Social–cognitive correlates of protective drinking behaviors and alcohol-related consequences in college students
Introduction
Heavy drinking among college students continues to be a public health concern for colleges and universities throughout the United States (Dawson et al., 2004, Johnston et al., 2007, Perkins, 2002). Prevalence rates of heavy episodic drinking in college populations range from 40 to 50%, with nearly one out of four students reporting extreme drinking tendencies including frequent heavy episodic drinking (3 times or more within a two-week period), as well as drinking on 10 or more occasions within the past 30 days (Johnston et al., 2007, Wechsler et al., 2002). This is disconcerting in view of research that shows frequent heavy episodic drinkers are at higher odds to experience physical, academic, interpersonal, sexual and legal alcohol-related consequences (Wechsler et al., 1998, Wechsler et al., 2000, Wechsler et al., 2002). Further, Hingson, Heeren, Winter, and Wechsler (2005) report that the prevalence of alcohol-related mortality among the college population is increasing at a rate that exceeds the non-college population.
A closer examination of the data reveals that, although students who drink are at higher risk to experience consequences, a large percentage of student drinkers do not report experiencing problems as a result of their drinking. For example, Wechsler et al. (2002) observed the prevalence of experiencing alcohol related problems among students who reported drinking within the past 30 days ranged from 10 to 30% depending on the particular consequence. Even among frequent heavy-episodic drinkers, a significant percentage (e.g., 40% or more depending on the consequence) do not report experiencing problems (Wechsler et al., 1994, Wechsler et al., 1998, Wechsler et al., 2000). This is not meant to understate the relationship between drinking and consequences, but merely highlights the notion that not all individuals who engage in heavy drinking experience consequences and not all individuals who engage in lighter drinking practices avoid experiencing alcohol-related problems. Thus, a more in-depth examination of factors beyond just drinking quantity and frequency is called for to explain why some individuals experience related consequences.
One possible explanation can be related to specific behaviors individuals engage in when drinking; namely, whether individuals engage in protective activities. An emerging body of literature indicates that students who routinely engage in behaviors such as setting limits, pacing drinks, diluting beverages, and taking social precautions (e.g., walking with home with friends) are at lower risk of experiencing alcohol-related consequences (Benton et al., 2004, Delva et al., 2004, Haines et al., 2006, Martens et al., 2004). For example, Martens et al. (2004) found that students who rarely engaged in protective behaviors were four times as likely to experience consequences relative to students who usually engaged in protective behaviors when drinking. Further, several studies have demonstrated intervention approaches that emphasize the utility of engaging in protective behaviors as a means of reducing alcohol-related consequences (e.g., BASICS; Dimeff, Baer, Kivlahan, & Marlatt, 1999) routinely tend to be among the most efficacious in reducing harm (see Larimer and Cronce, 2002, Larimer and Cronce, 2007).
Although these studies have established that protective behaviors are important for reducing alcohol-related harm only a few studies have examined variables related to the use of such behaviors. For example, Walters, Roudsari, Vader, and Harris (2007) examined correlates of protective behaviors including gender and parental history of drinking. They found that females engaged in protective behaviors significantly more often than males and individuals with a positive family history of problem drinking engaged in protective behaviors less frequently. Similarly, Benton et al. (2004) identified that female college students were more likely to engage in protective behaviors than males. With respect to drinking motives, Martens, Ferrier and Cimini (2007) found the likelihood of engaging in protective behaviors was negatively associated with motivations to drink for social reasons (e.g., celebrating) and enhancement (e.g., drinking because it feels good). Finally, a recent study by Benton, Downey, Glider, and Benton (2008) found the more students perceived other students engaged in protective behaviors, the more likely they were to engage in these behaviors themselves. Taken together, these studies offer only a partial explanation of why individuals choose to engage in protective behaviors. Further examination of the underlying decision process would help explain why some individuals do not engage in protective behaviors and provide insights into how to address the use of protective behaviors in intervention efforts.
Using perspectives of attitudinal theories of decision making (Ajzen and Fishbein, 1980, Jaccard, 1981, Jaccard and Becker, 1985), we posit a model for protective behaviors (see Fig. 1) in which one's attitude toward a protective behavior (e.g., how much one likes pacing drinks) is the proximal predictor of engaging in the behavior. Past studies have highlighted the importance of attitudes towards alcohol as an important predictor of consumption (Collins and Carey, 2007, Stacy et al., 1994, Turrisi, 1999), however, no studies have examined attitudes toward the use of protective behaviors. Therefore, we hypothesize that students who feel more favorable towards protective drinking behaviors, such as pacing one's drinking or setting limits, will be more likely to engage in such behaviors. According to cognitive theories of attitude formation (Jaccard, 1981, Jaccard and Becker, 1985), one's attitude toward the behavior is a direct function of the cumulative beliefs one holds toward the behavior. Beliefs we posit will be central to one's attitude toward engaging in a protective behavior will include how easy it would be to engage in the protective behavior (perceived self-efficacy), how effective the protective behavior would be in avoiding alcohol-related consequences (perceived effectiveness), and how supportive one's friends would be if one engaged in the protective behavior (subjective norm). Recent studies have identified self-efficacy as an important predictor of alcohol use, such that college students who are more confident in their ability to refuse alcohol are more likely to drink less (Collins and Carey, 2007, Johnston and White, 2003). Therefore, we anticipate that the more individuals think protective drinking behaviors are easy to use, the more they will like them and subsequently use them. Second, perceived risk of experiencing consequences has been related to drinking-related decisions (e.g., Turrisi, 1999, Turrisi and Jaccard, 1992). Thus, we hypothesize that students who expect that engaging in protective behaviors puts them at lower risk for experiencing harm will feel more favorable towards these behaviors and engage in them more frequently. Finally, the college drinking literature has well-established that norms about drinking activities are related to drinking tendencies (Borsari et al., 2007, Johnston and White, 2003, Neighbors et al., 2007). Thus, we anticipate if students perceive their friends approval in engaging in protective actions they will hold more favorable attitudes toward the protective behaviors and, subsequently, engage in them more frequently. Given the established link between normative beliefs and alcohol use we expect this variable may also directly influence the frequency to which one engages in protective behaviors, thus the direct path between normative beliefs and use of protective behaviors is also included in our hypothesized model.
Thus, the focus of the present paper was twofold: (1) we anticipated there would be a significant direct effect of protective behaviors on consequences after taking into account the effect of alcohol use and (2) we examined the relationships between perceived self-efficacy, perceived effectiveness, subjective norms and attitudes towards protective behaviors.
Section snippets
Sample
The sample consisted of 229 freshman drinkers (mean age = 18.61 years, 59.4% female) from a large, public university in the northeast. With respect to racial background, 91.7% identified as Caucasian, 4.4% as Asian, 1.7% as Multiracial, 0.9% as African American, and 0.9% identified as “Other.”
Participant recruitment and procedure
A sample of 600 college freshmen was randomly selected from the university's database of enrolled students. Each student received an email invitation to participate in an online, confidential survey which
Model fit
Results indicated good model fit for pacing, χ2 (10) = 23.78, p < .01; CFI = .97, setting limits, χ2 (10) = 35.88, p < .01; CFI = .96, and diluting, χ2 (10) = 30.25, p < .01; CFI = .96. With respect to social protective behaviors results suggest acceptable model fit, χ2 (10) = 57.87, p < .01; CFI = .91, for the hypothesized model. For item descriptives and correlations within each model, see Table 1. The path coefficients from the full models are presented in Table 2, Table 3. These will be discussed in turn, specific
Discussion
Risky drinking among college students continues to be an issue on college campuses throughout the United States and students who engage in heavy episodic drinking are at higher risk of experiencing related consequences (Dawson et al., 2004, Johnston et al., 2007, Wechsler et al., 2002). Yet, the data suggest that not all heavy drinkers experience consequences while not all light drinkers avoid them. The present study strengthens previous findings (Martens et al., 2004) that alcohol use alone is
Acknowledgements
Preparation of this article was supported by National Institute on Alcohol Abuse and Alcoholism Grants R01 AA12529 and R01 AA 15737 awarded to Rob Turrisi. The authors would like to thank Jerod Stapleton and Nadine Mastroleo for their helpful comments on a draft of this manuscript.
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