To gather data on alcohol consumption and problem drinking among university students in Slovakia we used four alcohol-related variables, which measure different aspects of drinking. Frequency of drinking, which is the most general indicator, does not assess the quantity of consumed alcohol. As it is such a broad measurement, a high reported frequency presents only a relatively small concern. However, it was demonstrated that alcohol-related health and social problems tend to increase as the frequency of alcohol consumption rises . Heavy episodic drinking and the frequency of episodes of drunkenness are both measures which provide useful information for detecting more hazardous drinking.
We found that 60.5% of all males drank once a week or more often, and that 77.0% of males reported heavy episodic drinking. A similar pattern was found for female students. This means that some students drink infrequently, but if they do, they drink a lot. Also other studies found heavy episodic drinking to be a very common pattern among university students . In general, our findings indicate a high frequency of drinking, heavy episodic drinking and drunkenness, as well as problem drinking among university students.
Among the studied factors, gender had the strongest association with all alcohol-related variables, with males being at higher risk, which is in contrast to some studies indicating a declining difference between genders in alcohol-related variables [60, 61]. However, our results are consistent with observations from many previous studies [62–65]. In the literature, the most common explanation for why males and females differ in their drinking behavior is that alcohol consumption symbolizes and enhances male's greater power in relation to females [66, 67]. From a biological point of view, females have lower rates of gastric metabolism of alcohol than males [68, 69] and smaller volumes of body water in which the alcohol is distributed [70, 71]. Thus females may need to consume less alcohol than males to derive the same effects and may be more likely than males to experience unpleasant acute effects from alcohol . Apparently, these patterns and explanations are still valid in the Slovak student population, in contrast to findings from some Western European countries . On the other hand, we found no interactions between gender and the other sociodemographic variables considered in this analysis, indicating that the effects of other variables on drinking do not differ strongly by gender.
Based on the assumption that the overall drinking behavior of university students has not changed in recent years, we found only partial evidence of a gradual change in alcohol drinking during the four university years. In our study, the academic year was associated only with heavy episodic drinking. The finding that students from higher study years are less involved in heavy episodic drinking than the students from lower study years may indicate that either the pattern of drinking turns out to be more stable as the students get used to the cultural norms of university life as time passes or that heavy episodic drinking becomes more prevalent in the new generation of university students. For all other alcohol-related variables, we did not find any significant differences across the university years. This is consistent with other findings related to the development of students during university years [73, 74].
Evidence on the relationship between SES and health risk behaviors in adolescence is often inconsistent or even contradictory. This study investigated two different dimensions of SES separately: parental education and students' perceived income sufficiency. According to our results, only students from both extreme groups--highly-educated families (both parents highly educated) as well as lowly-educated families (both parents with a low education level)--faced a higher risk of problem drinking. If students from higher SES families experienced more restraints during adolescence, they might be more prone to excessive drinking when gaining independence. On the other hand, students from lower SES groups might experience a more permissive environment with regard to alcohol and develop problem drinking . In families with differing levels of parental education, there was no difference, regardless of which of the parents achieved the higher level of education. We additionally assessed the effects of perceived income sufficiency on drinking behaviors and observed no association. An explanation for this could be that alcohol is relatively cheap and is easy to access, and that drinking on university campuses is a social activity and students having less money may still be invited by others to go out drinking.
Living at the parental home
Leaving the parental home often coincides with an increase in heavy alcohol use . We found that accommodation is an important risk factor for heavy episodic drinking, alcohol drunkenness and problem drinking among university students. Also, other authors have found an association between the social environment of university life and student drinking [62, 76, 77]. Probably, the reason for this is a strong response to the social environment (socialization effect). The proximity to parents appears to play a role in protecting students from alcohol problems, as evidenced by the lower rates of drinking problems among students who live with their parents. Parents probably do not tolerate negative alcohol-related behaviors, and they are also able to monitor students who live at home more than those who do not live at home . We did not find differences in the frequency of drinking between students living in the parental home and those who did not. However, as stated above, this is the least strong indicator of alcohol-related risk behavior, and the lack of a difference might be caused by social drinking at the parental home.
We found that having an intimate partner was associated with two alcohol-related variables: respondents with an intimate partner were less involved in frequent drinking and problem drinking than students who were not in an intimate relationship. Although the findings for other drinking patterns were not significant, the same trend was observed for frequency of drunkenness. As a potential explanation of this phenomenon, Silbereisen suggested that involvement in a relationship is accompanied by changes in leisure activities; partners go to pubs or discos less often and seek each other's company in private settings . Another explanation may be that one would not tolerate his/her partner's heavy drinking and students with frequent episodes of heavy drinking are less likely to have stable partnerships.
In this survey sociodemographic correlates of four different patterns of alcohol use among university students in Slovakia were studied. Given the self-reported measures of drinking, some underreporting, for example for problem drinking, which is socially undesirable, might have occurred. In line with the National Survey on Drug Use and Health we used the same criterion (5 or more drinks) for measuring heavy episodic drinking for both genders, while many authors argue that four drinks or more should be used for females [26, 80]. Due to different physiology, females reach higher blood alcohol concentration levels compared to males after consuming equivalent doses of alcohol and this might have resulted in an underestimation of heavy episodic drinking in female students.
A further limitation is the cross-sectional design, which makes impossible to formulate conclusive statements about causality. We cannot exclude possible biases regarding missing or incorrect information due to social expectation bias in self-reported data, but we made several steps to guarantee confidentiality, which typically reduces social expectation bias. Since the response rate was relatively high and the survey covered different areas and not only the here studied questions, selection bias is likely limited. Some measures used in our study are short and might not have derived the whole information. For example, socio-economic status was measured only indirectly. There are also limitations related to the representativeness of the sample of the present study for all students in Slovakia. While we studied a relatively systematic sample from three universities in one town, the prevalence of alcohol use may be different in other parts of Slovakia.