University Binge Drinking Patterns and Changes in Patterns of Alcohol ...

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Abstract. Objective: To examine patterns of binge drinking and changes in drinking patterns among Chinese university students. Participants and Methods: ...


University Binge Drinking Patterns and Changes in Patterns of Alcohol Consumption Among Chinese Undergraduates in a Hong Kong University Jean H. Kim, ScD; Karli W. C. Chan, BA; Julie K. W. Chow, MSocSci; K. P. Fung, PhD; Ben Y. F. Fong, MBBS; Ka Kin Cheuk, MPhil; Sian M. Griffiths, MBBChir, FFPH, FHKAM

Abstract. Objective: To examine patterns of binge drinking and changes in drinking patterns among Chinese university students. Participants and Methods: Responses to an anonymous questionnaire were compared between a random sample of 411 second year Chinese undergraduate students in 2006 and 2,630 first year students from the previous year. Students reporting any symptoms of alcohol abuse were classified as alcohol abusers whereas those reporting repeated inability to curtail use were categorized as alcohol dependent. Results: After 1 year of university, greatly increased rates of past-month drinking of different degrees were found in both genders. Binge drinking among second year undergraduates was significantly correlated with male gender, living in a student residence hall, smoking, drinking to relieve stress, and having friends who frequently drank. Conclusions: Alcohol misuse is a health hazard to Chinese students in a university environment. Proactive policies aimed at preventing harmful alcohol use should be considered by university authorities.

China reported that 81.4% of respondents between the ages of 18 to 24 years had never drunk alcohol in their lifetime.11 Nonetheless, the per capita alcohol consumption among Chinese adults over the age of 15 had rapidly increased from ∼3.2 to 4.5 L in the period of 1989 to 2001.12 The noted increase in alcohol consumption has been attributed to westernization, the proliferation of alcohol beverage industry, lifestyle changes brought about by greater affluence, and the effects of increased mass media exposure and tourism.13–15 Despite these recent trends, the actual context of the uptake of heavy drinking in Chinese populations is not well studied. It is also unclear whether the university environment predisposes young adults to heavy drinking and alcohol abuse and whether patterns of problem drinking among Chinese undergraduates is beginning to resemble those reported in the United States during this period of rapid globalization. As compared to Mainland China, the effects of globalization such as widespread international commerce, ease of entry by foreigners, the high penetration of uncensored international media, and ready availability of foreign food products all have had comparatively stronger reverberations on Hong Kong’s lifestyle due to Hong Kong’s laissez-faire economy under the “one China, two systems” policy guaranteed by the Sino-British Joint Declaration of 1984. Although studies conducted in the 1980s noted that only about 25% of Chinese males and very few Chinese females ever drank alcohol in Hong Kong,16 binge drinking has been rapidly increasing among younger residents and the age of first drinking has steadily declined in the past 2 decades.17 Individuals in their 20s currently report the highest rates of past-month binge drinking (23.3% of males, 8.7% of females) than any other

Keywords: alcohol, gender


Although binge drinking is prevalent risk behavior among US college students that has been noted to be strong risk factor for unintentional injury, avoidable deaths, and unlawful behaviors,1–5 the uptake of heavy drinking has been largely ignored in Chinese student populations6–8 due to the traditionally low prevalence of alcohol consumption.9,10 A 2003 survey conducted in Mainland Dr Kim, Miss Chan, Miss Chow, Mr Cheuk, and Professor Griffiths are with the School of Public Health, Dr Fung is with United College, and Dr Fong is with University Health Service, The Chinese University of Hong Kong, Shatin, Hong Kong. Copyright © 2009 Heldref Publications 255

Kim et al

age group.17 Although studies of drinking patterns of Hong Kong university students have noted the overall prevalence of binge drinking, alcohol abuse and dependence,6,8 there are no studies analyzing actual changes in drinking behaviors among students during their university years. In order to shed light on the relationship between university life and alcohol consumption during this period of rapidly rising alcohol consumption levels, it is necessary to examine changes in drinking-related behaviors and attitudes of Chinese students during their university years. Undergraduate programs in Hong Kong are typically 3 years in duration. This study’s objective was to compare the drinking patterns of Hong Kong undergraduates in the middle of their studies (in second semester of Year 2) with those just prior to the commencement of university studies using data from the previous year’s entrants. The study will examine the uptake of drinking during the university years, record changes on drinking behaviors such as binge drinking and alcohol abuse, and document the reasons given for alcohol consumption among Chinese students during their university studies. METHODS The original baseline study was conducted on 89% of (2630/2968) the first year entrants (Year 1) of The Chinese University of Hong Kong (CUHK) before the commencement of their university studies in August 2005. All students were sent an anonymous questionnaire in Chinese prior to the fall semester registration. Students were to return these questionnaires at their compulsory pre-enrollment university health checkups. Students were informed that returned questionnaires would not be associated with their university health records in any way. All undergraduate students are randomly allocated to 1 of the 4 colleges at the beginning of their studies. The second year students (Year 2) from 1 of the 4 colleges anonymously completed a questionnaire in the fall of 2006 that were distributed and collected during mandatory college assemblies. The questionnaires were also put into student residence hall mailboxes with instruction to return them via postage-free internal mail. The second year study instrument was identical to the previous year’s questionnaire except that a supplementary section with questions about school performance was added. Ethical approval was obtained from the Behavioral Research Ethics Committee of the Chinese University of Hong Kong. The response rate for the second year students was 57.2% (411/719). Measures The self-administered instrument assessed respondents’ demographic information (age, gender, faculty, and pastyear living arrangement) and smoking status. The instrument asked the information about the respondent’s history of ever drinking, history of past-month binge drinking, symptoms of alcohol abuse and dependence, and binge drinking frequency. The instrument classified students as ever drinkers if he or she had ever deliberately consumed an alcoholic 256

beverage and as past-month binge drinkers if the student consumed ≥5 servings of alcohol/one occasion in the past month. Based on criteria of Diagnostic and Statistical Manual of Mental Disorders–IV (DSM-IV),18 students who responded affirmatively to any of the four items for alcohol abuse were classified as an alcohol abuser (see Table 2). Students were classified as alcohol dependent if they responded affirmatively to an item asking whether they had unsuccessful efforts to cut down on drinking. Students were asked about their frequency of drinking (never, less than once per month, 1 to 3 times per month, 1 to 3 days per week, and 4+ days per week), the reasons they engaged in drinking alcohol (relaxation, improve health, taste, celebration, curiosity) and what proportion of their friends were frequent drinkers (none, few, some, or many). Respondents were asked about drinking attitudes (think that it is morally unacceptable, dislike taste, believe it to be habit forming, negative health effects). Additional detail of the survey has been detailed previously.8 Supplementary questions were added for Year 2 sample to investigate adverse outcomes related to drinking in the past year (missed class, lower grades, getting behind in academics, argued with others, criticized by friends, criticized by parents, unplanned sexual activities, drunk driving, smoked, used recreational drugs). Statistical Analysis After stratifying by gender, the drinking-related variables (drinking frequency, reasons for alcohol use, types of alcoholic drinks consumed, alcohol use for stress management and smoking status, binge drinking, alcohol abuse and dependence symptoms) of Year 2 binge drinkers were compared with Year 2 non-binge drinkers (referent) using odds ratios and 95% confidence intervals. Multivariate logistic regression methods were used to investigate factors associated with binge drinking (demographic attributes, tobacco use, motivations for drinking, and peer effects) among students midway through university. Due to the low prevalence of symptoms of alcohol abuse and dependence, only descriptive statistics were provided for this study sample. Gender-specific past year prevalence rates of drinking variables were calculated for Year 2 sample and compared with data from the Year 1 sample using the χ 2 test. Statistical significance was set at p

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