High-Risk Drinking in College: What We Know and What We Need To Learn

Epidemiology of Alcohol Use Among College Students

Although heavy episodic drinking in college is a major public health problem, the majority of college students do not binge drink or drink heavily (Wechsler et al., 2000b). In contrast, students who binge drink three or more times in a 2-week period consume very large quantities of alcohol. The 1997 College Alcohol Study found that this group (20.9 percent of students) consumed a median of 14.5 drinks per week and accounted for 68 percent of all the alcohol consumed by college students (Wechsler et al., 1999).

To form a research-based view of drinking among college students, many researchers working in the field rely on five key national sources of data on youth, each with different characteristics relating to population coverage, data collection methodology, instrumentation, and period of data collection. Findings from these five national data sets are in general agreement that approximately two of five U.S. college students engage in heavy episodic drinking (O’Malley and Johnston, 2002). The five data sets are:

1. The Harvard School of Public Health College Alcohol Study (CAS);
2. The Core Institute (Core), Southern Illinois University;
3. Monitoring the Future (MTF), University of Michigan;
4. The National College Health Risk Behavior Survey (NCHRBS), Youth Risk Behavioral Surveillance, Centers for Disease Control and Prevention (CDC) (unlike the others, this is not ongoing); and
5. The National Household Survey on Drug Abuse (NHSDA), Substance Abuse and Mental Health Services Administration (SAMHSA).

CAS, which is funded by the Robert Wood Johnson Foundation, surveyed more than 15,000 students in 1993; in 1997, there were usable data from more than 14,500 students and in 1999, from more than 14,000 students. Another survey was concluded in 2001. CAS has the following five advantages:

• The sample is randomly selected, allowing its findings to be used to generate national estimates;
• The population samples are large, allowing for the examination of subgroups;
• It provides information about institutions, and respondents are grouped by institution, so institution-level variables and policies can be analyzed;
• The survey focuses on alcohol use and misuse among college students and provides substantial assessments of alcohol use and related attitudes, beliefs, and behaviors; and
• The survey is repeated, so changes in prevalence over time can be studied.

Core is funded by the Drug Prevention in Higher Education Program of the Fund for the Improvement of Postsecondary Education of the U.S. Department of Education. The Core Alcohol and Drug Use Survey is specifically designed for use with college students; institutions participate on a voluntary basis, so the sample is not randomly selected. More than 45,000 students participated in the study’s fourth cycle, a period that covered 1992 to 1994. Core’s major advantages are:

• The samples are large, allowing subgroups to be examined;
• It provides information about institutions, and respondents are grouped by institution, so institutional variables and policies can be analyzed; and
• It includes questions about the use of alcohol and other drugs, and the survey’s “long form” contains questions about other alcohol-related attitudes, beliefs, and behaviors.

MTF is funded by a series of grants from the National Institute on Drug Abuse. Since 1976, the study has conducted annual nationwide surveys of about 17,000 high school seniors, with annual followup surveys of representative subsamples from all previously participating senior classes. These surveys include many respondents who are currently full-time college students.

In this study, students are not clustered by college, and thus there is very limited information about the institution. MTF’s major advantages are:

• Relatively long-term trend data are available, beginning in 1980;
• The study is ongoing;
• The design is longitudinal and includes data on students prior to high school graduation so changes in substance use that occur in college can be examined;
• The design includes both college students and same-age peers who do not attend college, so comparisons between the two groups can be made; and
• It provides considerable information about substance use, including tobacco and other drugs, as well as alcohol.

NCHRBS is a one-time study conducted between January and June of 1995 by the Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. More than 4,800 students completed mailed questionnaires, but no information about the institution is available on the public use data files. The major advantages of this sample are:

• Data are available on several health risk behaviors, including alcohol and drug use; and
• The study design allows some ethnic group comparisons.

NHSDA is a series of surveys employing in-home interviews. The study includes more than 4,800 respondents defined as college students and more than 7,000 respondents of college age (17 to 22) defined as not college students. The definition of college student includes both part-time and full-time students. No institutional data are available. The major advantages of NHSDA are:

• Trend data are potentially available beginning in 1991–1993;
• The study is ongoing;
• The design includes both college students and same-age peers who do not attend college or who have dropped out of high school; and
• A broad range of substance-abusing behaviors is represented.

In addition to the five key sources cited here, there are numerous other potentially valuable data sources. These sources include the University of California at Los Angeles Higher Education Research Institute Freshman and College Student Surveys, the National Longitudinal Survey of Youth, the National Longitudinal Survey of Adolescent Health, the National Archive of Criminal Justice Data, the Substance Abuse and Mental Health Data Archive, The Higher Education Center for the Prevention of Drug and Alcohol Abuse, and the U.S. Census Bureau. Other data are available from smaller surveys and laboratory studies carried out on a single campus or on a few campuses. All add to the knowledge base on drinking among college students.

Drinking Trends Among College Students

Data show a persistently high rate of drinking among young people, including college students, since World War II—a trend that continues to the present. College students generally have higher prevalence rates of alcohol use than their peers who graduate from high school but do not attend college. Although their noncollege same-age peers are somewhat more likely to drink every day, college students are more likely to drink at weekend parties and social gatherings. Data suggest that there are aspects of the college environment that support heavy episodic drinking in ways that are not experienced by noncollege peers. These aspects may include:

• Living in residence halls and Greek houses;
• Substantial amounts of unstructured time;
• More commingling of those who can and cannot purchase alcohol legally than occurs among noncollege peers; and
• Considerable amounts of alcohol advertising directed at the college student population.

Gender differences. Although approximately equal percentages of male and female college students consume alcohol, consumption is generally heavier for males than for females. Core data from 1994 show that about 2½ times as many males (26.4 percent) as females (9.6 percent) consume 10 or more drinks per week. Data from CAS and MTF for 1999, NCHRBS for 1995, and Core for 1994 also show that while binge drinking approached 50 percent for males, it was between 29 and 40 percent for females (O’Malley and Johnston, 2002).

Ethnic differences. The data from the surveys described above show that rates of binge drinking are highest for White college students. African-American students are lowest on measures of binge drinking, and Hispanic students fall between the two groups. On the basis of MTF data, differences among race/ethnic subgroups seem to have remained constant since 1980. According to CAS, Core, and MTF data, the prevalence of binge drinking among White students is between 40 and 50 percent, among Hispanic students between 30 and 40 percent, and among African-American students between 10 and 20 percent (O’Malley and Johnston, 2002).

Regional differences. Binge drinking rates among college students tend to be highest in the Northeast and North Central regions and lowest in the South and West (Wechsler et al., 1998, 2000). College students in California tend to be somewhat older on average, more likely to be married, and less likely to live on campus, which could contribute to lower binge drinking rates in the West (Wechsler et al., 1997b).

Other drug use. After alcohol, tobacco is the most frequently used substance among college students; about 31 percent of college students have smoked a cigarette in the past 30 days. About 20 percent are current marijuana users, and about 1 percent use cocaine. Data from MTF and NHSDA consistently show that college students drink more alcohol but use less marijuana, cocaine, and cigarettes than their noncollege peers. According to MTF data, about 40 percent of college students binge drink compared to about 33 percent of their noncollege peers, and 31 percent smoke as compared to 40 percent of their noncollege peers. The differences in marijuana use are slight (20 percent compared to 21 percent), but proportionately greater for cocaine (1 percent compared to 3 percent) (O’Malley and Johnston, 2002).

Alcohol abuse and dependence. In a recent study, 31 percent of students met criteria for a diagnosis of alcohol abuse and 6 percent for alcohol dependence in the past 12 months, according to questionnaire-based self-reports about their drinking (Knight et al., 2002). Another recent study estimates that 1.2 percent of 18- to 24-year-old college students and 2.8 percent of noncollege same age peers received alcohol or drug treatment (Hingson et al., 2002).

Strategies for Filling Gaps in Knowledge: Epidemiology of Alcohol Use Among College Students

The hypothesis that there are aspects of the college environment that tend to support drinking by college students warrants further study. Existing longitudinal data support the interpretation that college environments are somehow implicated in increasing alcohol use. But the link between college and increasing alcohol use has not been adequately defined. Is it partly that college students tend to drink more when they live on their own, since it is known that students who live on campus drink more than their student peers who still live at home? Additional longitudinal studies will help clarify the association between college environments, individual risk and protective factors, and rates of alcohol use among college students.

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Historical document
Last reviewed: 9/23/2005