the majority of students in need of identification and intervention. Despite recommendations for routine screenings of high-risk drinking, only 32% of student health centers conduct them, and only 12% use standardized screening instruments (Foote, 2004). There is a crucial need for development and increased use of empirically supported alcohol screening at student health centers (Foote, 2004). There is limited information on alcohol screening tests specifically used in college populations (Task Force of the National Advisory Council on Alcohol Abuse and Alcoholism, 2002). Alcohol screening instruments such as the CAGE (Ewing, 1984) and the 10-question Alcohol Use Disorders Identification Test (AUDIT; Saunders et al., 1993) have been advocated for routine use in primary health care settings, and their psychometric properties are based on general adult samples. A review of alcohol screening studies in primary care by Fiellin et al. (2000) concluded that the AUDIT was effective for detecting at-risk drinking and the CAGE was effective for detecting alcohol abuse and dependence. Multiple-question screens that require scoring are challenging to implement, and rates of use are low (Seale et al., 2006). Time, cost, and other competing health care priorities are barriers to effective alcohol screening in student health centers (Fleming, 2001), and simpler and more efficient screening instruments are needed. Single question screening has been studied (Taj et al., 1998; Williams and Vinson, 2001), and the NIAAA (Task Force of the National Advisory Council on Alcohol Abuse and Alcoholism; 2002) concludes that single quantity, frequency, and heavy episodic drinking questions are most applicable to detect high-risk drinking by college students. The 5/4 definition was used in this study, because it meets the NIAAA recommendation for an efficient single-question screen and it has been extensively used in large-scale studies to identify high-risk drinkers (Wechsler et al., 2002). It has a high sensitivity for identifying persons with the potential to experience alcohol-related problems but has low specificity (Seale et al., 2006). Researchers have advocated for a screening tool with improved specificity to identify college students with the highest prevalence of alcohol-related harms (Presley and Pimentel, 2006). Presley and Pimentel proposed categorizing students by both the amount and frequency of alcohol consumption. They grouped student drinkers into three categories: (1) nonheavy, (2) heavy—having five or more drinks at least once in the past 2 weeks, and (3) heavy and frequent—having five or more drinks at least once in the past 2 weeks and drinking 3 or more days per week. They found that heavy and frequent drinkers were three times more likely to experience alcohol-related harms than heavy drinkers and concluded that assessing the frequency of drinking in addition to the five-drink screen improved specificity for identifying those at highest risk for harms (Presley and Pimentel, 2006). The present study aims to (1) characterize the group of students who present to a student health center and screen positive for the 5/4 definition of high-risk drinking, (2) assess alcohol-related harms in this group, and (3) determine if the classification of students into categories similar to those proposed by Presley and Pimentel (2006) assists in stratifying their risk for experiencing alcohol-related harms. The goal of this article is to assist in identifying the best rapid, routine, student health center screen to detect high-risk drinking and, ultimately, to reduce alcohol-related harms.
Databáze: OpenAIRE
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