Díaz MA, Díaz MLR, Hernández-Ávila CA, Narro RJ, Fernández VH, Solís TC

Language: Spanish
References: 29
Page: 271-282
PDF size: 156.40 Kb.

ABSTRACT

Background: In Mexico, alcohol is the most widely used substance among young adults. Alcohol consumption in this age group contributes importantly to the most frequent causes of mortality and morbidity (e.g., accidents, violence, homicides, suicide and risky behaviors).
Around the world, college or university attendance has emerged in the literature as a risk factor for drinking problems among young adults. In Mexico, data from the most recent National Survey on Addictions showed that lifetime and current drinking is experienced by more than half of the Mexicans attending college education. Despite this, in our country there is a paucity of epidemiological studies examining drinking behavior and correlates among those attending college. Findings in non-representative samples of students attending public and private universities in Mexico City suggest that, during the last two decades, there has been an increase in the frequency of lifetime and current drinking in this population. Additionally, these studies have shown that, in comparison to young adults of the same age in the general population, university students may experience a greater prevalence of lifetime and current alcohol drinking.
Regarding the frequency of unhealthy drinking among Mexican college students, to our knowledge there are no prevalence estimates of hazardous or harmful drinking published. However, observations in non-random samples of university students in Mexico City suggested that at least one in three men and one in five women incurred in unhealthy drinking (e.g., ≥ 5 drinks per occasion or drinking to intoxication) at least once during the last month. Hazardous and harmful drinking is respectively defined by a pattern of alcohol consumption conferring a greater risk for health problems or that is frankly conducive to medical or psychological complications (e.g., accidents, victimization, violence, alcohol dependence, liver cirrhosis and/or other medical complications).
The Alcohol Use Disorders Identification Test (AUDIT), developed by the World Health Organization, is currently the only instrument specifically designed to identify hazardous and harmful drinking. Although the AUDIT was initially validated among older adult patients in primary care settings, this instrument has consistently shown to be valid and reliable in detecting alcohol problems in different populations such as the college students in many countries around the world.
Given the public health implications of estimating the frequency of hazardous and harmful drinking among college students in Mexico, and given the importance of elucidating the variables influencing this problem, we decided to conduct the present study. To our knowledge, this is the first report published in the international literature on the prevalence of hazardous and harmful drinking among college students in a Latin American country.
Objective: In the analysis described here, derived from the project entitled Early Identification and Treatment of Problem Drinkers at the National Autonomous University of Mexico (UNAM), our aim was to examine the frequency and risk factors for hazardous and harmful drinking among Mexican university students. More specifically, our objectives were: 1. To determine the past-year prevalence of hazardous and harmful drinking among UNAM college freshmen; and 2. To examine in this population the effects of demographic and family variables on the likelihood of hazardous and harmful drinking.
Subjects and methods: This study was a cross-sectional survey that was conducted at the beginning of the school year during the registration period between September 1st and September 30th, 2005. In 2005, a total of 34 000 students were accepted to initiate college at the nine UNAM college campuses located in the Mexico City metropolitan area. Of these, 24 921 (73.3%) students (age=18.7±4.3 years; 55.7% women) consented in answering the survey and provided complete data. Consequently, 9 079 students (26.7%) were excluded from the analysis due to lack of consent, incomplete data or due to their absence at the time of registration.
We used the Alcohol Use Disorders Identification Test (AUDIT) to examine past-year prevalence of hazardous and harmful drinking. This self-report instrument includes 10 items that examine frequency and intensity of drinking (items 1-3), presence of alcohol dependence symptoms (items 4-6) and negative consequences of drinking (items 7-10), yielding a maximum possible score of 40 points. Among adult patients in primary care settings, it has been accepted that an AUDIT score of 0-7 points reflects safe levels of alcohol consumption, whereas a score of 8 points or greater indicates the presence of hazardous and harmful drinking. It has been described, however, that among college students, an AUDIT score of 6 points or greater reliably identifies those students experiencing this problem.
In the analysis presented here, we separately examined and reported the prevalence estimates and correlates of hazardous and harmful drinking using both AUDIT cut-off scores (≥ 6 and ≥ 8).
The AUDIT was administered at the same time as a wellness screening survey that the UNAM Medical Services routinely administer to all registering freshmen at the beginning of the school year. Questions in the wellness survey pertained students’ medical and dental health, family medical history, immunizations, use of tobacco and other drugs.
In addition, demographic and socioeconomic information was obtained from a questionnaire also routinely administered by the UNAM registrar’s office. This questionnaire included 37 items inquiring about gender, age, employment and marital status, monthly family income, parental education, place and type of residency, persons with whom the student resided, and questions on previous academic performance.
We estimated the prevalence of hazardous and harmful drinking and their respective 95% confidence intervals [95% CI] in the total of the sample, and separately by age group, gender, marital and working status, monthly family income group, parental education, and by variables reflecting whether the students lived with their family, peers or alone. These variables were modeled using simulated binary terms (0,1). Subsequently, multinomial logistic regression was used to examine the relationship between hazardous and harmful drinking and the demographic and socioeconomic variables listed above. These were entered simultaneously into the logistic regression equation. In order to summarize the level of risk of hazardous and harmful drinking conferred by significant variables in the logistic regression model, odds ratios (OR) and their respective 95% CI’s were estimated. All the significant effects reported here were adjusted considering the effects of the remaining demographic and socioeconomic variables.
Results: Among the university freshmen examined here, when an AUDIT cutoff score of ≥ 8 was used, the prevalence of hazardous and harmful drinking was 11.1%. When an AUDIT score of ≥ 6 was considered, a frequency of 18.4% was then observed. Men (AUDIT ≥ 8: 17.3%; AUDIT ≥ 6: 27.4%) experienced this problem more frequently than women (AUDIT ≥ 8: 6.2%; AUDIT ≥ 6: 11.3%). The greater prevalence of hazardous and harmful drinking among men was observed in all age groups and regardless of working or marital status, family income, parental education or regardless of the persons with whom the student reported to reside. Controlling for demographic and socioeconomic differences between men and women, we found that the risk of experiencing hazardous and harmful drinking among men was almost three times greater than in women (OR’s [95% CI]: AUDIT ≥ 8 or ≥ 6 respectively: 2.9[2.7-3.3] or 2.8[2.6-3.0]).
In both, men and women, the greatest frequency of hazardous and harmful drinking occurred among those 20 to 25 years of age. Older students showed a gradual reduction in the prevalence of this problem; with those who were 29 years old or older experiencing the lowest risk of being affected.
Among those students who reported to work, there was a greater frequency and increased risk of hazardous and harmful drinking. Furthermore, this risk increased with the number of reported weekly working hours. This last effect was seen unequivocally only in men, with the greatest likelihood of hazardous and harmful drinking being observed among the group of male students weekly working 32 hours or longer.
Also, a higher monthly family income was associated with a greater chance of hazardous and harmful drinking. Men in the highest family income group (10 or more minimum salaries) experienced the greatest risk for this problem. Among women, however, this effect was only observed when an AUDIT cut-off score of six or greater was used to screen for hazardous and harmful drinking.
Although we did not find any effects of the number of years of parental education on the probability of drinking problems in male students, among women, there was a greater risk of hazardous and harmful drinking among students having a father with a greater number of years of education (≥ 12 years). Similarly, among female students, a greater number of years of education in the mother (≥ 12 years) also increased the chance of being affected by hazardous and harmful drinking.
Regarding variables that conferred a reduction in the prevalence and in the risk of hazardous and harmful drinking, we observed that those students who were married experienced a reduction in the likelihood of this problem.
Finally, in our sample, there were no effects on the probability of hazardous and harmful drinking from variables reflecting whether the students lived with their family, with peers or alone.
Conclusions: Hazardous and harmful drinking is a frequent problem among Mexican university freshmen. Variables associated with an increased risk of this problem may exert their effects by facilitating availability and access to alcoholic beverages, and facilitating exposure to highrisk activities for alcohol consumption. These findings have direct implications in designing preventive and treatment interventions in the larger population of college and university students in Mexico.

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