No-risk alcohol drinking
48 ABSTRACT Increasing episodes of campus violence have warranted an investigation into college students perception of safety on campus. In this study, 56,811 students responded to the Core Alcohol and Drug Survey during the 2010 academic school year. Numerous universities administered the survey and students completed the survey either in class or electronically. More than 92% of non-drinkers (n=19,481) felt safe on campus compared to 94% of drinkers (n=31,443). A higher proportion of non-drinkers (almost 8%, n=1,603) felt unsafe compared to those who drink alcohol (about 6%, n=1,998). After adjusting for gender, race/ethnicity, and place of residence, students who felt unsafe on campus had 20% less odds of drinking compared to students who felt safe. Students who drink may have a false sense of security, take unnecessary risks, or place themselves in dangerous situations. These findings confirm the need for education and awareness campaigns among college students to reduce victimization and perpetration related to alcohol use. Key words: safety, violence, college, alcohol The Perception of Safety Between Drinkers and Non-Drinkers Among U.S. College Students Gayle Walter, Ph.D., MPH, CHES Grand Canyon University David Florkowski, Ph.D., CEAS Thompson Rivers University Peter Anderson, Ph.D., FSSSS Walden University Micheal Dunn, Ph.D. Coastal Carolina University
THE PERCEPTION OF SAFETY BETWEEN DRINKERS AND NON-DRINKERS 49 Drinking on college campuses in the United States is a serious public health issue that has not been addressed in an effective manner. Alcohol is the most widely used and abused substance during the college years (Baker & Boland, 2011). An important correlate to consider is problem drinking among college students and its relationship to sexual aggression, acts of violence, and criminal activity (Baker & Boland, 2011). In a study conducted by Brahms, Ahl, Reed, and Amaro (2011), women who experienced sexual violence reported less use of protective alcohol strategies and more mental health symptoms (Brahms et al., 2011). Alcohol use before or during verbal aggression was also negatively associated with condom use (Fair & Vanyur, 2011). A reduction in condom use may lead to an increase in pregnancy and sexually-transmitted infections. In the same study, alcohol use was also significantly associated with a rise in occurrences of coercion and aggression. Another study performed by researchers confirmed this finding that the expression of aggression and violence are strongly linked to alcohol intoxication, and males display more pro-violent attitudes than females (Mitchell, Rutherford, Wrinch, & Egan, 2008).
DRINKING AND VIOLENCE Excessive alcohol use can result in many damaging effects. These effects can impact the drinker as well as those individuals in the immediate environment (i.e., secondary effect of someone elses alcohol use) (Kapner, 2008). The damaging effects of excessive alcohol use include issues such as poor academic achievement, engaging in risky behaviors such as unplanned sexual encounters, and the engagement in violent acts of behavior including fights and sexual victimization (Hingson, Heeren, Winter, & Weschler, 2005; Logan, Teague, Vaughn, Luk, & King, 2012). As for the secondary effect, individuals can be exposed to violent acts of those abusing alcohol; these acts may include being sexually harassed, fights, injuries, and theft or destruction of property (Kapner, 2008). In fact, it has been estimated that in 2009, 696,000 college students were assaulted by another student who had been drinking and 599,000 college students were unintentionally injured while being drunk (Hingson et al., 2005). When exploring the causes of alcohol use/abuse and the subsequent negative consequences, there is a need to explore the environment in which the behavior takes place. Researchers have suggested that the environment may be as strong, if not stron50
THE PERCEPTION OF SAFETY BETWEEN DRINKERS AND NON-DRINKERS ger, than individual factors when it comes to college alcohol use (Quinn & Fromme, 2011; Weitzman, Nelson, & Weschler, 2003). GENDER According to the 2012 National Survey on Drug Use and Health (NSDUH), among young adults aged 18 to 25, an estimated 62.9% of males and 57.5% of females were current drinkers. In this same group, the binge drinking percentage rates were 45.8% for males and 33.2% for females. The pattern of higher rates of current alcohol use, binge alcohol use, and heavy alcohol use has remained consistent since 2002 (Substance Abuse and Mental Health Services Administration [SAMSHA], 2012). These findings are a concern since there is a potential for the prevalence of co-morbidities to include alcohol abuse and mental illness, which may further contribute to campus violence (SAMSHA, 2012). In addition to campus violence, age of first drink has also been associated with the likelihood of being the victim of a date fight (DuRant, Champion, Wolfson, Omli, & McCoy et al., 2007). College students who had their first drink of alcohol at the age of 15 or less were more likely to be the victim of a date fight than those students who had their first drink at the age of 16 or older (DuRant et al., 2007). According to the study, males who had been threatened with physical violence during the previous 30 days as a result of another students drinking were more likely to be the victim of a date fight. In the same study, females who reported being pushed, hit or assaulted in the previous 30 days by another student who had been drinking were also substantially more likely to be the victim of a date fight (DuRant et al., 2007). In addition to simply focusing on sex-based identity, Peralta, Callanan, Steele, and Wiley (2011) conducted a study to determine if gender-based identity (masculinity and femininity) had an impact on acts of violence performed under the influence of alcohol. Consistent with other findings, sex-based identities who engaged in heavy episodic drinking displayed a positive association with alcohol-related aggression. Having masculine characteristics did not increase the odds of alcohol-related violence, and actually reduced the odds of violence against friends and acquaintances. Feminine characteristics decreased the odds of alcohol-related violence against strangers and significant others, but had no effect on violence against friends and acquaintances.
THE PERCEPTION OF SAFETY BETWEEN DRINKERS AND NON-DRINKERS 51 Acts of violence as a result of heavy episodic drinking vary based on the type of relationship that you have with the other person. The literature confirms that gender is an important predictor in alcohol-related violence (Peralta et al., 2011). RACE In a longitudinal study performed by Willams, Van Dorn, Ayers, Bright, and Hawkins et al., 2007, race and gender differences in delinquent acts and the initiation of alcohol during adolescence was evaluated. The study sample included African American and Caucasian adolescents in grades 7-12. There was no statistical significance among female adolescents by race as to their involvement in delinquent acts and the initiation of alcohol. African American male youths were no more likely than Caucasian youths to initiate minor or major non-violent acts and less likely to initiate alcohol use, but were more likely to initiate violent acts. This finding may be influenced by extraneous variables such as parental supervision or influence of peers (Williams, Van Dorn, Ayers, Bright, & Abbott et al., 2007). Racial differences were also explored in a study to determine differences in assault and care characteristics between black women and white women who were treated in the emergency room after a sexual assault (Boykins, Alvanzo, Carson, Forte, & Leisey et al., 2010). From the women questioned during a twoyear period, white women were more likely than black women to report the personal use of alcohol prior to their assault. White women were also more likely than black women to report both they and their assailant had used a substance, and black women were more likely to have been assaulted by the use of a weapon (Boykins et al., 2010). These findings demonstrate that alcohol use plays an important role in sexual violence towards women and should be taken into consideration in prevention strategies. No literature was identified that addressed the association between race, violence, and alcohol use among college students.
PLACE OF RESIDENCE The college environment is not necessarily the most conducive in terms of promoting the health and welfare of students. The relationship between the college environment and alcohol use among students is complicated. Some of the environmental 52
THE PERCEPTION OF SAFETY BETWEEN DRINKERS AND NON-DRINKERS factors that may influence a students alcohol use include such things as place of residence, advertising that promotes drinking, and campus alcohol rules and regulations (Presley, Meilman, & Leichliter, 2002). Place of residency is one of the factors that has not been explored extensively in regards to how living arrangements influence alcohol use behaviors. Where one resides while in college may influence normative beliefs regarding the use of alcohol. On the other hand, students may choose where to live based on their alcohol expectations (Presley, Meilman, & Leichliter, 2002). Typically, students have the choice of living in a residence hall, fraternity/sorority house, off campus housing, or at home and where one chooses to live may influence ones drinking patterns. Previous research has suggested that college students may be more influenced by their close living environment than their perceptions of what most students are engaging in (Keeling, 2000). Page and OHegarty (2006) assessed the type of college residence and the influence on alcohol use. The results of this study found that males living in off campus housing were significantly more likely to have used alcohol in the past 30-days compared to those living in a campus residence hall (88.75%, 69.57%). The same result was found for binge drinking with 36.11% of males in off campus housing binge drinking in the past week compared to 20.22% of males living in a campus residence hall. Additionally, females living in off campus housing were significantly more likely to have used alcohol in the past 30 days compared to those living in a campus residence hall (69.70%, 62.92%). On the other hand, binge drinking was more likely to occur in those females who lived in campus residence halls compared to off campus housing (17.17%, 14.89%) (Page & OHegarty, 2006). Additionally, females living in sorority houses were significantly more likely to have drank in the past 30 days and to have binge drank in the past week compared to females living in residence halls or off campus housing. Other studies have found similar results with those living in fraternity/sorority houses engaging in more alcohol use and abuse, followed by off campus living in apartments (Quinn & Fromme, 2011; Fromme, Corbin, & Kruse, 2008). As such, living arrangements may influence alcohol use and abuse. The abuse of alcohol can then result in unintentional injury to the drinker, as well as secondary alcohol effects to those exposed to the drinking behaviors of others (Logan et al., 2012; Hingson et al., 2005; Kapner, 2008). THE
PERCEPTION OF SAFETY BETWEEN DRINKERS AND NON-DRINKERS 53 As such, the purpose of this study was to assess the differences between drinkers and non-drinkers related to their perception of safety on college campuses, adjusting for the covariates of gender, race/ethnicity, and place of residence. METHODS Participants Permission was granted by the Core Institute at Southern Illinois University (SIU) to use the national data set from the Core Alcohol and Drug Survey long form. The participants were students from numerous universities, both public and private, across the United States. The students responded to the survey during the 2010 academic year. The original data set contained survey responses of 56,937 total participants. Only 55,145 participants (96.8%) provided a valid response to the question about average number of alcohol drinks per week and gender. Valid values of gender of the participant and total number of alcoholic drinks consumed per week were needed to calculate the risk of alcohol drinking, therefore, only 55,145 participants were used for final analysis to assess the differences between drinkers and non-drinkers and their feeling of safety on college campuses. Procedures Numerous universities administered the Core Alcohol and Drug Survey during the 2010 academic year. The Core Alcohol and Drug Survey is commonly used to assess the nature, scope, and consequences of alcohol and drug use on college campuses. According to Southern Illinois University, the Core Institute, who administers the survey, has the largest database on alcohol and drug use in post-secondary educational institutions (SIU, 2014). The number of college students who completed the survey in 2013 was 168,499, further demonstrating the acceptance and wide use of the survey (SIU, 2013). Participants responded by completing either the electronic version or the written form of the Core Survey. Only schools that responded with data that was representative of their school were included in the 2010 Core Institute annual national dataset. For example, if a school administered the survey to only freshmen, that data was not included in the dataset utilized for the purposes of this paper. Since this was aggregate data from numerous universities, it was not known what specific 54
THE PERCEPTION OF SAFETY BETWEEN DRINKERS AND NON-DRINKERS procedure each specific university used to administer the survey. In addition, the sample included both public and private universities but was not differentiated for the purpose of this study. Measures For the purpose of the study, two measures were used: the average number of drinks consumed by the student per week and the students perception of safety on campus. For this measure, a drink was defined as a bottle of beer, a glass of wine, a wine cooler, a shot glass of liquor, or a mixed drink (Core Institute, 1994). The response to the question about average number of drinks per week was stored as a numerical value between 0 and 98. The number of alcoholic drinks per week and gender was used to group each participant into an alcohol drinking risk group. The alcohol drinking and risk levels were taken from the risk chart created by the HAMS Harm Reduction Network, a non-profit agency that provides support for safer drinking, a reduction in drinking, or quitting alcohol altogether (hamsnetwork.org, 2009). The values were based on definitions by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), as well as information gathered from a meta-analysis of literature. The values were differentiated between men and women on a weekly basis. If men consumed >= 50 drinks per week, they were categorized as high risk, and if women consumed >=40 drinks per week, they were also categorized as a high-risk drinker. Table 1 shows the criteria used for alcohol risk grouping among males and females based on number of drinks per week. For the second measure, students perception of safety on campus was based on the question ?Do you feel safe on this campus? (Core Institute, 1994). If the response was ?yes, the participant was assigned to a ?feel safe on campus group. Likewise, if the response was ?no, the participant was assigned to a ?do not feel safe on campus group. Data Analysis Initially, the data were analyzed to generate descriptive statistics, which demonstrated demographic characteristics of the sample population and distribution of other variables used in this study. Descriptive statistics of categorical or binomial variables will be reported with frequencies and percentages. The differ
THE PERCEPTION OF SAFETY BETWEEN DRINKERS AND NON-DRINKERS 55 ence in risk levels of drinking among those that feel safe on campus was compared to those that dont feel safe on campus and was assessed with ordinal logistic regression models. Unadjusted odds ratios were estimated by including independent variables separately in the multinomial logistic regression model. Finally, adjusted odds ratios were estimated with the multinomial logistic regression model with all predictor variables to include age, race/ ethnicity, gender, and place of residence. RESULTS The characteristics of the study population are shown in Table 2. More than 80% of the study population consisted of students less than 22 years of age. In the study population, almost 63% (n=34,497) were females, 80% were non-Hispanic Whites, 7% were non-Hispanic Blacks, 95% were enrolled in undergraduate programs and almost 50% lived off campus. More than 85% of the study population had no-risk alcohol drinking, 12% had low-risk alcohol drinking, and the remaining 3% had medium- to high-risk alcohol drinking. More than 93% of students felt safe on campus compared to only 7% of students who felt unsafe on campus. Table 3 shows distribution of the respondents alcohol drinking risk status. More than 10% of high-risk alcohol drinkers felt unsafe on campus compared to only about 7% of those who had no-risk alcohol drinking. This difference was statistically significant (p-value <0.001). A higher proportion of high risk alcohol drinkers (more than 55%) lived off-campus compared to no-risk (48.7%), low-risk (46.4%), and medium-risk (53.0%) alcohol drinkers. This difference was statistically significant (p-value<0.01). A significantly higher proportion of high-risk (78.5%) and medium risk-alcohol drinkers (75.1%) were males compared to no-risk (36.6%) and low-risk (35.3%) alcohol drinkers (p-value<0.01). In the category of non-Hispanic whites, 86% were identified as high-risk alcohol drinkers. More than 2% of high-risk alcohol drinkers were American Indians/AK natives compared to less than 1% among no-risk, low-risk and medium-risk alcohol drinkers. This difference of distribution levels of alcohol drinking among different race/ethnicity groups was statistically significant (p-value = 0.001). 56
THE PERCEPTION OF SAFETY BETWEEN DRINKERS AND NON-DRINKERS Tables 4 and 5 show the unadjusted, as well as adjusted, results of multinomial logistic regression analysis respectively. After adjusting for effects of gender, race/ethnicity, and place of residence, when compared to students who felt safe on campus, the students who felt unsafe on campus had 89% higher odds of high-risk drinking vs. no-risk drinking and 29% greater odds of medium-risk drinking vs. no-risk drinking. This effect was statistically significant (p-value <0.05). However, the students who felt safe on campus had higher odds of low-risk drinking vs. no-risk drinking when compared to students who felt unsafe. After adjusting for effects of feeling safe on campus, place of residence and race/ethnicity, male students had more than 6 times higher odds of high-risk drinking vs. no-risk drinking and more than 5 times higher odds of medium-risk drinking vs. no-risk drinking compared to female students. Female students had 6% higher odds of low-risk drinking vs. no-risk drinking when compared to male students. Effect of gender on various levels of alcohol drinking remained statistically significant after adjusting for other covariates. After adjusting for other covariates, students who resided off-campus had 13% higher odds of medium-risk drinking vs. no-risk drinking compared to students who resided on campus. In contrast, students who resided on campus had almost 9% higher odds of low-risk drinking vs. no-risk drinking when compared with students who resided off-campus. This association between primary residence and low-risk and medium-risk alcohol drinking was statistically significant (p-value <0.05), however, no significant association was observed between residence and high-risk level drinking. Asian or Pacific Islander students had 83% lower odds of medium-risk drinking vs. no-risk drinking and 62% lower odds of low-risk drinking vs. no-risk drinking when compared to students of any other race. Black students had 76% lower odds of medium-risk drinking vs. no-risk drinking and 73% lower odds of low-risk drinking vs. no-risk drinking when compared to non- Black students. Non-Hispanic White, American Indian or Alaskan Native, and Hispanic races were not significantly associated with levels of alcohol drinking.
THE PERCEPTION OF SAFETY BETWEEN DRINKERS AND NON-DRINKERS 57 DISCUSSION The purpose of this study was to assess the differences between drinkers and non-drinkers related to their perception of safety on college campuses, adjusting for the covariates of gender, race/ethnicity, and place of residence. A higher proportion of non-drinkers (almost 8%, n=1,603) felt unsafe compared to those who drank alcohol (about 6%, n=1,998). After adjusting for effects of gender, race/ethnicity, and place of residence when compared to students who felt safe on campus, the students who felt unsafe on campus had 89% higher odds of high-risk drinking vs. no-risk drinking and 29% greater odds of medium-risk drinking vs. no-risk drinking. Even though overall school crime rates have decreased, acts of violence on campus grounds continue to remain a public health problem (Gellert, 2010). The regression results show higher odds of high-risk and medium-risk drinking among those who feel unsafe compared to those who feel safe on campus. This may lead to a false sense of security for those students who are drinking alcohol and they may place themselves in dangerous situations unknowingly. Students may become careless about socializing with strangers, walking at night in an isolated area unaccompanied, and leaving doors to their living quarters unlocked. Based on these conclusions, being a victim of intimate partner violence, assault, and robbery are legitimate concerns that remain on college campuses. Baker and Boland (2011) surveyed faculty, staff, and students on their perceptions of feeling safe on their college campus. A high percentage (98.3% for students and 99.4% for faculty and staff combined), generally felt safe on campus (Baker & Boland, 2011). Even though a small percentage may have been victims of an act of violence, one act may have long-lasting effects such as the victim leaving school and faculty, staff, and other students continuing to feel threatened (Baker & Boland, 2011). Even after being victimized, very few people file complaints and when they witness an act of violence, they are most likely to ignore it. Students must feel empowered to speak up if they are victims of violence or they suspect one of their classmates may be at risk for engaging in an act of violence. Other suggestions to improve safety on college campuses is to reevaluate the overall campus safety plans and make revisions or additions to provide information on safety features of the campus, reporting mechanisms, rape 58
THE PERCEPTION OF SAFETY BETWEEN DRINKERS AND NON-DRINKERS prevention programs, and self-defense classes (Baker & Boland, 2011). As a society, we must get involved to define the problem, why it is occurring, and offer evidence-based strategies and solutions to prevent another tragedy. The results of this study must be considered in light of several limitations. As with any self-reported tendency, there is the potential for participants to over- or under-estimate their actual alcohol amount of alcohol consumed. As not all the potential participants responded to the survey, there is a possibility of non-respondent bias. Those who responded to the survey may differ on important study-related characteristics compared to those who did not participate in the survey. This bias may underestimate the true association between perception of safety on campus and alcohol drinking behavior. It is possible that participants response toward alcohol drinking may be biased toward what they believe is socially desirable rather than the true amount consumed. Despite the changes in drinking age restrictions, drinking on college campuses and campus safety will continue to be a public health concern. If students who feel safe engage in high-risk drinking, the outcomes would be more likely to involve victimization due to lack of awareness or protection of self (Hingson et al., 2005). If students who feel unsafe engage in high-risk drinking, the outcomes would more likely involve risky behaviors or perpetration due to the combined effects of alcohol and emotion (Hingson, Heeren, Winter, & Weschler, 2005; Logan, Teague, Vaughn, Luk, & King, 2012). Our respondents showed higher odds of high-risk (and medium-risk) drinking among the small percent who felt unsafe compared to those who felt safe on campus. Among our respondents there could be a greater likelihood of risk behaviors and perpetration (either violent or sexual or both) by this small group. This potential outcome should be studied further to determine if the combination of feelings of safety and drinking impact personal safety on campus. Correspondence concerning this article should be addressed to: Gayle Walter, Ph.D., MPH, CHES, Grand Canyon University, College of Nursing and Health Care Professions, 3300 West Camelback Road, Phoenix, AZ 85017.
THE PERCEPTION OF SAFETY BETWEEN DRINKERS AND NON-DRINKERS 59 REFERENCES Baker, K. & Boland, K. (2011). Assessing safety: A campus-wide initiative. College Student Journal, 683-699. Boekeloo, B.O., Bush, E., & Novik, M.G. (2009). Perceptions about residence hall wingmates and alcohol-related secondhand effects among college freshmen. Journal of American College Health, 57, 619-626. Boykins, A.D., Alvanzo, A.H., Carson S., Forte J., Leisey, M., & Plichta, S.B. (2010). Minority women victims of recent sexual violence: Disparities in incident history. Journal of Womens Health, 19,453-461. Brahms, E., Ahl, M., Reed. E., & Amaro, H. (2011). Effects of an alcohol intervention on drinking among female college students with and without a recent history of sexual violence. Addictive Behavior, 36, 1325-1328. Core Institute. (1994). Core Alcohol and Drug Survey Long Form. Retrieved from https://core.siu.edu/surveys/index.html. DuRant, R., Champion H., Wolfson, M., Omli, M., McCoy T., DAgostino Jr., R.B., & Mitra, A. (2007). Date fighting experiences among college students: Are they associated with other health-risk behaviors?. Journal of American College Health, 55,291-296. Fair, C.D., Vanyur, J. (2011). Sexual coercion, verbal aggression, and condom use consistency among college students. Journal of American College Health, 59, 273-280. Fromme, K., Corbin, W., Kruse, M. (2008). Behavioral risks during the transition from high school to college. Developmental Psychology, 44, 1497-1504. Gellert, G. (2010). Confronting violence. 3rd ed. Washington, DC: American Public Health Association. Hamsnetwork.org. (2009). Risk and alcohol drinking levels. Retrieved from https://www.hamsnetwork.org/limits/ 60
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THE PERCEPTION OF SAFETY BETWEEN DRINKERS AND NON-DRINKERS TABLE 1 Risk level of alcohol drinking by gender Number of drinks per week Risk level Male Female No risk <=14 <=7 Low risk 15-29 8-24 Medium risk 30-49 25-39 High risk >=50 >=40
THE PERCEPTION OF SAFETY BETWEEN DRINKERS AND NON-DRINKERS 63 TABLE 2 Demographic characteristic of the study population Count % Age <18 yrs. 8,046 14.67 19 ? 20 yrs. 22,800 41.56 21 ? 22 yrs. 15,066 27.46 23 ? 24 yrs. 3,244 5.91 25 ? 30 yrs. 3,120 5.69 31 ? 40 yrs. 1,507 2.75 >41 yrs. 1,075 1.96 Gender Female 34,497 62.56 Male 20,648 37.44 Race/Ethnicity Amer Ind/AK native 376 0.69 Hispanic 2,756 5.05 Asian/Pac Isl 2,272 4.16 White (non-Hisp) 43,684 80.07 Black (non-Hisp) 3,814 6.99 Other 1,656 3.04 Residence Off-campus 25,774 48.59 On-campus 27,268 51.41 Classification Freshman 14,840 26.95 Sophomore 12,424 22.57 Junior 12,656 22.99 Senior 12,168 22.1 Grad/professional 2,387 4.34 Not seeking degree 135 0.25 Other 447 0.81 Drinking No risk 47,130 85.47 Low risk 6,657 12.07 Medium risk 1,093 1.98 High risk 265 0.48 Campus Safety Feel safe on campus 50,035 93.4 Do not feel safe on campus 3,534 6.6 64
THE PERCEPTION OF SAFETY BETWEEN DRINKERS AND NON-DRINKERS TABLE 3 Distribution of study-related characteristics of population by alcohol drinking risk status No Risk (%) Low Risk (%) Medium Risk (%) High Risk (%) Chi-square test (p-value) Camp
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