This document provides a broad overview of the factors presented during SAMHSA’s Center for the Application of Prevention Technologies (CAPT) June 18, 2013 webinar entitled Factors that Impact Binge Drinking Among Adolescents, Young Adults, and College Populations.
FACTORS AFFECTING ADOLESCENTS
Favorable Attitudes Toward Use1
A review of 19 community coalitions in Kentucky engaging in evidence-based community prevention strategies implemented between 1999 and 2002 found that favorable attitudes toward substance use was associated with binge drinking among adolescents (Collins et al., 2007).
Age of Onset3
Studies suggest that age of first drunkenness is more strongly associated with predicting the progression to heavy drinking than age of first drink (Gilligan et al., 2012).
Drinking as a way to manage emotional problems, especially for adolescent girls, has been found to be associated with heavy episodic drinking (Stolle et al., 2009).
Three review articles provide evidence that sensation-seeking personality characteristics, such as impulsivity, novelty-seeking, and risk taking, are associated with binge drinking among adolescents (Borsari et al., 2007; Stolle et al., 2009; Wicki et al., 2010). A study examining the relationship among impulsivity, executive functioning behaviors, and risk of addiction found that high levels of impulsivity experienced during adolescence may represent an important risk factor for binge drinking (Crews & Boettiger, 2009).
Permissive Parenting Practices/Tolerant Attitudes Toward Use1,4
Inconsistent and permissive parenting styles have been associated with greater risk of binge drinking in children and adolescents (Stolle et al., 2009). Tolerant parental attitudes have been linked with binge drinking among adolescents (Collins et al., 2007).
Community Context/Domain (also includes School and Peer Contexts/Domains)
Availability/Perceived Availability and Neighborhood Adult Attitudes1
A review of 19 community coalitions in Kentucky engaging in evidence-based community prevention strategies implemented between 1999 and 2002 found that greater perceived availability of alcohol and/or drugs was associated with greater likelihood of binge drinking during adolescence. It is important to note that while this study used statistical techniques to pool data from adolescents across communities, the sample is geographically limited and therefore caution must be used when generalizing these results (Collins et al 2007).
Exposure to Alcohol Merchandise2
A review of 13 studies published between 1990 and 2008 that studied research participants over time (longitudinal study) showed that greater exposure to alcohol-related merchandise was associated with an increase in underage drinking. Twelve of the 13 studies found a relationship between exposure to alcohol advertising and increased levels of consumption among drinkers after controlling for other potential factors (e.g., family, peer drinking, relevant demographics) that might contribute to binge drinking. The majority of studies (10 out of 13) did not report outcomes for binge drinking specifically (Anderson et al., 2009).
School Bonding/Attachment1 and Poor Academic Performance/Truancy/Poor School Attendance1
Greater school commitment or bonding has been found to be a protective factor against binge drinking. Conversely, associations between academic failure and increased levels of binge drinking, as well as number of school days skipped and increased binge drinking, were found within a geographically limited sample (Collins et al., 2007).
Peer Alcohol or Other Substance Use1,3,4
A geographically limited study found that having friends who engage in drug use was associated with binge drinking (Collins et al., 2007). Reviews of binge drinking among children and adolescents found that having close friends who consumed alcohol in the past month (Gilligan et al., 2012) and excessive drinking among peers (Stolle et al., 2009) were both associated with binge or risky drinking among adolescents.
FACTORS AFFECTING COLLEGE POPULATIONS
Other Substance Use6,9
A review of European college student drinking revealed a significant association between both cigarette smoking and illicit drug use, and higher levels of alcohol use and risky single occasion drinking (RSOD) (Wicki et al., 2010). Similarly, a longitudinal study of college students in the U.S. found that past-month cigarette smoking and marijuana use was associated with a greater likelihood of heavy episodic drinking (Jessor et al., 2006, as cited in HEC’s 2009 review).
Age of Onset3,8,9
Early onset of binge drinking has been linked to increased risk of binge drinking in adulthood (Courtney & Polich, 2009; Wicki et al., 2010). Studies suggest that age of first drunkenness is more strongly associated with predicting the progression to heavy drinking than age of first drink (Gilligan et al., 2012).
Alcohol expectancies include both positive and negative beliefs about the effects and consequences of using alcohol. Fewer positive alcohol expectancies are associated with fewer binge drinking episodes among young adults, but negative alcohol expectancies do not appear to be related to binge drinking episodes (Courtney & Polich, 2009). A review of European college student drinking also reported a significant association between positive alcohol expectancies and RSOD. In addition, this review also indicated that, in some European samples, fewer negative expectancies were related to RSOD (Wicki et al., 2010).
Drinking as a way to manage emotional problems, especially for adolescent girls, has been found to be associated with heavy episodic drinking (Borsari et al., 2007; Stolle et al., 2009). A review of student drinking among European samples cited one Swiss study that demonstrated an association between coping reasons and frequencies of RSOD (Wicki et al., 2010). In a study of college athletes, athletes with high attachment avoidance had the highest rates of heavy drinking (binge criteria were not specified). Attachment avoidance suggests difficulty developing closeness in interpersonal relationships. The authors concluded that those with high attachment avoidance may use drinking as a coping strategy to manage negative emotions in social situations (Doumas et al., 2006, as cited in HEC’s 2009 review). Predictors of alcohol use in college students found that social motivations such as “fitting in” were more common among college students who engaged in binge drinking compared to those that did not (Wicki et al. 2010; Borsari et al., 2007). Another study found that college students who reported “celebration” as a motivation to drink had higher levels of intoxication on two holidays associated with drinking (Halloween, and St. Patrick’s Day) when compared to students without “celebration” motivations (Glindemann, Wiegand, & Geller, 2007 as cited in HEC’s 2009 review).
A review article found that lower self-efficacy (defined as ability to refuse drinks easily or ability to stop drinking) has been linked with binge drinking. A binge in this study was defined as more than six drinks for males/four drinks for females per drinking period (Courtney & Polich, 2009)
Personality Characteristics: Sensation Seeking/Novelty Seeking/Self Control4,5,9,10
Three review articles provide evidence that sensation-seeking personality characteristics—such as impulsivity, novelty seeking, and risk-taking—are associated with binge drinking among adolescents (citations if needed: Borsari et al., 2007; Stolle et al., 2009; Wicki et al., 2010). In a longitudinal study of students transitioning from high school to college, lower sensation-seeking was a protective factor against increasing heavy episodic drinking (White et al., 2006, as cited in HEC’s 2009 review). A study of college students from four southern universities found that low self-control mediated a significant relationship between being a sports fan and binge drinking (Higgins, Tewksbury, & Mustaine, 2007 from HEC’s review). Another review found that high levels of impulsivity experienced during adolescence may represent an important risk factor for binge drinking (Crews & Boettiger, 2009).
Placing little emphasis or importance on religion has been associated with binge drinking in young adult samples (Borsari et al., 2007; Courtney & Polich, 2009). A large, longitudinal study of college age students found that attendance at church services buffered the risk of heavy episodic drinking (Jessor et al., 2006, as cited in HEC’s 2009 review). Higher religiosity (measured as the average of the frequency of attending religious services and the importance of religion to one’s life) protected against an increase in heavy episodic drinking among students transitioning from high school to college (White et al., 2007 as cited in HEC’s review). Religious affiliation has also been found to be a protective factor for binge drinking in European college students (Wicki et al., 2010). A review of religiosity found that depth of personal religious commitment may be a better predictor of alcohol use for college-age young adults than behavioral measures (e.g., attendance at religious services) (Borsari et al., 2007).
Family History of Alcoholism8
A review of binge drinking among young adults found that a family history of alcoholism has been linked to an increased risk of binge drinking in this age group (Courtney & Polich, 2009).
Permissive Parenting Practices/Tolerant Attitudes Toward Use6
A longitudinal study of students demonstrated a significant protective effect of conventional beliefs held by parents and other social influences (e.g., parental disapproval of substance use and other deviant behavior) on heavy episodic drinking among college students (Jessor et al., 2006, as cited in HEC’s 2009 review).
The Harvard School of Public Health’s College Alcohol Study identified a set of interrelated community or environment factors that were correlated with initiation of binge drinking among college students. These include residential setting, low-priced alcohol, a high density of alcohol outlets, and the overall drinking rate at the college. (Wechsler & Nelson, 2008). Other studies have found correlations between these factors and binge drinking, as well.
Availability or Perceived Availability6,7,11
A study that followed 975 students between Fall 2002 and Spring 2004 revealed a relationship between greater perceived ease of access to alcohol and binge drinking after controlling for other plausible factors (Jessor et al., 2006, as cited in HEC’s 2009 review). The College Alcohol Study (cited above) also found correlations between a community’s overall level of adult binge drinking and college binge drinking. In cases where there state reported high rates of binge drinking among the general population (as measured by the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance Survey) so did the college(s).
Peer Alcohol or Other Substance Use6,7,8
A longitudinal study of students found that having fewer friends who use substances was protective against an increase in heavy episodic drinking during the transition from high school to college (White et al., 2006, as cited by HEC’s review). Peer use of alcohol and other drugs has also been found to be a significant risk for heavy episodic drinking in a longitudinal study of college-age students (Jessor et al., 2006, as cited in HEC’s review). Having school friends present during a drinking event has also been found to predict binge drinking in college-age samples. (Courtney & Polich, 2009).
A review of European college students’ alcohol use examined the results of 65 studies published between 1989 and 2009; it found that students living alone, with a roommate, or in student housing were more likely to engage in higher volume alcohol use and Risky Single Occasion Drinking (RSOD) than students living with their parents or partners and/or children (Wicki, Kuntsche, & Gmel, 2010). (RSOD was not consistently defined in this article, although the authors stated that it was often measured as six or more drinks on one occasion.) Another review article also suggested that involvement in Greek life is a consistent predictor of heavy alcohol use among college students (Borsari et al., 2007). Among college students, living with a roommate or in a fraternity or sorority is also significantly correlated with binge drinking (Courtney & Polich, 2009). Conversely, the College Alcohol Study reported findings related to an inverse relationship between pro-social or productive college activities, such as volunteer service and binge drinking (i.e., pro-social students reported less binge drinking.)
- Collins, D., Johnson, K., & Becker, B. J. (2007). A meta-analysis of direct and mediating effects of community coalitions that implemented science-based substance abuse prevention interventions. Substance Use Misuse, 42(6), 985-1007
- Anderson, P., de Bruijn, A., Angus, K., Gordon, R., & Hastings, G. (2009). Impact of alcohol advertising and media exposure on adolescent alcohol use: a systematic review of longitudinal studies. Alcohol Alcohol, 44(3), 229-243.
- Gilligan, C., Kypri, K., & Lubman, D. (2012). Changing parental behavior to reduce risky drinking among adolescents: Current evidence and future directions. Alcohol Alcohol, 47(3), 349-354.
- Stolle, M., Sack, P. M., & Thomasius, R. (2009). Binge drinking in childhood and adolescence: Epidemiology, consequences, and interventions. Dtsch Arztebl Int, 106(19), 323-328.
- Borsari, B., Murphy, J. G., & Barnett, N. P. (2007). Predictors of alcohol use during the first year of college: implications for prevention. Addict Behav, 32(10), 2062-2086.
- Higher Education Center for Alcohol and Other Drug Abuse and Violence Prevention (2009). Annotated Bibliography of Alcohol, Other Drug, and Violence Prevention Resources 2006–2008.
- Wechsler, H. & Nelson, T. (2008) What we have learned from the Harvard School of Public Health College Alcohol Study: Focusing attention on college student alcohol consumption and the environmental conditions that promote it. J. Stud. Alcohol Drugs 69, 481-490.
- Courtney, K. E., & Polich, J. (2009). Binge drinking in young adults: Data, definitions, and determinants. Psychol Bull, 135(1), 142-156.
- Wicki, M., Kuntsche, E., & Gmel, G. (2010). Drinking at European universities? A review of students' alcohol use. Addict Behav, 35(11), 913-924.
- Crews, F. T., & Boettiger, C. A. (2009). Impulsivity, frontal lobes, and risk for addiction. Pharmacol Biochem Behav, 93(3), 237-247.
- Nelson, TF, Winters, KC & Lyman, VL, Preventing Binge Drinking on College Campuses: A Guide to Best Practices, 2012 Hazelden Publishers
- Nelson, T, Naimi, T., Brewer, R. & Wechsler, H. (2005) The state sets the rate: The relationship among state-specific college binge drinking, state binge drinking rates, and selected alcohol control policies. American Journal of Public Health, 95(3), 441-448.
Developed under the Substance Abuse and Mental Health Services Administration’s Center for the Application of Prevention Technologies contract (Reference #HHSS277200800004C).