College students’ drinking constitutes a major challenge to public health. Numerous studies document heavy patterns of
use and problems related to use. These studies stress how frequently students drink, how many students drink in a heavy episodic pattern or are binge drinkers, and the associated costs to the drinkers and to those around them.1-3 Studies of this nature frame their results as "bad news" and are typically used to raise awareness and bring action by administrators and public officials.
Curiously, raising awareness about extreme behaviors of college students could be viewed as counter to the purposes of the public health messages being conveyed. Despite the well-recognized patterns of heavy drinking noted in the studies
listed above, other studies suggest that students often tend to overestimate both the acceptability and the actual drinking behavior of their peers.4–7 Students’ beliefs that such extreme norms exist may serve to justify and explain extreme behavior and, thus, may influence students to engage in heavy drinking.
An intervention technique following from this line of inquiry is to challenge and attempt to correct these inaccurate perceptions. Prevention programs that use norm-correction strategies, ranging from campus-wide information
campaigns8,9 to providing personalized feedback and advice, have produced encouraging results.10–12
But what is normative for college students? What kinds of data can and should be used to challenge normative beliefs? For example, when considered in terms of average standard drinks consumed per week, Meilman et al13 reported that 51% of students at 4-year colleges reported consuming 1
drink or less in a typical week. These norms present quite a different picture of college student life from those mentioned above. However, the nature of the way these data are presented (when all students are grouped together, regardless of drinking status) provides especially low estimates. Although statistically accurate, such norms can be
dismissed by students as false.
In this article, we use the data from the Harvard School of Public Health College Alcohol Study (CAS) to present seemingly disparate measures of college student drinking. We seek to provide administrators and those designing prevention programs, as well as students, with clear estimates (calculated in different ways) to show what is normative use of alcohol on college campuses. We also show that, when we divide students into groups according to drinking patterns, some groups of students
consume much more alcohol than others and account for the bulk of alcohol consumed and the majority of drinking-related problems on campus.
This report is based on data from the CAS survey of 17,592 students at 140 participating colleges in 1993. The colleges represent a cross-section of American higher education. Details of the study design and other findings have been previously published in the Journal of American College Health and other professional
A 20-page mailed questionnaire asked students about their drinking attitudes and behaviors, including an assessment of rates of binge drinking and total alcohol consumed. Students were also asked about campus and personal problems resulting from their drinking.
We defined a drink for the respondents as either a 12-oz (360 mL) can/bottle of beer, a 4-oz (120 mL) glass of wine, a 12-oz (360 mL) bottle/can of wine cooler, or a 1.25 oz (37 mL) shot of liquor straight or in a mixed drink. In this study, we defined binge drinking as the consumption of 5 or more drinks in a row for men and 4 or more drinks in a row for women during the 2 weeks immediately preceding the survey.15
We combined four questions to assess binge drinking status for each student: (a) respondent’s sex, (b) recency of the last drink, (c) how many times they had 5 or more drinks in a row over the last 2 weeks (for men), and (d) how many times
they had 4 drinks in a row (for women). (If the responses were missing for any of these items, the student was excluded from the binge drinking analysis.)
We used three categories of drinkers in the current analysis: (a) nonbinge drinkers were those who consumed alcohol in the past 30 days but did not binge in the 2 weeks preceding the survey, (b) infrequent binge drinkers were those who binged one or two times in the past 2 weeks, and (c) frequent binge drinkers were defined as those who binged three
or more times in the past 2 weeks.
We calculated the volume of alcohol consumed among students who reported they drank in the past 30 days. The 12,140 respondents who indicated that they had alcohol during that time period were asked two questions that we used to determine the volume of alcohol consumed per week. The first question asked on how many occasions the respondent had a drink of alcohol in the past 30 days. Response choices, in number of occasions, were 1–2, 3–5, 6–9, 10–19, 20–39, or 40 or more
occasions. For analysis, we used the midpoint of each of the response categories to define how often the students drank in the past 30 days; we calculated the maximum answer of 40 or more as 40.
We used the second question to determine the volume of alcohol consumed: "In the past 30 days, on those occasions when you drank alcohol, how many drinks did you usually have?" The response choices for "usual
number of drinks" were 1, 2, 3, 4, 5, 6, 7, 8, 9+. We calculated the maximum response choice of 9+ as 9 drinks.
We determined the number of drinks the students consumed per month by multiplying the number of occasions of drinking by the usual number of drinks in a 30-day period. The possible number of drinks in the past 30 days therefore ranged
from 1.5 to 360 for this analysis. Dividing this number by 4 resulted in the number of drinks consumed by the students per week. Thus, the number of drinks per week ranged from 0 (.375 was rounded down to 0) to 90 drinks. We computed both
medians and means (see Tables 1 and 2) to make the results presented in this study comparable to other published studies that report either one or both of these measures of central tendency.
We included questions to determine the extent of alcohol-related problems in the college population. If the students reported any drinking in the previous year (n = 14,588), we asked them to indicate whether they
experienced any of 12 problems attributable to their own drinking (see Table 3 for specific problems assessed). The students were given the response choices of (a) not at all, (b) once, and (c) twice or more. At least one problem was reported by 70.7% of the students who drank in the past year for whom we had complete data for drinking-related problems.
We used the Statistical Analysis System (SAS), Version 6.0718 for all analyses, and we used contingency table analysis to determine frequencies.
The data in Table 1 show weekly alcohol consumption for all students, with men and women listed separately. Figures for nonbinge drinkers, drinkers, and frequent binge drinkers are shown. Consumption is
reported as percentiles, or cumulative percentages. Data presented in this way make evident the percentages of students
reporting consumption up to different numbers of drinks. We did not give students who completely abstained from drinking a separate column in this table because all of them drank zero drinks per week. They are, however, included in the column showing percentiles for the total sample. For all students, the median weekly consumption is 1 drink for women, 2 drinks for men, and 1.5 for the sample overall. These medians are quite similar to those from 1994–1996 reported by Meilman
et al13 for 4-year institutions.
The mean number of drinks per week for all students in the current study was found to be 5.1 (Table 2). This is somewhat higher than the 4.5 mean number of drinks per week reported by Meilman et al13(p202) for 1992–94. However, the latter is based on students attending both 2-year and 4-year institutions.
"All students" represents a quite heterogeneous population. For this study, we divided the sample according to patterns of drinking to illustrate how the volume consumed differs between groups. Frequent binge drinkers consumed an average (mean) of 17.9 drinks per week, infrequent binge drinkers consumed an average of 4.8 drinks per week, and the combination of drinkers who did not binge drink as well as those who did not drink at all consumed an average of 0.8 drinks per week.
Looking instead at medians for the sample divided by drinking patterns, the median number of drinks per week for frequent binge drinkers was 14.5, the median number of drinks for infrequent binge drinkers was 3.7, and the median number of drinks per week for nonbinge drinkers and nondrinkers was very close to zero.
The data in Table 2 clearly show that the frequent binge drinkers consumed the majority of the alcohol—68% of the 87,008 drinks consumed, although they constituted only 19% of the total sample. The infrequent binge drinkers, who represented 24% of the total sample, consumed close to their share, or 23% of the alcohol.
Binge drinkers as a whole represent less than half of the college population (44%), but they account for almost all (91%) of the alcohol consumed by college students. The nonbinge drinkers and nondrinkers represented 56% of the sample, yet they consumed only 9% of the alcohol.
At least one problem attributable to the students’ drinking was reported by 70.7% (n = 9,781) of the respondents who drank in the past year. The frequent binge drinkers, however, accounted for approximately half of the students who reported they had experienced any of the 12 problems shown on the list (Table 3). For example, of those students who drove after drinking or binge drinking, 41% were classified as frequent binge drinkers; almost 59% of those who damaged property or were injured were in this binge category. For most of the problems we surveyed, the frequent binge drinkers accounted for more than double their 24% representation among drinkers in the sample.
These patterns of binge drinking vary widely across college campuses. Data in Figure 1 indicate that, among the 140 campuses surveyed, the percentages of respondents who met binge drinking criteria ranged from 1% on the campus with the lowest percentage to 70% at the school with the highest percentage. At almost one third of the campuses
(44 out of 140), more than 50% of the students reached or exceeded the binge drinking definition we established for this study.
Norms for alcohol consumption on college campuses can be presented in many different formats. The CAS data, consistent
with other national estimates,1 suggests that drinking on college campuses is both extreme and not extreme. Distinct audiences will take away different meanings, depending on which presentation of the data they choose to examine.
College students’ drinking is risky and dangerous when one considers that many young people are heavy episodic or binge
drinkers. In interpreting our previous studies, using the above criterion of 5 drinks in a row for men and 4 for women, we suggested that 25% of the students binged occasionally and 19% did so frequently.
An intensive look at students’ drinking patterns indicates that binge drinkers account for the lion’s share of alcohol consumed and the problems encountered on campuses. Administrators and others concerned with public health should use this information in formulating campus prevention programs and policies.
One would be mistaken to assume that such heavy episodic drinking is the norm for all (or even most) students. More than half of the students surveyed did not binge drink at all. When norms are considered across all students in all colleges, the median number of drinks (1.5) consumed per student during a week is very small. The frequent binge drinkers who
consume 68% of the alcohol raise the mean, or average number of drinks per week, to 5.1, which seems high.
Patterns of drinking also vary between college campuses. These facts are critically important for students to know. Our data also show that, for some subgroups and some colleges, "norms" about alcohol consumption, that is,
the patterns, volume, and problems associated with drinking that are normative on a campus, can indeed be quite extreme.
Our conclusion from the present examination of the CAS data is that it is not possible to design an effective "one size fits all" approach to address college alcohol use. The data indicate that, rather than being uniformly high,
behavioral norms for alcohol consumption vary widely among students and across colleges.
Some of the difficulty in changing norms may be that heavy drinking is highly visible and may be assumed to be the norm, even at schools where our data suggest that this is not the case. Colleges where relatively less heavy drinking
takes place may benefit most from marketing campaigns informing students about the actual rates of drinking to challenge false assumptions that heavy drinking is "typical" of life at their college.9
In many settings, although highly visible, frequent heavy drinking is not normative. However, in settings or
schools with a high proportion of heavy drinkers, information or marketing campaigns become less straightforward. In some heavy drinking settings, actual norms may be so high that presentation of data unfortunately confirms assumptions
or beliefs about others’ risky behavior. Different intervention approaches should be employed in such settings. Yet, when working with students individually11 or in small or well-defined groups, norms can
be selected (ie, by gender, living settings, Greek affiliation, or, as in this article, by drinking patterns) to create contrasts with expectations and beliefs. Presentations of actual norms for other students’ drinking can demonstrate that not everyone uses alcohol in the same way.
For further information, please address communications to Henry Wechsler, PhD, Director, College Alcohol Studies, Harvard School of Public Health, Department of Health and Social Behavior, 677 Huntington Avenue, Boston, MA 02115. E-mail: firstname.lastname@example.org
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