배경 및 목적 : 미국과한국양국의대학생의음주문제는심각한사회문제이며, 대학생의음주문제를예방 하기 위한 다양한 노력들이 시도되고 있다. 본 연구는 미국과 한국대학생들의 음주와 폭음에 대한 인식 및 태도에 차이가 있는지를 비교 분석하기 위해 설계되었다. 방법 : 데이터는 2001년 미국의 하버드 보건대학원의 College Alcohol Study (CAS) 팀에서 미국의 120개 4년제대학에서10,904명에게서조사한원자료와한국에서는2003년삼육대학교보건복지대학원의 Korean College Alcohol Study (KCAS) 팀에서 전국의 60개 4년제 대학의 2,385명의 원자료를 함께 통합하여사용하였다. 이자료의특징은CAS에서 개발한설문지를한국과미국양측에서공동으로 사용하여 양 국가를 대표한 4년제 대학생의 표본을 대상으로 음주와 관련된 조사를 수행한 점이다. 결과 : 한국남학생 들이폭음할기회가7.74배더많고여학생의경우는3.36배더많다. 지난한달동안 3회 이상 술 취한 경험율에서 한국 남학생들의 경험율이 34.3%로 미국의 20.4%보다 많고, 여학생의 경우 도 24.6%로 미국 여학생의 11.1%보다 현저히 더 많다. 한국 대학생들의 폭음자 비율이 미국 대학생들의 폭음자 비율보다 많은 것과같이, 한국 대학생들이 미국의대학생들 보다폭음이 안전한것으로 인식하고 있 으며, 음주에있어서도더욱허용적인태도를가지고있다. 한국남학생의78.4%와여학생의67.3%가폭음 이상의 량을 안전하다고 인식하고 있다(미국은 남학생은 50.3%, 여학생은 34.1%). 폭음에 해당하는 음주 량(남자는5잔이상, 여자는4잔이상)을안전하다고인식하는정도에서한국의대학생들이미국의대학생들 에 비해서 남학생은 4.06배, 여학생이 3,96배 더 높다. 결론 : 한국 학생들 중에서도 음주의 량이 더 많은 학생들이 다른 학생들보다 음주와 술 취함과 폭음에 관하여 더욱 허용적이고, 안전한 음주에 대해 더욱 둔감한 태도와 신념을 보이고 있다.

BACKGROUND:Heavy alcohol use among U.S. college students is a major contributor to young adult morbidity and mortality. The aim of this study was to examine whether college alcohol policy enforcement levels predict changes in student drinking and related behaviors in a state system of public colleges and universities, following a system-wide change to a stricter policy.METHODS:Students and administrators at 11 Massachusetts public colleges/universities completed surveys in 1999 (N of students = 1252), one year after the policy change, and again in 2001 (N = 1074). We calculated policy enforcement scores for each school based on the reports of deans of students, campus security chiefs, and students, and examined the correlations between perceived enforcement levels and the change in student drinking rates over the subsequent two year period, after weighting the 2001 data to adjust for demographic changes in the student body.RESULTS:Overall rates of any past-30-days drinking, heavy episodic drinking, and usual heavy drinking among past-30-days drinkers were all lower in 2001 compared to 1999. School-level analyses (N = 11) found deans' baseline reports of stricter enforcement were strongly correlated with subsequent declines in heavy episodic drinking (Pearson's r = -0.73, p = 0.011). Moreover, consistently high enforcement levels across time, as reported by deans, were associated with greater declines in heavy episodic drinking. Such relationships were not found for students' and security chiefs' reports of enforcement. Marijuana use did not rise during this period of decline in heavy drinking.CONCLUSIONS:Study findings suggest that stronger enforcement of a stricter alcohol policy may be associated with reductions in student heavy drinking rates over time. An aggressive enforcement stance by deans may be an important element of an effective college alcohol policy.

Alcohol consumption control policies at U.S. intercollegiate sports events, and their association with student drinking, were assessed using data from a 2001 nationally representative survey of students and administrators (n = 7,261 students, N = 117 colleges). Alcohol was available to sports event attendees through in-stadium sales, tailgating parties, and allowing spectators to bring in alcohol. Policies varied by college, with fewer restrictions at large public schools with NCAA Division I athletics. Permitting alcohol at tailgate parties was associated with more students drinking at sports events. Future research should evaluate whether enacting policy restrictions can reduce drinking and related problems at intercollegiate sports events.

Alcohol use health consequences are considerable; prevention efforts are needed, particularly for adolescents and college students. The national minimum legal drinking age of 21 years is a primary alcohol-control policy in the United States. An advocacy group supported by some college presidents seeks public debate on the minimum legal drinking age and proposes reducing it to 18 years. We reviewed recenttrends in drinking and related consequences, evidence on effectiveness of the minimum legal drinking age of 21 years, research on drinking among college students related to the minimum legal drinking age, and the case to lower the minimum legal drinking age. Evidence supporting the minimum legal drinking age of 21 years is strong and growing. A wide range of empirically supported interventions is available to reduce underage drinking. Public health professionals can play a role in advocating these interventions. (Am J Public Health. 2010;100:986-992. doi:10.2105/AJPH.2009.178004)

The objective of this paper is to investigate the effects of state tobacco control program expenditures on individual-level tobacco use behaviors among young adults. Data come from the 1997, 1999 and 2001 waves of the Harvard School of Public Health College Alcohol Study (CAS). Our findings indicate that a higher level of state spending on tobacco control programs in the prior year is associated with a statistically significant increase in the probability that current daily smokers report at least one attempt to quit smoking in the past year. We also find evidence that higher state expenditures on tobacco control programs in the prior year are associated with reductions in the prevalence of daily smoking and 30-day cigar use among college students. We do not find any statistically significant association between state tobacco control program expenditures and the number of attempts to quit smoking among those with at least one attempt, or on the prevalence of smokeless tobacco use in the past month.

Alcohol use health consequences are considerable; prevention efforts are needed, particularly for adolescents and college students. The national minimum legal drinking age of 21 years is a primary alcohol-control policy in the United States. An advocacy group supported by some college presidents seeks public debate on the minimum legal drinking age and proposes reducing it to 18 years. We reviewed recent trends in drinking and related consequences, evidence on effectiveness of the minimum legal drinking age of 21 years, research on drinking among college students related to the minimum legal drinking age, and the case to lower the minimum legal drinking age. Evidence supporting the minimum legal drinking age of 21 years is strong and growing. A wide range of empirically supported interventions is available to reduce underage drinking. Public health professionals can play a role in advocating these interventions.

OBJECTIVE The purpose of this study was to examine drinking levels, related harms, and secondhand effects of alcohol use at heavy drinking colleges between 1993 and 2005 at colleges with high levels of drinking in 1993. METHOD Students attending 18 colleges with high levels of heavy episodic drinking (50% of students or more) from the 1993 Harvard School of Public Health College Alcohol Study were surveyed in 2005 (n = 4,518). Data collected through mailed and Web-based questionnaires were compared with responses from students at the same schools in 1993, 1997, 1999, and 2001 (N = 13,254) using time trend analyses. RESULTS Overall, levels of alcohol consumption, experience of problems, and levels of secondhand effects remained high among students attending heavy drinking colleges. More than four of five students at these schools drank alcohol (range: 85%-88%), and more than half engaged in heavy episodic drinking (range: 53%-58%). The stability of drinking behavior occurred among subgroups of students as well. The few statistically significant changes occurred mainly between 1993 and 1997. A decline in driving after any drinking between 1997 and 2005 was observed, but no similar decline was found in two other measures of drinking and driving. CONCLUSIONS Heavy drinking and associated problems continue unabated, with few exceptions, at colleges that are most in need of intervention: those with high levels of heavy episodic drinking. Addressing student alcohol use at heavy drinking colleges may require stronger, more consistent, and more comprehensive approaches, with increased emphasis on the alcohol environment.

Objectives: To compare alcohol secondhand effects among US and Korean students. Methods: Nationally representative 4-year colleges of two countries were involved in this cross-national comparison study. Data from the 2001 U.S. College Alcohol Study and the 2003 Korean College Alcohol Study came from 120 colleges in 38 U.S. states and the District of Columbia and 60 colleges in Korea. Randomly selected 4-year college students from the U.S. (10,924) and Korea (2,385) participated in the study using self-reports of alcohol use and perceptions of drinking as assessed by College Alcohol Study questionnaires. Results: Korean students were tend to more likely to have being a victim of sexual assault or date rape, having to take care of drunken students and finding vomit in the hall or bathroom of residence, than US students, while US students were tend to more likely to have being insulted or humiliated, having a serious argument and quarrel, being pushed, hit, or assaulted, having study/sleep interrupted, and experiencing an unwanted sexual advance than Korean students. Conclusion: In general, US students were more likely to suffer interrelationship problems after drinking while Korean students were more likely to have physical and individual drinking related problems.

This study compares the drinking behavior of and correlates of fraternity and sorority members with nonmembers to determine if public perceptions of alcohol use by students affiliated with Greek social organizations are warranted.

The Harvard School of Public Health College Alcohol Study surveyed students at a nationally representative sample of 4-year colleges in the United States four times between 1993 and 2001. More than 50,000 students at 120 colleges took part in the study. This article reviews what we have learned about college drinking and the implications for prevention: the need to focus on lower drink thresholds, the harms produced at this level of drinking for the drinkers, the secondhand effects experienced by other students and neighborhood residents, the continuing extent of the problem, and the role of the college alcohol environment in promoting heavy drinking by students. In particular, the roles of campus culture, alcohol control policies, enforcement of policies, access, availability, pricing, marketing, and special promotions of alcohol are highlighted.

College student alcohol use is associated with an estimated 1700 deaths and 500 000 unintended injuries each year [1]. Life at campuses and adjoining communities is affected negatively by the second-hand effects of heavy drinking—violence, vandalism, noise and vomit [2,3]. College attempts to intervene have focused thus far primarily on educational efforts and have yielded little success [4]. Environmental interventions, for instance cracking down on centers of heavy drinking such as fraternities and athletic programs, risk antagonizing students and alumni. Cutting down on the supply and access to alcohol requires cooperation from the local community [5]. One university decided to try to cash in on the problem [6]. A team of evaluators was funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) to examine student drinking rates over eight semesters before and after the introduction of alcohol sales to determine whether rates of binge drinking and drunkenness changed during that time-period. They also compared the rates at the school where alcohol was sold with those at another college. Before the results of this study are used to justify policy changes, we need to ask a few questions, as follows. First and foremost, the study title promises an examination of student drinking and drinking problems. However, the study looks only at rates of binge drinking and drunkenness. It would have been helpful to see whether changes occurred in the rates of health, social and educational problems experienced by drinkers, as well as in the second-hand effects of heavy drinking experienced by others in the dormitories and in the adjoining community. What is the price that was paid for adding profit from the sale of alcohol ($127 435) to the school coffers over the 5-year period? Is there a decline in the quality of life on campus? Are more students injured, assaulted or vandalized? Do more students fall behind in school work or drop out? Do school health and safety expenditures rise to pay for higher health service and security costs? The answers to these questions could help to guide college policies about alcohol. The authors conclude that the introduction of alcohol sales did not lead to any statistically significant change in binge drinking and drunkenness by the end of the study period, despite an initial significant increase in both measures. That increase dissipated over the years, but the level of drunkenness remained higher, although not significantly so, throughout most of the study period. The average number of times drunk in the past 4 weeks rose from 2.07 at pretest to 3.21 in the autumn of 2001, and then tapered off gradually to 2.34 by the autumn of 2003, only dropping below the pretest rate to 1.92 in the last semester. Although the differences between semesters are not significant, a trend analysis may have indicated whether or not there was a statistically significant increase throughout most of the study period. If this was a drug trial and the incidence of episodes of important problems rose in the early years of the study, the study may have been stopped and the drug taken off the market. In any event, attributing changes in drinking to the sales of alcohol may be, at best, risky. Other factors may account for such changes. What else changed during the period of the study? Did alcohol policies or enforcement actions change in the school, or in the town or state? There are a number of issues related to the research design that may affect the interpretation of the findings, and limit our ability to generalize from this campus to other college settings. The authors are aware that selection of students for the surveys poses a problem. Catching students passing a central point on campus does not ensure a representative sample. Checking on a few demographic factors does not resolve this, particularly as there is no way to gauge response rates, or even the number of refusals. Perhaps heavy drinkers did not want to participate in the survey, or non-drinkers were not interested. Perhaps willingness to participate changed during the years of the study. Ironically, the authors were not able to use a standard random selection method for inclusion of the study because of costs. Perhaps the college could have contributed from its profits to pay for this necessary expense. The study employs a comparison school, where the sale of alcohol is not initiated, to serve as a control for the college studied. While the use of a control is usually considered desirable, one college may not be an appropriate control for another. The control college needs to be as similar as possible in all respects except for the introduction of alcohol sales. We know that the two schools differ significantly in at least one important respect: the initial rate of binge drinking and drunkenness is higher at the comparison school. There are also many things that we do not know about both schools. What are the alcohol control policies in the dormitories? Which alcohol educational and prevention programs do they use? What control policies are in effect in the towns and states in which the colleges are located? How have these changed during the time-period of the study? A study of serving practices at the school and two control sites in the community revealed that, for the most part, there was good compliance with ID checks of youthful-appearing patrons and non-serving of people showing signs of intoxication. While this may sound reassuring to state alcohol control agencies, it should be noted that in 25% of the instances observed there was no ID check when a youthful-appearing student was sold a drink. This may meet minimum requirements, but is hardly a gold standard. The central problem with this study involves what will be made of the findings. The authors conclude that it is too early to decide whether alcohol can be brought safely onto campus. Indeed, they state that ‘readers should be wary that of interpreting our failure to find an increase in student drinking as an indication that liberalizing alcohol policy has no negative consequences’. However, at the school they studied profit from sales has been dropping, and school administrators are contemplating adding more sales venues. They are obviously not as cautious as the authors. Will the quest for more profits lead to the expansion of marketing techniques, special promotions such as ladies’ nights, happy hours and other inducements to have students purchase alcohol? I hear the faint noise of popping champagne corks in the background. The Clydesdale horses (in the Budweiser advertisements) must be celebrating.

AIMS The present study examines the prevalence trends and college-level characteristics associated with the non-medical use of prescription drugs (i.e. amphetamines, opioids, sedatives, tranquilizers) and illicit drug use among US college students between 1993 and 2001. DESIGN Data were collected from self-administered mail surveys, sent to independent cross-sectional samples of college students from a nationally representative sample of 119 colleges in 4 years between 1993 and 2001. SETTING Nationally representative 4-year US colleges and universities in 1993, 1997, 1999 and 2001. PARTICIPANTS Representative samples of 15,282, 14,428, 13,953 and 10,904 randomly selected college students at these colleges in 1993, 1997, 1999 and 2001, respectively. FINDINGS The results indicate that life-time and 12-month prevalence rates of non-medical use of prescription drugs (NMPD) increased between 1993 and 2001. Specific college-level characteristics were found to be correlated positively (marijuana use) and negatively (historically black college status and commuter status) with NMPD, consistently across the four cross-sectional samples. Significant between-college variation in terms of trajectories in the prevalence of NMPD over time was found in hierarchical linear models, and selected college-level characteristics were not found to explain all of the variation in the trajectories, suggesting the need for further investigation of what determines between-college variance in the prevalence trends. CONCLUSIONS The findings of the present study suggest that continued monitoring of NMPD and illicit drug use among college students is needed and collegiate substance prevention programs should include efforts to reduce these drug use behaviors.

OBJECTIVE:The purpose of this study was to examine the association between Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), alcohol-use disorders (AUDs) and nonmedical use of prescription drugs (NMPD) among U.S. college students. A secondary aim of this study was to identify individual-level and college-level characteristics associated with the co-occurrence of AUDs and NMPD. METHOD:Data were collected from self-administered mail surveys, sent to a random sample of approximately 14,000 college students from a nationally representative sample of 119 U.S. colleges and universities. RESULTS:Among U.S. college students, those with AUDs represented approximately 75% of nonmedical users of prescription drugs. Multivariate logistic regression analyses indicated that college students with past-year DSM-IV alcohol abuse only (adjusted odds ratio [AOR]=4.46, 95% confidence interval [CI]=3.59-5.55) and students with past-year DSM-IV alcohol dependence (AOR=9.17, 95% CI=7.05-11.93) had significantly increased odds of NMPD in the past year compared with students without AUDs. The co-occurrence of AUDs and NMPD was more likely among college students who were male, white, earned lower grade point averages, and attended co-ed colleges and institutions located in Southern or Northeastern U.S. regions. CONCLUSIONS:The findings provide evidence that NMPD is more prevalent among those college students with AUDs, especially individuals with past-year DSM-IV alcohol dependence. The assessment and treatment of AUDs among college students should account for other forms of drug use such as NMPD.

This study assessed the prevalence, trends, and student- and college-level characteristics associated with the non-medical use of anabolic steroids (NMAS) among U.S. college students. Data were collected through self-administered mail surveys, from 15,282, 14,428, 13,953, and 10,904 randomly selected college students at the same 119 nationally representative colleges in 1993, 1997, 1999 and 2001, respectively. The prevalence of lifetime, past-year and past-month NMAS was 1% or less and generally did not change significantly between 1993 and 2001, with one exception: past-year NMAS increased significantly among men from 1993 (0.36%) to 2001 (0.90%). Multiple logistic regression analyses revealed that lifetime and past-year NMAS were associated with student-level characteristics such as being male and participation in intercollegiate athletics. Lifetime and past-year NMAS were also positively associated with several risky behaviors, including cigarette smoking, illicit drug use, drinking and driving, and DSM-IV alcohol use disorders. Nearly 7 out of every 10 lifetime non-medical users of anabolic steroids met past-year criteria for a DSM-IV alcohol use disorder. Although the overall prevalence of NMAS remained low between 1993 and 2001, findings suggest that continued monitoring is necessary because male student-athletes are at heightened risk for NMAS and this behavior is associated with a wide range of risky health behaviors. The characteristics associated with NMAS have important implications for future practice and research.

Gambling on college and professional sports and the influence of attending colleges with differing levels of "sports interest" were examined among athletes, sports fans, and other students (N = 10,559) at 119 colleges in the United States using multilevel statistical analysis. Athletes and fans reported more sports gambling compared to other students, with no differences between athletes and fans. Male students were more likely to gamble than female students, but gender did not moderate the relationship between athletic participation and sports gambling. Students attending schools with a greater "Sports interest" were more likely to gamble on college sports after adjusting for individual characteristics. Athletes, sports fans, and students attending schools with high "sports interest" are appropriate targets for prevention efforts.

OBJECTIVESTo examine social disparities and behavioral correlates of overweight and obesity over time among college students.METHODSMultilevel analyses of BMI, physical activity, and television viewing from 2 representative surveys of US college students (n=24,613).RESULTSOverweight and obesity increased over time and were higher among males, African Americans, and students of lower socioeconomic position and lower among Asians. Television viewing and in activity were associated with obesity, and disparities in these behaviors partially accounted for excess weight among African Americans.CONCLUSIONSSocial disparities in overweight and obesity exist among college students. Promoting physical activity and reducing television viewing may counteract increasing trends.

Although the concept of a downward-sloping demand curve is far from novel, its application to intoxicating substances remains an important contribution by economists to the general literature on addiction. Understanding the extent to which initiation, regular use, heavy use, and use by dependent populations respond to changes in the full cost of a drug, where the full cost represents not just the monetary cost of acquiring the drug but also the understood legal and health consequences associated with using the substance, is important. Economic studies, such as the one included in this volume, clearly show that even behaviors that are widely believed to be the result of random chance opportunities (in the case of experimentation and initiation) or uncontrollable urges (in the case of addicted users) are still responsive to external incentives and hence malleable (albeit, perhaps modestly) by policies that change these incentives. What economists find encouraging is not that we have been able to demonstrate the law of demand in yet another instance, but that we have been able to find statistically significant results consistently across studies even with poor consumption and price data. We know consumption is largely underreported, and hence results considering the effect of any variable must be biased toward zero. We also know that the limited price data available for analyses are largely based on convenience samples and limited in variability in terms of geography and time. Hence, current estimates of the elasticity of demand are known to be flawed. Those reported in the literature are generally viewed by economists as neither precise nor accurate estimates of the actual elasticities, merely imperfect approximations that can be improved on with better data. Thus, it is quite likely that the literature will continue to develop new estimates of the elasticity of demand for different substances. Other important questions about demand remain, however. Two areas in which economists can provide unique insights are the importance of incentives in deterring the escalation of use and the cost-effectiveness of alternative prevention strategies targeting different levels of demand. Although the etiology of drug abuse is largely an area of concern for epidemiologists, to date no one has evaluated the impact of prices and other aspects of the full cost on the escalation of drug use, from initiation to regular use or regular use to dependent use.

In this commentary, we describe the use of a 5/4 drink summary measure of heavy episodic alcohol consumption, or "binge" drinking, in survey research and its usefulness for preventing negative alcohol-related consequences. Data from 4 nationally representative surveys of more than 50,000 college students are utilized to examine the utility of this measure in comparison with alternative cut-points. Our analysis demonstrates that while higher drink threshold measures incrementally improve the ability to identify correctly students who experience harms or who meet DSM-IV diagnostic criteria of alcohol abuse and dependence, they capture only a small proportion of those college students experiencing harms. We conclude that the selection of a measurement tool should be consistent with the purpose for which it is to be used. The 5/4 measure of binge drinking provides a valuable means for understanding and preventing alcohol-related harms in a college population and can be utilized as a screen to identify students who may need additional clinical assessment for intervention.