prevalence of at-risk drinking among a national sample of medical students primary...
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PREVALENCE OF AT-RISK PREVALENCE OF AT-RISK DRINKING AMONG A DRINKING AMONG A
NATIONAL SAMPLE OF NATIONAL SAMPLE OF MEDICAL STUDENTSMEDICAL STUDENTS
Primary Investigator/Presenter: Ameet Shah, Primary Investigator/Presenter: Ameet Shah, MDMD
Department of Family Medicine, Kaiser Department of Family Medicine, Kaiser PermanentePermanente
Co-Authors: Shahrzad Bazargan-Hejazi, PhDCo-Authors: Shahrzad Bazargan-Hejazi, PhDKenneth Wolf, PhDKenneth Wolf, PhD
Richard Lindstrom, MARichard Lindstrom, MA
BackgroundBackground Motor vehicle accidentsMotor vehicle accidents FallsFalls DrowningDrowning HomicidesHomicides SuicidesSuicides Child AbuseChild Abuse Domestic violenceDomestic violence
HypertensionHypertension Heart attacksHeart attacks PancreatitisPancreatitis Liver CirrhosisLiver Cirrhosis UlcersUlcers Neurological SxNeurological Sx CHFCHF
They have all been associated with . . .They have all been associated with . . .
Alcohol MisuseAlcohol Misuse
BackgroundBackground
24% of physicians drink alcohol daily24% of physicians drink alcohol daily
16% misuse alcohol16% misuse alcohol
Specific AimsSpecific Aims
1)1) To assess the prevalence of harmful To assess the prevalence of harmful drinking among medical students drinking among medical students and and
2)2) To assess the correlates of at-risk To assess the correlates of at-risk drinkingdrinking
Study HypothesisStudy Hypothesis
1)1) 11stst and 2 and 2ndnd year medical students will year medical students will report a significantly higher level of at-risk report a significantly higher level of at-risk drinking as compared to 3drinking as compared to 3rdrd and 4 and 4thth year year medical students.medical students.
2)2) Medical students who report lower levels Medical students who report lower levels of social support will be more likely to of social support will be more likely to report at-risk drinking.report at-risk drinking.
3)3) Medical students who report higher levels Medical students who report higher levels of stress will be more likely to at-risk.of stress will be more likely to at-risk.
MethodsMethods
Cross-sectional structured, web-based survey Cross-sectional structured, web-based survey study of 1st -4th year medical studentsstudy of 1st -4th year medical students
The study was approved by the Charles Drew The study was approved by the Charles Drew university IRBuniversity IRB
Permission requested from all 126 accredited Permission requested from all 126 accredited U.S. M.D.-granting medical schools to contact U.S. M.D.-granting medical schools to contact their respective studentstheir respective students
MethodsMethods
States Sampled
36 medical schools agreed to take part in the survey.36 medical schools agreed to take part in the survey.
• 2710 responses obtained2710 responses obtained
Alcohol Use Disorders Identification Test (AUDIT)Alcohol Use Disorders Identification Test (AUDIT)
MethodsMethodsMeasures used in the study include:Measures used in the study include:
Sociodemographics BMI Exercise Have Regular Physician Stressful life event Social Support Center for Epidemiologic Studies Depression Scale (CES-D) South Oaks Gambling Screen (SOGS) Impulsivity Risk Perception Risky Sexual Behavior Current Tobacco Product Use Illicit Drug Use Alcohol Use Disorders Identification Test (AUDIT)
AUDITAUDIT
Alcohol Use Disorders Identification Alcohol Use Disorders Identification TestTest
Detects at-risk, hazardous, and Detects at-risk, hazardous, and alcohol dependencealcohol dependence
Cut-off score of 8 or more considered Cut-off score of 8 or more considered at-risk drinkingat-risk drinking
92% sensitivity and 94% specificity92% sensitivity and 94% specificity
DemographicsDemographics GenderGender
Male (40%)Male (40%) Female (60%)Female (60%)
AgeAge 20 to 48 years 20 to 48 years (mean age 25.6; SD (mean age 25.6; SD 3.2)3.2)
Marital statusMarital statusUnmarriedUnmarried N=195N=19588
72.8%72.8%
MarriedMarried N=730N=730 27.2%27.2%
Medical School YearMedical School Year 11stst Year (32.5%) Year (32.5%) 22ndnd Year (25.2%) Year (25.2%) 33rdrd Year (23.3%) Year (23.3%) 44thth Year (19.0%) Year (19.0%)
DemographicsDemographics
1st Year33%
4th Year19%
3rd Year23%
2nd Year25%
AlcoholAlcohol
85.6% of Medical Students Drink 85.6% of Medical Students Drink Alcohol on a Regular BasisAlcohol on a Regular Basis
AUDITAUDIT Sensitivity of 92%Sensitivity of 92% Specificity of 94%Specificity of 94%
15.4% of Medical Students At-Risk Drink
85.6% of Medical Students Drink 85.6% of Medical Students Drink Alcohol on a Regular BasisAlcohol on a Regular Basis
Alcohol ConsumptionAlcohol ConsumptionQuantity of DrinkingQuantity of DrinkingFrequency of Binge Frequency of Binge
DrinkingDrinking22.9%
36.5%
20.0%
6.1%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Per
cen
t of
Dri
nk
ing
Sam
ple
monthly
2 - 4/m
onth
2- 4/week
4+/week
Frequency of Alcohol Consumption
Frequency of DrinkingFrequency of Drinking
1 to 2 drinks 64.9%
3 to 4 drinks 23.1%
5 to 9 drinks 11.2%
>=10 drinks0.8%
>=10, 0.8%
1 to 2, 64.9%
5 to 9, 11.2%
3 to 4, 23.1%
34.6%
17.2%
7.2%
0%
5%
10%
15%
20%
25%
30%
35%
Per
cen
t o
f D
rin
kin
g
Sam
ple
< Monthly Monthly Weekly
Frequency
Frequency of Binge Drinking
Frequency of Drinking Quantity of Drinking
Alcohol-Related Harm
0%
5%
10%
15%
20%
25%
30%
35%
% o
f S
amp
le
1st/2nd Year 3rd/4th Year
Year of School
30.4%24.2%
Medical School Year vs. Drinking Medical School Year vs. Drinking BehaviorBehavior
0%
5%
10%
15%
20%
25%
% o
f S
am
ple
1st/2nd Year 3rd/4th Year
Year of School
At-Risk Drinking
17.1%13.3%
0%
10%
20%
30%
40%
50%
60%
70%
% o
f S
am
ple
1st/2nd Year 3rd/4th Year
Year of School
Hazardous Drinking62.7% 58.5%
0%
5%
10%
15%
20%
25%
% o
f S
amp
le1st/2nd Year 3rd/4th Year
Year of School
Alcohol Dependency21.7%
15.4%
p<0.001 p<0.05
p<0.001 p<0.001
Correlates of At-Drinking with ΧCorrelates of At-Drinking with Χ22 testtest
CharacteristicsCharacteristics nn %% p-valuep-value
Age (mean; SD)
Male
Unmarried
1st/2nd Year
Smoker
Illicit Drug Use
Risky Sexual Behavior
Pathological Gambler
Depressed
Moderate to Major Stressors
Impulsive Behavior
Low Risk Perception
26
244
369
265
172
238
116
34
224
258
308
265
3.2
22.7
18.8
17.1
10.8
26.4
27.6
41.5
20.5
18.3
52.2
22.4
0.000
0.000
0.007
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Younger Age
CharacteristicsCharacteristics OROR 95% CI95% CI p-valuep-value
3.04
2.71
2.04
2.04
1.79
1.78
1.72
1.71
1.71
1.49
1.05
(2.32-3.97)
(1.89-3.88)
(1.60-2.60)
(1.20-3.47)
(1.39-2.29)
(1.37-2.31)
(1.34-2.21)
(1.33-2.20)
(1.28-2.29)
(1.16-1.91)
(1.01-1.10)
p<0.001
p<0.001
p<0.001
p<0.01
p<0.001
p<0.001
p<0.001
p<0.001
p<0.001
p<0.01
p<0.05
Predictors of At-Risk Predictors of At-Risk DrinkingDrinking
DiscussionDiscussion 11stst Hypothesis: Hypothesis: more 1more 1stst and 2 and 2ndnd year year
medical students than 3medical students than 3rdrd and 4 and 4thth year medical year medical students at-risk drinkstudents at-risk drink
No difference in at-risk drinking among the No difference in at-risk drinking among the years.years.
The medical school curriculum plays no The medical school curriculum plays no significant role in reducing at-risk drinking significant role in reducing at-risk drinking rates among students.rates among students.
Partially approved!Partially approved!
0
5
10
15
20
25
30
1st/2nd
Year3rd/4th
Year
Leve
l of
At-
Ris
k D
rinki
ng
DiscussionDiscussion
2nd Hypothesis:2nd Hypothesis: medical students with medical students with lower levels of social support are more likely to lower levels of social support are more likely to engage in at-risk drinking.engage in at-risk drinking.
We found no difference in the level of social We found no difference in the level of social support and drinking behavior.support and drinking behavior.
Previous studies have suggested social support Previous studies have suggested social support plays a protective role for at-risk drinking.plays a protective role for at-risk drinking.
REJECTED!REJECTED!
DiscussionDiscussion 33rdrd Hypothesis: Hypothesis: medical students with medical students with
higher levels of stress are more likely to at-risk higher levels of stress are more likely to at-risk drinkdrink
At-risk drinking positively correlated with stress.At-risk drinking positively correlated with stress.(Lower stress at 12% vs. Higher stress at 18%)(Lower stress at 12% vs. Higher stress at 18%)
Stressed students 1.5 times more likely to at-risk Stressed students 1.5 times more likely to at-risk
drink.drink. Level of at-risk drinking possibly influenced by Level of at-risk drinking possibly influenced by
unique pattern of exposure to stressors.unique pattern of exposure to stressors. At-risk drinking could be a manifestation of a At-risk drinking could be a manifestation of a
coping system medical students implement.coping system medical students implement.
ACCEPTED!
ACCEPTED!
LimitationsLimitations
1)1) Online SurveyOnline Survey
2)2) Survey under-reportingSurvey under-reporting
3)3) Cross-sectional studyCross-sectional study
ConclusionConclusion
With at-risk alcohol consumption being With at-risk alcohol consumption being a possible marker for future alcohol a possible marker for future alcohol abuse and its potential health, social, abuse and its potential health, social, and economic impacts, the results of and economic impacts, the results of this study stress the need for effective this study stress the need for effective interventions among medical students. interventions among medical students.
AcknowledgementAcknowledgement
My mentors:My mentors:
Family and FriendsFamily and Friends
KennethWolf, PhD
Richard Lindstrom, MA
Shahrzad Bazargan-Hejazi,
PhD
ReferencesReferences CDC. General Alcohol Information. August 04, 2004. Available at: http://
www.cdc.gov/alcohol/factsheets/general_information.htm. Accessed January 8, 2005.
Center on Addiction and Substance Abuse. "College Commission Finds Excessive Drinking Puts Students at High Risk for AIDS, Rape, Violence and Unplanned Pregnancies: Dramatic Increase in College Women Drinking to Get Drunk" Center on Addiction and Substance Abuse web site, www.casacolumbia.org. Accessed Feb 27, 2006.
Cherpitel, C. (1993). "Alcohol, injury, and risk-taking behavior: data from a national sample." Alcohol Clinical and Experimental Research 17((4)): 762-6.
Holmes, T. H. and R. H. Rahe (1967). "The Social Readjustment Rating Scale." J Psychosom Res 11(2): 213-8.
Johnston L, O'Malley P, Bachman J. Volume II: College Students and Adults Ages 19-40. Bethesda, Maryland: National Institute on Drug Abuse; 2003.
Lesieur, H. R. and S. B. Blume (1987). "The South Oaks Gambling Screen (SOGS): a new instrument for the identification of pathological gamblers." Am J Psychiatry 144(9): 1184-8.
Makar M, Wolf K, Bazargan M. Do physicians practice what they preach? Paper presented at: Association for the Behavioral Sciences and Medical Education 34th Annual Meeting, 2004; Vail, Colorado.
References (contd.)References (contd.) McMunn AM, Mwanje R, Paine K, Pozniak AL. Health service utilization in London's
African migrant communities: implications for HIV prevention. AIDS Care. Aug 1998;10(4):453-462.
Radloff, L. (1977). "The CES-D scale: A self-report depression scale for research in the general population." Applied Psychological Measurement 1: 385-401.
Results from the 2004 National Survey on Drug Use and Health: National Findings. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2005.
Saunders, J. B., O. G. Aasland, et al. (1993). "Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II." Addiction 88(6): 791-804.
St Lawrence JS. African-American adolescents' knowledge, health-related attitudes, sexual behavior, and contraceptive decisions: implications for the prevention of adolescent HIV infection. J Consult Clin Psychol. Feb 1993;61(1):104-112.
Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2004. Hyattsville, Maryland: Department of Health and Human Services, Center for Disease Control; December 2005. 228.
Wells KB, Lewis CE, Leake B, Ware JE, Jr. Do physicians preach what they practice? A study of physicians' health habits and counseling practices. JAMA. 1984;252(20):2846-2848.