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A cross sectional evaluation of an alcohol intervention targeting young university students

  • Sharyn Burns1Email author,
  • Jonine Jancey1,
  • Gemma Crawford1,
  • Jonathan Hallett1,
  • Linda Portsmouth1 and
  • Janelle Longo2
BMC Public HealthBMC series – open, inclusive and trusted201616:610

https://doi.org/10.1186/s12889-016-3314-4

Received: 6 October 2015

Accepted: 15 July 2016

Published: 20 July 2016

Abstract

Background

Hazardous drinking has been found to be higher among young university students compared to their non-university peers. Although young university students are exposed to new and exciting experiences, including greater availability and emphasis on social functions involving alcohol there are few multi strategy comprehensive interventions aimed at reducing alcohol-related harms.

Methods

Random cross sectional online surveys were administered to 18–24 year old students studying at the main campus of a large metropolitan university in Perth, Western Australia. Prior to the completion of the second survey an alcohol intervention was implemented on campus. Completed surveys were received from 2465 (Baseline; T1) and 2422 (Post Year 1: T2) students. Students who consumed alcohol in the past 12 months were categorised as low risk or hazardous drinkers using the Alcohol Use Disorders Identification Test (AUDIT). Due to the cross sectional nature of the two samples two-tailed two-proportion z-test and two sample t-tests were employed to determine statistical significance between the two time periods for categorical and continuous variables respectively.

Results

At T1 and T2 89.1 % and 87.2 % of the total sample reported drinking alcohol in the past month respectively. Hazardous levels of alcohol consumption reduced slightly between T1 (39.7 %) and T2 (38 %). In both time periods hazardous drinkers reported significantly higher mean scores for experienced harm, second-hand harm and witnessed harm scores compared to low risk drinkers (p <0.001). Hazardous drinkers were significantly more likely to experience academic problems due to their alcohol consumption and to report more positive alcohol expectations than low risk drinkers at both time periods (p <0.001).

Conclusions

Harms and problems for students who report hazardous drinking are of concern and efforts should be made to ensure integrated and targeted strategies reach higher risk students and focus on specific issues such as driving while intoxicated and alcohol related unplanned sexual activity. However there is also a need for universal strategies targeting all students and low risk drinkers as they too are exposed to alcohol harms within the drinking and social environment. Changing the culture of the university environment is a long term aim and to effect change a sustained combination of organisational actions, partnerships and educational actions is required.

Keywords

AlcoholUniversity studentsAUDITAlcohol-related harmsAlcohol-related problemsAlcohol expectancies

Background

The transition period from secondary school to college or university has been identified as a particularly high risk period for a range of health compromising behaviours, including excessive alcohol consumption [1, 2]. Many young university students drink alcohol at levels that place themselves and others at risk of a range of short and long term harms [37]. Hazardous drinking has been found to be higher among young university students in New Zealand compared to their non-university peers [8] with suggestions that the university environment contributes to these differences [8, 9]. Young university students are exposed to new and exciting experiences, including greater availability and emphasis on social functions involving alcohol [8]. This is an important developmental period during which many young people explore their identity and form more mature relationships [1]. In addition to these changes some students live away from their family home for the first time [8].

Significant increases in proportions of 12–17 year olds in Australia choosing to abstain from alcohol and fewer young people exceeding adult guidelines for single occasion risk between 2010 and 2013 demonstrate encouraging changes in alcohol consumption for school-aged students. However despite these encouraging findings young people aged 18–24 years were more likely to drink at harmful levels on a single occasion than other adult age groups [10]. These data support the ongoing need to provide positive and effective strategies to reduce levels of alcohol consumption and associated harm as young people move to tertiary education and the workforce.

Although the university has been identified as an ideal setting for health promotion interventions [2, 11], there is paucity of integrated, comprehensive interventions focusing on reducing alcohol-related harms among Australian universities described in the literature. Despite this, there have been interventions focusing on a single strategy, usually brief interventions, that have demonstrated some short term changes in alcohol consumption levels [12, 13] and alcohol related problems [12] however no significant differences were reported for alcohol-related harms [13].

This paper describes a university based alcohol intervention and compares low risk and hazardous drinking prevalence and experienced, second-hand, witnessed and academic harms for the total sample, and makes comparisons between low risk and hazardous drinkers at baseline and after the first year of the intervention. The paper will describe the effect of the intervention after year one.

Theoretical basis of the youth alcohol project intervention

The Youth Alcohol Project (YAP) was implemented at a large and culturally diverse university campus in Australia with the aim of reducing the witnessed and experienced harms associated with alcohol consumption among 18–24 year old students. Social Cognitive Theory (SCT) was used to inform the development of the intervention. The underlying premise of SCT is reciprocal determinism, in particular the relationship between the individual, behaviours and the environment [14]. Individual traits such as personality, genetic factors and gender have been found to influence alcohol consumption and related behaviours [1517]. The environment is a significant influence in initiation and drinking behaviours of young people [16, 17]. The university environment which may include events that encourage excessive drinking and new peer networks [8] along with the belief that excessive alcohol use is a ‘rite of passage’ [18] and an integral part of the university experience [19] are important influences. Social and cultural norms which suggest for some young people drinking to get drunk is the main goal of many events and social occasions [20, 21] are often influenced by alcohol expectancies which are formed through social influences including family, peers and culture [22]. SCT recognises the power of observational learning such as the actions of peers and significant others [14] which is supported in the alcohol literature, recognising drinking behaviours are strongly influenced by the behaviours of peers, siblings and other family [15]. Norms and expectations help reinforce physical aspects of the environment including availability, promotion of alcohol and poorly implemented policy which together encourage excessive alcohol consumption [8, 15].

The intervention

The YAP was implemented using a multi-strategy staged approach. At year one (T1) data analysis some strategies had been only partially implemented. Commitment to a capacity building approach was adopted to embed strategies into university structures. Capacity building involves processes that build infrastructure, program sustainability and work to skill and empower individuals and groups [23, 24]. The intervention includes a focus on organisational actions, partnerships and education actions. The strategies of the intervention are identified in Fig. 1 with their implementation status highlighted.
Fig. 1

Intervention Strategies

To coordinate and provide effective support to strategy implementation [24], partnerships were established with the Guild (student body), student support services, health services, security and housing personnel, campus venues such as taverns, cafes and sports clubs with licences to serve alcohol. These partnerships have worked to ensure more responsible promotion of alcohol on campus. The initiation and maintenance of a Local Drug Action Group (LDAG) (see http://localdrugaction.com.au) provides on going opportunities for community action, advocacy and education. During the first year of the intervention the LGAG produced an educational wallet card with first aid strategies for helping intoxicated friends and supported the Mental Health First Aid (MHFA) strategy.

Specific training, such as Responsible Service of Alcohol (RSA) training and MHFA were implemented to enhance the skills of the student community [25]. Provision of face-to-face Responsible Service of Alcohol training courses enhances skills and employability of students. These courses provide an additional opportunity for advocacy for responsible service, especially among clubs and groups. The adoption of responsible service practices was found to reduce levels of high risk drinking at community sporting clubs [26]. During the first year of the intervention two face-to-face RSA trainings were conducted with university sports club committee members (n = 30). Young university students have been found to experience higher levels of mental health problems than their peers [27] and high comorbidity with mental health problems and harmful alcohol consumption [28] reinforcing the importance of integrated strategies. MHFA aims to improve mental health literacy and to develop skills and confidence to provide help and referral in a mental health crisis or for ongoing mental health problems, including those related to alcohol and other drug use. The program has previously demonstrated effectiveness in the community [29], among university students [30] and workplaces [31]. During the first year of the intervention 295 students received MHFA training.

The web-based THRIVE (Tertiary Health Research Intervention Via Email) alcohol brief intervention, developed through this university and evaluated through a randomised controlled trial [13, 32], was updated and integrated into the university website to provide an easily accessible and anonymous intervention for students. The program is a brief motivational health intervention consisting of an online alcohol assessment that delivers immediate and personalised feedback to participants on drinking behaviour, risks of harm, strategies for reducing consumption, and available support services for those drinking at harmful levels [13]. THRIVE is embedded in the student web portal and is voluntarily accessed. The program’s referral system supports student transition to other existing interventions and alcohol and other drug counselling services provided through campus health services. Promotional strategies including the development of a bookmark distributed at campus events and web-based promotion were implemented to enhance the awareness of THRIVE.

To improve skills and empower young people the development of intervention strategies have been embedded into a core health promotion unit for undergraduate students. Students worked in small groups to develop, implement and evaluate a number of organisational actions, partnerships and educational actions. Embedding strategies within a unit supports sustainability and a committed group of project officers which stretches limited health promotion dollars further [33]. In the first year students worked on a range of projects linked to the ongoing strategies of the YAP.

The YAP is currently planning educational strategies with a focus on media and social media. Six focus groups were conducted with key stakeholders from the Tavern (n = 5), Security (n = 6) and students (four groups; n = 35 students) to inform the development of educational strategies. Educational actions can be effective in improving knowledge, attitudes, skills and behaviours [23]. Based on the findings of the focus groups the intervention will utilise social media to facilitate positive change during the second year of the intervention Policy interventions are often integral to positive changes in health behaviour [34, 35]. The development and implementation of an alcohol policy is a current focus of the intervention.

Methods

Random cross sectional online surveys were conducted during July-August 2013 (baseline: T1) and 2014 (year 1: T2) in one university. The YAP commenced implementation after T1 data collection. For both time periods 6000 students aged 18–24 years were emailed via their student email address by the University Surveys Office to invite them to participate in the study. Inclusion criteria required that the respondents’ be studying at the main campus of the university and enrolled internally. In addition, random intercept surveys, administered by trained research assistants and completed online via i-pad, were conducted on campus market day (food and market stalls and activities) during the data collection period. Due to costs associated with data collection both surveys were cross sectional and a specific cohort was not followed. This study was approved by the Curtin University Human Ethics Committee (Approval no. HR 54/2013).

Instrumentation

Students were asked if they had drunk alcohol during the last 12 months [36]. Students who responded ‘no’ to this question did not complete the 10 item Alcohol Use Disorders Identification Test (AUDIT) [37] and the Alcohol Problems Scale [38] questions.

Consistent with other Australian studies the AUDIT scores were computed to binary variables low risk (non-hazardous; < 8) and hazardous (risky; ≥ 8) drinking [5, 6, 13] to measure level of alcohol-related harm and consumption.

Harms experienced in the past 12 months were measured by the Alcohol Problems Scale, a 17 item scale of harms as a result of personal alcohol consumption) [4, 38]. Students responded yes, no or prefer not to answer [score range 0–17] (See Table 4 for specific items). Second-hand harm, harms as a result of other students drinking during the past 4 weeks were measured using an 11 item scale [38, 39]. Witnessed harms, harms witnessed as a result of other students drinking during the past 4 weeks included a scale comprised of six harms [40]. For second-hand and witnessed harms students were provided with responses ranging from never to four or more times [score range 0–44 and 0–24 respectively with 0 representing no harm] (see Table 5 for specific items for second-hand and witnessed harms) [40].

The Academic Role Expectations and Alcohol Scale (AREAS) [38] included four items with responses ranging from not at all to four or more times during a four week reference period [score range 0–16]. The Brief Comprehensive Effects of Alcohol Scale (B-CEOA) [41] was used to measure alcohol expectancies. The scale included nine items with responses agree, neither agree or disagree or disagree [score range 9–27] (see Table 6 for specific items for AREAS and B-CEOA). Proportion of friends who regularly drink alcohol was measured to determine the influence of close peers on alcohol consumption.

Demographic data included age, gender, international or domestic student status, Faculty of enrolment (Business, Engineering and Science, Health Science or Humanities or Centre for Aboriginal Studies) and place of residence while at university (living in a shared house, with a parent or guardian, as a boarder or alone or with partner/children). The questionnaire was tested for face validity (n = 10) and content validity (n = 8). Test-retest was conducted with a purposive sample of the target group (n = 60). A detailed discussion of the development of this questionnaire and description of the variables can be found elsewhere [40].

Data analysis

The dependent variable for this study was the binary AUDIT score of low risk and hazardous drinking. Chi square analysis was used to determine statistical significance and proportions for categorical variables to compare low risk and hazardous drinkers at data collection periods. Analysis of Variance (ANOVA) was used to compute means and to determine statistical significance for continuous variables at each time period. Continuous variables included experienced, second-hand and witness harms, academic problems and alcohol expectancies. A two-tailed two-proportion z-test and two sample t-tests were employed to determine statistical significance between the two time periods for categorical and continuous variables respectively. Highly and moderately significant differences were discerned by p-values of p < 0.001 and p < 0.05 respectively [42].

Results

Demographics

At T1 1930 students responded to the online survey (32.2 % response rate) and a further 628 were recruited via intercept. At T2, 1825 (30.4 % response rate) responded online and 681 via intercept modes respectively. Completed surveys were received from 2465 (T1) and 2422 (T2) students. There was no significant difference between data collected online or via random intercept at T1 or T2.

Between T1 and T2 there was no significant difference between the proportions of students who responded in regard to gender, age, international or domestic student status, Faculty or place of residence (apart from slightly more students living with parents at T2 (p <0.05). For both data collection time periods females were more likely to respond (62.1 %) (Table 1).
Table 1

Demographics for the total sample at baseline and post 1

 

Baseline (T1) (2013)

Post 1 (T2) (2014)

significance (p) T1/T2

Gender

 Male

926 (37.6)

908 (37.5)

0.968

 Female

1531 (62.1)

1504 (62.1)

0.992

 Other

8 (0.3)

9 (0.4)

0.779

 Total

2465

2421

 

Age

 18–20 years

1191 (48.3)

1208 (49.9)

0.271

 21–24 years

1275 (51.7)

1214 (50.1)

0.200

 Total

2466

2422

 

International/domestic student status

 International student

300 (12.2)

283 (11.6)

0.603

 Domestic student

2166 (87.8)

2139 (88.3)

0.603

 Total

2466

2422

 

Faculty

 Health Science

918 (37.5)

876 (36.2)

0.441

 Science and Engineering

552 (22.4)

541 (22.3)

0.968

 Humanities

494 (19.6)

537 (22.2)

0.067

 Business

496 (19.7)

462 (19.1)

0.363

 Aboriginal Studies

6 (0.2)

6 (0.2)

0.976

 Total

2466

2422

 

Place of residence while at university

 Share flat/house

559 (23.5)

590 (25.1)

0.190

 Student housing

105 (4.4)

114 (4.9)

0.465

 Parent/guardian

1507 (63.3)

1418 (60.3)

0.038**

 Live alone

39 (1.6)

46 (2)

0.406

 With partner/children

114 (4.8)

128 (5.4)

0.303

 Board/live with other relative or friend/other

58 (2.5)

54 (2.3)

0.756

 Total

2382

2350

 

*(p <0.001)

**(p <0.05)

Hazardous vs low risk drinkers

There were some significant differences in some demographics when current drinkers were categorised as low risk drinkers (< 8 AUDIT score) or hazardous drinkers (> 8 AUDIT score) (Table 2). At T2 older students (21–24 years) were less likely to be categorised as hazardous drinkers and more likely to be low risk drinkers compared to T1. There were significantly less international students and significantly more domestic students who reported hazardous drinking at T2 and significantly less domestic students who reported low risk drinking at T2.
Table 2

Demographics, harms and influencing factors for low risk and hazardous drinkers at the two time periods

 

T1

T2

 

Low risk

Hazardous

Total

P value

Low risk

Hazardous

Total

P value

N (%)

N (%)

N (%)

N (%)

N (%)

N (%)

Gender

   

0.000

   

0.000**

 Male

407 (53.1)

359 (46.9)

766

 

405 (57.5)

299 (42.5)

704 (37.3)

 

 Female

823 (64.8)

447 (35.2)

1270

 

761 (65)

413 (35)

1174 (62.2)

 

 Other

0

4 (100)

4

 

3 (37.5)

5 (62.5)

8 (0.4)

 

 Total

1230

810

2040

 

1169

717

1886

 

Age

   

0.528

   

0.004*

 18–20 years

606 (61)

388 (39)

994 (48.7)

 

563 (59)

391 (41)

954 (50.6)

 

 21–24 years

624 (59.6)

423 (40.4)

1047 (51.3)

 

607 (65)*

326 (35)*

933 (49.4)

 

 Total

1230

811

2041

 

1170

717

1887

 

International Students

   

0.000

   

0.000**

 International

160 (74.8)

54 (25.2)

214 (10.5)

 

157 (88.2)*

21 (11.8)*

178 (9.4)

 

 Domestic

1070 (58.6)

757 (41.4)

1827 (89.5)

 

1013 (59.3)

696 (40.7)

1709 (90.6)

 

 Total

1230

811

2041

 

1107

717

1887

 

Faculty

   

0.285

   

0.116

 Health Science

474 (61.5)

297 (38.5)

771 (37.2)

 

429 (62.5)

257 (37.5)

686 (36.4)

 

 Science and Engineering

262 (58)

190 (42)

452 (22.4)

 

245 (59.8)

165 (40.2)

410 (21.7)

 

 Humanities

246 (58.6)

174 (41.4)

420 (20)

 

285 (66)*

147 (34)

432 (22.9)

 

 Business

247 (62.7)

147 (37.3)

394 (20.1)

 

210 (59.2)

145 (40.8)

355 (18.8)

 

 Aboriginal Studies

1 (25)

3 (75)

4 (0.2)

 

1 (0.1)

3 (0.4)

4 (0.2)

 

 Total

1230

811

2041

 

1170

717

1887

 

Place of residence while at university

   

0.279

   

0.000**

 Share flat/house

275 (58)

199 (42)

474

 

274 (23.4)

209 (29.1)*

483 (25.6)

 

 Student housing

57 (63.3)

33 (36.7)

90

 

46 (3.9)

44 (6.1)

90 (4.8)

 

 Parent/guardian

786 (60.6)

510 (39.4)

1296

 

728 (62.2)

407 (56.8)*

1135 (60.1)

 

 Live alone

21 (68.4)

12 (34.6)

33

 

19 (1.6)

13 (1.8)

32 (1.7)

 

 With partner/children

67 (68.4)

31 (31.6)

98

 

82 (7.0)

25 (3.5)

107 (5.7)

 

 Board/live with other relative or friend/other

24 (48)

26 (52)

50

 

21 (1.8)

19 (2.6)

40 (2.2)

 

 Total

1230

811

2041

 

1170

717

1887

 

Experienced harm

M2.453

M 5.6662

M 3.596

0.000

M 2.089

M6.0713-

M 3.5958

0.000**

SD 2.453

SD 3.088

SD 3.20

SD 2.394

SD 3.2023

SD 3.3421

CI 2.079–2.357

CI 5.451–5.881

CI 4.455–3.736

CI 1.951–2.227

CI 5.833–6.308

CI 3.443–3.748

Second-hand harm

M 1.305

M 3.221

M 2.070

0.000

M 1.284

M 3.906

M 2.279

0.000**

SD 2.550

SD 4.660

SD 3.668

SD 2.525

SD 5.720

SD 4.240

CI 1.61–1.44

CI 2.89–3.54

CI 1.919–2.231

CI 1.134–1.425

CI 3.471–4.342

CI 2.080–2.478

Witnessed harm

M 1.476

M 3.148

M 2.144

0.000

M 1.279

M 3.160

M 1.990

0.000**

SD 2.841

SD 4.101

SD 3.497

SD 2.479

SD 4.036

SD 3.287

CI 1.316–1.636

CI 2.864–3.431

CI 1.992–2.296

CI 1.136–1.422

CI 2.861–3.459

CI 1.841–2.140

Academic problems

M 0.4891

M 2.555

M 1.314

0.00

M 0.489

M 2.798

M 1.363

0.000**

SD 1.454

SD 3.578

SD 2.721

SD 1.461

SD 3.726

SD 2.798

CI 0.406–0.571

CI 2.307–2.804

CI 1.195–1.434

CI 0.405–0.574

CI 2.522–3.075

CI 1.235–1.490

Alcohol expectancies

M 21.110

M 23.312

M 21.985

0.000

M 20.817

M 23.555

M 21.857

0.000**

SD 3.669

SD 2.920

SD 3.558

SD 3.990

SD 2.964

SD 3.869

CI 20.905–21.315

CI 23.110–23.513

CI 21.830–22.139

CI 20.588–21.0460

CI 23.337–23.772

CI 21.682–22.032

Friends who drink regularly

   

0.000

   

0.000**

 None

34 (2.9)

4 (0.5)

38 (1.9)

 

58 (5.1)**

4 (0.6)

62 (3.4)

 

 A few

432 (36.2)

87 (11)

519 (26.2)

 

428 (37.6)

65 (9.4)

493 (27.0)

 

 Half

217 (18.2)

76 (9.6)

293 (14.8)

 

192 (16.9)

87 (12.6)

279 (15.3)

 

 Most

431 (36.2)

431 (54.6)

862 (43.5)

 

394 (34.6)

358 (51.9)

752 (41.1)

 

 All

78 (6.5)

192 (24.3)

270 (13.6)

 

67 (5.9)

176 (25.5)

243 (13.3)

 

*p <0.05 between T1 and T2; **p <0.001 between T1 and T2

Reporting of alcohol consumption

At T1 89.1 % and at T2 87.2 % of the total sample reported drinking alcohol in the past month. Hazardous levels of alcohol consumption reduced slightly between T1 (39.7 %) and T2 (38 %) however these results were not statistically significant. There were no statistically significant differences in mean scores for a) experienced harms, b) witnessed and second-hand harms, c) academic problems or d) alcohol expectancies over the two time periods (Table 3). There were some moderately significant differences in the proportion of close friends who drank alcohol at each time period with more students reporting that none of their close friends drank alcohol (6.4 % T2 vs 4.5 % T1) and less students reporting most of their friends drank alcohol at T2 (40.7 % T1 vs 37.7 % T2) (p <0.05).
Table 3

Drinking levels, harms and friends alcohol consumption for total sample at T1 and T2

 

Baseline (T1) (2013)

Post 1 (T2) (2014)

significance (p) T1/T2

Drunk alcohol in last 12 months

 Yes

2061 (89.1)

1905 (87.2)

0.051

 No

252 (10.9)

279 (12.8)

0.051

 Total

2313

2184

 

AUDIT Score

 Low risk

1230 (60.3)

1170 (62)

0.262

 Hazardous

811 (39.7)

717 (38)

0.262

 Total

2041

1887

 

Experienced harm score

M: 3.596

M: 3.618

0.963

Total n

1995

1853

Second-hand harms score

M: 2.0495

M: 2.2270

0.999

Total n

2013

2013

Witnessed harms score

M: 2.0500

M: 1.8968

0.970

Total n

2013

2136

Academic problems score

M: 1.3034

M: 1.4544

0.963

Total n

1995

1853

Alcohol Expectancies score

M: 21.5124

M: 21.2314

0.965

Total n

2041

2184

Friends who drink regularly

 None

99 (4.5)

134 (6.4)

0.005**

 A few

619 (27.9)

615 (29.3)

0.327

 Half

322 (14.5)

308 (14.7)

0.896

 Most

902 (40.7)

792 (37.7)

0.044**

 All

275 (12.4)

252 (12)

0.681

 Total

2217

2101

 

*(p <0.001)

**(p <0.05)

Low risk versus hazardous drinkers and associated harms

Further analyses were conducted using the dependent variable low risk and hazardous consumption at each time period (Table 3). When harms (experienced; second hand; witnessed) and academic problems were compared there were little differences in total mean scores for all current drinkers, at T1 compared to T2. In both time periods hazardous drinkers reported significantly higher mean scores for experienced harm, second-hand harm and witnessed harm scores compared to low risk drinkers (p <0.001). Of the total sample approximately 71 % had experienced hangovers at both time periods. Hazardous drinkers were significantly more likely than low risk drinkers to have experienced unprotected sex (Hazardous T1 34.5 %; T2 35.4 %; Low risk T1 9.35; T2 9.6 %)), had driven a car while intoxicated (Hazardous T1 28.7 %; T2 32 %; Low risk T1 9.2 %; T2 6.7 %), were a passenger in a car where the driver was intoxicated (Hazardous T1 39.6 %; T2 43.2 %; Low Risk 11.1 %; 10.7 %) and had been removed or banned from a club or pub because of their drinking (Hazardous T1 22.8 %; T2 23.1 %; Low Risk T1 5.4 %; T2 4 %) (Table 4). Hazardous drinkers were also significantly more likely than low risk drinkers to have experienced second-hand harms (as a result of other students drinking) such as being insulted or humiliated (Hazardous T1 28.5 %; T2 29.1 %; Low risk T1 12.5 %; T2 12.2 %) and taking care of another student who had drunk too much (Hazardous T1 44.4 %; T2 48.4 %; Low risk T1 27.5 %; T2 26.5 %)) (Table 5). Witnessing someone pass out (Hazardous T1 50.5 %; T2 26.4 %; Low risk T1 28.9 %; T2 26.4 %), a serious argument or quarrel (Hazardous T1 41 %; T2 21.3 %; Low risk T1 17.9 %; T2 15.7 %) and sexual assault (Hazardous T1 20 %; T2 9.7 %; Low risk T1 9.5 %; T2 9.7 %) was significantly more likely for hazardous drinkers compared to low risk drinkers at both time periods (Table 5).
Table 4

Experienced Harms and Level of Alcohol Consumption for Low Risk and Hazardous drinkers at T1 and T2

 

T1 (n = 1995)

T2 (n = 1853)

 

Low risk

Hazardous

Total

Low risk

Hazardous

Total

N (%)

N (%)

N (%)

N (%)

N (%)

N (%)

Hangover

692 (57.8)

729 (91.5)

1421 (71.2)a

668 (58)

647 (92.3)

1315 (71)b

Emotional outburst

321 (26.8)

457 (57.3)

778 (39)a

285 (24.7)

418 (59.6)

703 (37.9)b

Vomiting

486 (40.6)

584 (73.3)

1070 (63.6)

422 (36.6)

535 (76.3)

957 (51.6)b

Heated argument

139 (11.6)

315 (39.5)

454 (22.8)a

157 (13.6)

304 (43.4)

461 (24.9)b

Physically aggressive

45 (3.8)

162 (20.3)

207 (10.4)a

44 (3.8)

147 (21)

191 (10.3)b

Blackouts

286 (23.9)

567 (71.1)

853 (42.8)a

244 (21.2)

541 (77.2)

785 (42.4)b

Inability to pay bills

19 (1.6)

62 (7.8)

81 (4.1)a

14 (1.2)

67 (9.6)

81 (4.4)b

Unprotected sex

111 (9.3)

275 (34.5)

386 (19.3)a

111 (9.6)

248 (35.4)

359 (19.4) b

Sexual situation unhappy about at time

57 (4.8)

118 (14.8)

175 (8.8)a

52 (4.5)

130 (18.5)

182 (9.8)b

Sexual encounter later regretted

98 (8.2)

237 (29.7)

335 (16.8)a

85 (7.4)

235 (33.5)

320 (17.3)b

Suffered an injury

20 (1.7)

74 (9.3)

94 (4.7)a

18 (1.6)

74 (10.6)

92 (5)b

Drove a car

110 (9.2)

229 (28.7)

339 (17)a

77 (6.7)

224 (32)

301 (16.2)b

Passenger in a car

133 (11.1)

316 (39.6)

449 (22.5)a

123 (10.7)

303 (43.2)

426 (23)b

Stole private or public property

39 (3.3)

110 (13.8)

149 (7.5)a

28 (2.4)

111 (15.8)

139 (7.5)b

Act of vandalism

21 (1.8)

81 (10.2)

102 (5.1)a

20 (1.7)

85 (12.1)

105 (5.7)b

Removed or banned from a pub or club

65 (5.4)

182 (22.8)

247 (12.4)a

46 (4)

162 (23.1)

208 (11.2)b

Arrested

16 (1.3)

18 (2.3)

34 (1.7)

13 (1.1)

25 (3.6)

38 (2.1)b

T1 Significant between low risk and hazardous drinkers (p <0.001)a T2 Significant between low risk and hazardous drinkers (p <0.001)b

Table 5

Second-hand and Witnessed Harms and Level of Alcohol Consumption for Low Risk and Hazardous drinkers at T1 and T2

Second-hand Harms

 

T1 (n = 2103)

T2 (n = 1861)

 

Low risk

High risk

Total

Low risk

High risk

Total

n (%)

n (%)

n (%)

n (%)

n (%)

n (%)

Been insulted or humiliated

149 (12.3)

229 (28.5)

378 (18.8)a

141 (12.2)

205 (29.1)

346 (18.6)b

Had a serious argument or quarrel

87 (7.2)

180 (22.4)

267 (13.3)a

93 (8)

187 (26.6)

280 (15)b

Been pushed, hit or otherwise assaulted

44 (3.6)

109 (13.6)

153 (7.6)a

35 (3)

105 (14.9)

140 (7.5)b

Had your property damaged

46 (3.8)

111 (13.8)

157 (7.8)a

52 (4.5)

119 (16.9)

171 (9.2)b

Had to baby-sit or take care of another student who had drunk too much

333 (27.5)

357 (44.4)

690 (34.3)a

307 (26.5)

341 (48.4)

648 (34.8)b

Found vomit in halls or bathroom of residence

83 (6.9)

117 (14.6)

200 (9.9)a

78 (6.7)

144 (20.5)

222 (11.9)b

Had studying or sleep interrupted

236 (19.5)

275 (34.2)

511 (25.4)a

187 (16.2)

258 (36.6)

445 (23.9)b

Experienced an unwanted sexual advance

103 (8.5)

178 (22.1)

281 (14)a

82 (7.1)

154 (21.9)

236 (12.7)b

Been a victim of sexual assault (including date rape)

11 (0.9)

25 (3.1)

36 (1.8)a

10 (0.9)

30 (4.3)

40 (2.1)b

Been a victim of another crime on campus

8 (0.7)

22 (2.7)

30 (1.5)a

11 (1)

30 (4.3)

41 (2.2)b

Been a victim of another crime off campus*

14 (1.2)

42 (5.2)

56 (2.8)a

77 (7.1)a

110 (16.4)

187 (10.6)b

Witnessed Harms

 

T1 (n = 2013)

T2 (n = 1861)

 

Low risk

High risk

Total

Low risk

High risk

Total

n (%)

n (%)

n (%)

n (%)

n (%)

n (%)

Someone being pushed, hit or otherwise assaulted

217 (17.9)

271 (33.7)

488 (24.2)a

182 (15.7)

224(34.7)

426 (22.9)b

Serious argument or quarrel

274 (22.7)

330 (41)

604 (30)a

246 (21.3)

288 (40.9)

534 (28.7)b

Property damage

136 (11.2)

225 (28)

361 (17.9)a

150 (13)

194 (27.6)

344 (18.5)b

Someone pass out

349 (28.9)

406 (50.5)

755 (37.5)a

306 (26.4)

381 (54.1)

687 (36.9)b

Someone you suspect had alcohol poisoning

122 (10.1)

189 (23.5)

311 (15.4)a

109 (9.4)

148 (21)

257 (13.8)b

A sexual assault

115 (9.5)

161 (20)

276 (13.7)a

112 (9.7)

147 (20.9)

259 (13.9)b

T1 Significant between low risk and hazardous drinkers (p <0.001)a T2 Significant between low risk and hazardous drinkers (p <0.001)b

Similarly hazardous drinkers were significantly more likely to experience academic problems at both time periods compared to low risk drinkers (P <0.001). For example, at T1 and T2 42.8 and 45.6 % of hazardous drinkers respectively indicated they had been unable to concentrate in class because of their drinking compared to 12.5 % (T1) and 12.7 % (T2) of low risk drinkers. Hazardous drinkers were more likely to report positive alcohol expectancies at both time periods (p <0.001). These students anticipated alcohol would enable them to act more sociably (Hazardous T1 86.4 %; T2 66.8 %; Low risk T1 72.4 %; T2 66.8 %) and to have fun/ a good time (Hazardous T1 81 %; T2 57.5 %; Low risk T1 61.5; T2 57.5 %) (Table 6).
Table 6

Academic Problems and Alcohol Expectancies for Low Risk and Hazardous Drinkers at T1 and T2

Academic Problems

 

T1 (n = 1995)

T2 (n = 1853)

 

Low risk

Hazardous

Total

Low risk

Hazardous

Total

N (%)

N (%)

N (%)

N (%)

N (%)

N (%)

Been late for a class

87 (7.3)

242 (30.4)

329 (16.5)a

78 (6.7)

225 (32)

303 (16.3)b

Missed a class

129 (10.8)

310 (38.9)

439 (22)a

123 (10.6)

299 (42.6)

422 (22.7)b

Unable to concentrate in class

150 (12.5)

341 (42.8)

491 (24.6)a

146 (12.7)

320 (45.6)

466 (25.1)b

Failed to complete an assignment on time

22 (1.8)

96 (12)

118 (5.9)a

23 (1.9)

104 (14.8)

127 (6.8)b

Alcohol Expectancies

 

T1 (n = 2041)

T2 (n =

 

Low risk

Hazardous

Total

Low risk

Hazardous

Total

N (%)

N (%)

N (%)

N (%)

N (%)

N (%)

Act more sociably

891 (72.4)

710 (86.4)

1592 (78)a

782 (66.8)

621 (86.6)

1403 (74.4)b

Find it easier to talk to people

880 (71.5)

680 (83.8)

1560 (76.4)a

806 (68.9)

626 (87.3)

1432 (75.9)b

Feel calmer/more relaxed

736 (59.8)

630 (77.7)

1366 (66.9)a

679 (58)

559 (78)

1238 (65.6)

Enjoy sex more

220 (17.9)

286 (35.3)

506 (24.8)a

207 (17.7)

261 (36.4)

468 (24.8)

Take risks

693 (56.3)

630 (77.7)

1323 (64.8)a

605 (51.7)

563 (78.5)

1168 (61.9)b

Be more aggressive

239 (19.4)

284 (35)

523 (25.6)a

210 (17.9)

276 (38.5)

486 (25.8)b

Feel more courageous

680 (55.3)

599 (73.9)

1279 (62.7)a

622 (53.2)

557 (77.7)

1179 (62.5)b

Act loud, boisterous, noisy

663 (53.9)

569 (70.2)

1232 (60.4)a

634 (54.2)

538 (75)

1172 (62.1)b

Have fun/good time

757 (61.5)

657 (81)

1414 (69.3)a

673 (57.5)

590 (82.3)

1263 (66.9)b

T1 Significant between low risk and hazardous drinkers (p <0.001)a T2 Significant between low risk and hazardous drinkers (p <0.001)b

Discussion

Although the intervention had minimal impact during the first year the cross sectional nature of this evaluation provided only a limited analysis and it was difficult to determine differential effects of specific strategies. It is likely the staggered approach to the implementation of the strategies may have also impacted the findings. In addition, population based behaviour change is a complex and slow process [34]. Across both time periods the proportion of young university students who reported consuming alcohol at hazardous levels was high. There was a slight but not significant decrease in the proportion of current drinkers who reported hazardous drinking at T1 (39.7 vs 38 %). Analyses of the sample over the two time periods found hazardous drinkers were significantly more likely to experience harms as a result of their own alcohol consumption, to experience second-hand harms and to witness harms as a result of other students drinking.

There were no significant differences between almost all demographics variables respondents at T2 were moderately significantly more likely to live with their parents. A New Zealand study found students living in university residential accommodation or shared house to drink at higher levels than those living with parents [3]. This study found most students to live with parents (T1 63.6 %; T2 60.3 %) to live with parents in comparison 18.9 % of respondents in the New Zealand study [3]. However these data are similar to that of another Australian university that found 54.9 % of respondent lived with parents [5]. The university in this study is largely a commuter university which impacts the proportion of young people living at home.

The intervention did not impact significantly on harms associated with alcohol consumption however the high levels of harms experienced by those classified as hazardous drinkers’ highlights the need for comprehensive strategies for this sub-group. While minimal intervention has been recognised as achieving some change, single strategy interventions are unlikely to have a significant impact on behaviour [34]. For example the web-based THRIVE alcohol brief intervention demonstrated positive short term results in reducing drinking frequency but found differences in alcohol-related harms to be non-significant [13]. Further exploration as how targeted promotion and personal referral could enhance this on line strategy for hazardous drinkers would be beneficial as well as research focusing on how such strategies can be extended to support long term behavioural change.

Alcohol expectancies remained similar across both time periods with students drinking at hazardous levels more likely to report positive expectancies. However, there was some reduction in the proportion of respondents reporting close friends consuming alcohol at T2. Associations between broad social motives, descriptive norms (the perception of what others do), personal drinking values and alcohol expectancies have been found to influence alcohol consumption and related harms among college students [43] and are consistent with Social Cognitive Theory which suggests behaviour is influenced by peers and expectations [14]. While there was little change between the two time periods this study found strong associations at both time periods between hazardous drinking and alcohol expectancies and associations between peer drinking and hazardous drinking, which demonstrate a need to focus on strategies that challenge descriptive and injunctive norms. Social acceptability of behaviours has been influenced positively through integrated and dedicated efforts at national, local and societal levels for issues such as smoking [34], however it is recognised that such changes take time and are most effective when a combination of educational, organisational, economic and political actions have been employed [35].

Many health promotion strategies are time consuming and complex and can be compromised if funded on short-term cycles [33]. This project had limited financial and personnel resources and as not all strategies of this intervention were implemented during the first year of the project. Organisational and policy actions have been identified as essential for effective health promotion [23, 34, 35] and the development and implementation of alcohol policy is one of the strategies yet to be implemented. Effective policies in communities and organisations need to be well developed with considerable emphasis on the adoption and implementation phase [44, 45]. Campus alcohol policy should reinforce and support responsible use of alcohol, reduce access, especially low cost and free alcohol, restrict heavy drinking on drinking premises and work to eliminate alcohol sponsorship on campus and in local communities to effect long term change [46]. From a population level it is recognised that comprehensive universal strategies that incorporate significant focus on policy are essential to effect change [47]. Policy implementation and promotion will be implemented as part of the ongoing intervention. In addition, strategies to build partnerships will be further developed in subsequent stages of this intervention. The establishment of partnerships and building capacity are time consuming and challenging however provide significant opportunities for change and will therefore be a focus of this intervention in the future [48].

The findings from the two data collection periods will help inform the development of additional strategies and provide evidence to support targeting specific sub-groups e.g. those drinking at hazardous levels. However, although the findings indicate that while more prevalent among hazardous drinkers, experienced, second-hand and witnessed harms and academic problems are of concern for both the low risk and hazardous drinkers. These data are similar to findings elsewhere [4, 5] and confirm the need for enhanced education and awareness of these issues.

This study has a number of limitations which should be considered when interpreting the findings. The cross sectional nature of the study precludes casual assumptions and rigorous intervention evaluation however when implementing and evaluating interventions in communities there are practical and financial constraints which may preclude more rigorous evaluation strategies [49, 50]. A cohort study, collecting data about recall of intervention strategies at T2, would provide a more rigorous evaluation, however was beyond the financial scope of this study [33]. Data were only collected from one university which may limit generalizability. Low response rates could have resulted in a non-respondent bias. Low response rates have been reported elsewhere [5]. It has been suggested non-respondents are more likely to participate in adverse health behaviours [3]. Self-report questionnaires may be subject to issues of social desirability, however comparisons with other studies suggest these data are reliable [46, 13].

Conclusion

The findings over the two year period confirm the need for on-going alcohol interventions for young university students. After one year this study found relatively small changes in prevalence of hazardous drinking levels and maintenance of alcohol related harms, expectancies and behaviours, however, a number of the intervention strategies had not been implemented or had only been partially implemented. These findings do however provide the opportunity to refine and focus strategies. Harms and problems for students who report hazardous drinking are of concern and efforts should be made to ensure integrated and targeted strategies reach higher risk students and focus on specific issues such as drink driving and alcohol related unplanned sex. However there is also a need for universal strategies targeting all students and low risk drinkers as they too are exposed to alcohol harms within the drinking and social environment. Changing the culture of the university environment is a long term aim and to effect change a sustained combination of organisational actions, partnerships and educational actions is required.

Declarations

Acknowledgements

We would like to acknowledge Kristen Hunt who was the project officer for YAP. We would also like to acknowledge the participants of this study who gave their time to complete the survey, the Curtin Office for Strategy and Planning and health promotion students for help administering the survey. We gratefully acknowledge Healthway (The Western Australian Health Promotion Foundation) for funding this project.

Availability of data and materials

The datasets during and/or analysed during the current study available from the corresponding author on reasonable request.

Author’s contributions

SB, JJ, JH, GC have made substantial contributions to the conception and design of the paper. SB made substantial contributions to the data analysis. All authors were involved in planning and implementing the intervention. All authors reviewed the article for important intellectual content. All authors read and approved the final manuscript.

Authors’ information

SB, JJ, JH, GC and LP conduct research within the Collaboration for Evidence, Research and Impact in Public Health at the School of Public Health, Curtin University. JL is a health promotion practitioner within the South Metropolitan Public Health Unit.

Competing interests

The authors declare that they have no competing interests.

Consent for publication

Not applicable.

Ethics approval and consent to participate

This study was approved by the Curtin University Human Ethics Committee (Approval no. HR 54/2013). Participants provided consent when they completed the online survey.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
School of Public Health, Curtin University
(2)
South Metropolitan Population Health Unit, Department of Health

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