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SoRAD Centre for Social Research on Alcohol and Drugs Stockholm University

Alcohol, Drugs and Student Lifestyle

A Study of the Attitudes, Beliefs and Use of Alcohol and Drugs among Swedish University Students

Sandra Bullock

SoRAD – Research Report nr 21 – 2004


A Study of the Attitudes, Beliefs and Use of Alcohol and Drugs among Swedish University Students

Sandra Bullock

SoRAD – Research Report nr 21 – 2004

Alcohol, Drugs and Student Lifestyle A Study of the Attitudes, Beliefs and Use of Alcohol and Drugs

among Swedish University Students by Sandra Bullock

© Sandy Bullock

SoRAD – Forskningsrapport nr 21 – 2004 SoRADs rapportserie ISSN 1650-5441

ISBN 91-975134-7 Tryck av Akademitryck AB, Edsbruk 2004


Table of Contents

Page List of Tables ................................................................................................................................... iii List of Figures .................................................................................................................................. v Acknowledgements.......................................................................................................................... vi Executive Summary......................................................................................................................... 1 Sammanfattning på Svenska........................................................................................................... 5 1. Introduction and Method.............................................................................................................. 9 Background ........................................................................................................................... 9 Objectives of the Study ......................................................................................................... 9 Methodology.......................................................................................................................... 9 Sample Design ................................................................................................................ 9 Data Collection ................................................................................................................ 10 Mail Procedures .............................................................................................................. 11 Participation Rate .................................................................................................................. 12 Questionnaire Content .......................................................................................................... 13 Data Analysis ........................................................................................................................ 14 Core Measures Used in This Report..................................................................................... 15 Alcohol, Tobacco and Other Drug Use ........................................................................... 15 Missing Data.......................................................................................................................... 16 2. Sample Characteristics................................................................................................................ 18 Age and Sex Distribution of the Students ............................................................................. 18 Living Situation Prior to Age 18............................................................................................. 19 Current Social Status ............................................................................................................ 20 Students’ Current Educational Situation ............................................................................... 22 Participation in Activities at the University............................................................................. 24 3. Prevalence of Alcohol and Tobacco Use .................................................................................... 26 Use of Tobacco Products ...................................................................................................... 26 Alcohol Consumption and Drinking Patterns......................................................................... 28 Risk Factors for Weekly Drinking and Binge Drinking .......................................................... 30 Individual Characteristics ................................................................................................ 30 Pre-university Factors ..................................................................................................... 32 University-related Characteristics ................................................................................... 32 Beverage Preference ...................................................................................................... 34 Multivariate Risk Factors for Binge Drinking ......................................................................... 36 Multivariate Risk Factors for Weekly Drinking....................................................................... 38 4. Prevalence and Context of Illicit Drug Use.................................................................................. 40 Prevalence of Drug Use ........................................................................................................ 40 Prescription Drugs........................................................................................................... 41 University Specific Prevalence Rates ............................................................................. 42 Context and Details of Cannabis Use ................................................................................... 43 Age of Debut ................................................................................................................... 45 Context and Details of Amphetamine and Ecstasy Use ....................................................... 46 Prevalence of Use of Other Drugs ........................................................................................ 47 Risk Factors for Current Cannabis and Prescription Drug Use ............................................ 48 Individual Characteristics ................................................................................................ 48 Pre-university Factors ..................................................................................................... 50 University-related Characteristics ................................................................................... 50 Other Substance Use ...................................................................................................... 53 Multivariate Risk Factors for Cannabis Use.................................................................... 54

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5. Drug and Alcohol Use Problems ................................................................................................. 56 The Occurrence of Substance Use-related Harms ............................................................... 56 Alcohol and Drug Harms by Site ........................................................................................... 57 Risk Factors for Alcohol and Drug Related Harms ............................................................... 57 Individual Characteristics ................................................................................................ 58 Pre-university Factors ..................................................................................................... 58 University-related Characteristics ................................................................................... 60 Other Substance Use ...................................................................................................... 60 The Alcohol Use Disorders Identification Test (AUDIT)........................................................ 62 Driving Under the Influence................................................................................................... 62 Riding in a Car When the Driver Had Been Drinking ...................................................... 63 6. Reasons Why Students Choose NOT to Try Drugs .................................................................... 64 Desire to Try Drugs ............................................................................................................... 64 Reasons Given by Participants for Not Using Drugs ............................................................ 64 7. Sources of Information, Help and Treatment .............................................................................. 66 Previous Sources of Information and Advice ........................................................................ 66 Preferred Future Sources of Information and Advice............................................................ 67 Treatment for Alcohol and Drug Problems............................................................................ 68 8. Attitudes Towards Drug and Alcohol Use.................................................................................... 70 How Easy is it to Obtain Drugs?............................................................................................ 70 The Relative Importance of Student Alcohol and Drug Use in Context of Campus Life...................................................................................................... 70 At What Age is it Acceptable to for a Person to Start Smoking, Drinking and Using Drugs? ............................................................................................... 72 General Attitudes Towards Drugs and Alcohol ..................................................................... 73 9. Alcohol and Drug Policy and Action ...................................................................................... 78 Does the University Have a Drug or Alcohol Policy? ............................................................ 78 Are the Narcotics Sentences too Severe in Sweden? .......................................................... 78 How Should the University Administration Handle Drug Use Offences on Campus?....................................................................................................... 78 What would I do?................................................................................................................... 80 10. Summary and Conclusions....................................................................................................... 82 References ...................................................................................................................................... 84 Appendix A – Study Materials ......................................................................................................... 85

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List of Tables

Page Table 1.1 Response Rate ......................................................................................................... 13 Table 1.2 Reasons for Removing Students From The Gross Sample...................................... 13 Table 1.3 Classification of Tobacco, Alcohol and Other Drugs ................................................ 16 Table 2.1 Age and Sex of the Study Sample, by Site............................................................... 18 Table 2.2 Living Situation of the Study Sample Prior to Age 18, by Site .................................. 20 Table 2.3 Current Student Social Status, by Site...................................................................... 21 Table 2.4 Educational Characteristics of the Sample by Site ................................................... 23 Table 3.1 Percentage of Students Reporting the Use of Tobacco1 Products, by Site.............. 26 Table 3.2 Percentage of Students Reporting the Use of Tobacco1 Products, by Sex, Age and Current Living Situation, and Number of Academic Points ........................ 27 Table 3.3 Frequency of Alcohol Consumption and Binge Drinking by Site .............................. 30 Table 3.4 Individual Characteristics That Increase the Risk of Drinking Weekly and Binge Drinking by Students................................................................................ 31 Table 3.5 Pre-university Factors That Increase the Risk of Drinking Weekly and Binge Drinking by Students....................................................................................... 33 Table 3.6 University-Related Factors That Increase the Risk of Drinking Weekly and Binge Drinking by Students................................................................................ 35 Table 3.7 Multivariate Logistic Regression Identifying Risk Factors for Bi-weekly Binge Drinking Among Students ............................................................................... 37 Table 3.8 Multivariate Logistic Regression Identifying Risk Factors for Weekly Drinking Among Students ......................................................................................... 39 Table 4.1 Prevalence of Use, for the Three Most Regularly Used Categories of Drugs, by Site............................................................................................................ 42 Table 4.2 Agreement with Statements About Control over Cannabis Use, and

Fear Of Consequences............................................................................................. 46 Table 4.3 Age of Debut ............................................................................................................. 46 Table 4.4 Drug Use Prevalence................................................................................................ 48 Table 4.5 Individual Characteristics That Increase the Risk For Cannabis and Prescription Drug Use by Students.................................................................... 49 Table 4.6 Pre-university Factors That Increase the Risk for Cannabis and Prescription Drug Use by Students........................................................................... 51 Table 4.7 University-Related Factors That Increase the Risk for Cannabis and Prescription Drug Use by Students.................................................................... 52 Table 4.8 Substance Use Correlates with the Use of Cannabis and Prescription Drugs by Students ................................................................................ 53 Table 4.9 Multivariate Logistic Regression Identifying Risk Factors for Cannabis Use During the 12 Months Prior to the Study ........................................................... 55

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Table 5.1 Harms experienced by Students as a Result of Substance Use .............................. 56 Table 5.2 Cumulative number of areas in which students experienced Negative Consequences........................................................................................... 57 Table 5.3 Percentage of Students Who Experienced at least One negative consequence due to Drinking or Drug Use in the 12 months Prior to the Study, by Site ............................................................................................................ 58 Table 5.4 Individual Characteristics That Increase Students’ Risk of Experiencing Alcohol and Drug-related Problems ........................................................................ 59 Table 5.5 Pre-university Factors That Increase Students’ Risk of Experiencing Alcohol and Drug-related Problems ........................................................................ 60 Table 5.6 University-Related Factors That Increase Students’ Risk of Experiencing Alcohol and Drug-related Problems ........................................................................ 62 Table 5.7 Substance Use Correlates of Experiencing Alcohol and Drug-related Problems ............................................................................................ 62 Table 6.1 Reasons Not to Use Drugs, by Site .......................................................................... 64 Table 7.1 Past Sources of Drug-related Information and Advice ............................................. 66 Table 7.2 Preferred Future Sources of Drug-related Information and Advice .......................... 68 Table 8.1 Perceived Ease of Obtaining Drugs.......................................................................... 70 Table 8.2 Student’s Rating of the Severity of Various Social Problems on their University Campus.................................................................................................... 71 Table 8.3 Relative Ranking of Social Problems........................................................................ 72 Table 8.4 The Social Clock, and When Students Judge that it is Acceptable to Participate in Contested Behaviours......................................................................... 73 Table 8.5 Students’ Agreement and Disagreement with Statements about Alcohol and Drug Use, Abuse and Care in Sweden................................................. 74 Table 8.6 Students’ Agreement Statements about Alcohol and Drug Use, Abuse and Care in Sweden, by site ..................................................................................... 75 Table 8.7 Students’ Agreement Statements about Alcohol and Drug Use, Abuse and Care in Sweden, by Use of Drugs...................................................................... 76 Table 8.8 Students’ Agreement Statements about Alcohol and Drug Use, Abuse

and Care in Sweden, by Drinking Style and Frequency ........................................... 77 Table 9.1 Student’s Response to finding out that someone they know is involved

with Drugs ................................................................................................................. 81

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List of Figures

Page

Figure 1.1 Receipt of Questionnaires......................................................................................... 14 Figure 2.1 Participation in Activities on Campus (current term)................................................. 25 Figure 3.1 How Recently Did Students Have Their Last Drink .................................................. 29 Figure 4.1 Use of Any Drug, by Site (Excluding Prescriptives).................................................. 41 Figure 4.2 Use of Any Drug, by Site (Including Prescriptives) ................................................... 42 Figure 4.3 Number of Times Cannabis Has Been Used, by Site – Lifetime .............................. 44 Figure 4.4 Number of Times Amphetamines and Ecstasy Have Ben Used – Lifetime............. 47 Figure 6.1 Top 10 Reasons Given for Not Using Drugs ............................................................ 65 Figure 9.1 Respondent’s Opinions on the Laws Regarding the Selling of Drugs and the Use of Drugs in Sweden ................................................................... 79 Figure 9.2 Students’ Views Regarding How the University Should Handle Students Who are Caught With Drugs...................................................................... 79

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Acknowledgements

This study could not have been completed without the numerous students and employees at each of the four participating universities. They worked tirelessly throughout the questionnaire development and data collection phases of the study, randomly selecting the participants, creating mailing labels and compiling and mailing questionnaire packages, receiving response cards as they were returned to the study office and preparing tracking update reports. Thank you also to the local coordinators at University for overseeing the tremendous amount of work that had to be accomplished in a relatively short time period. The coordinators were: Anna Sonrei from the University of Kalmar, Anna Hansen from Lund University, Claus Jochheim from Umeå University, and Elizabet Flennemo and Ulrica Olsson from Växjö University. I would also like to thank my colleagues at The Centre for Social Research on Alcohol and Drugs (SoRAD), at Stockholm University and Pia Steen in particular, for their assistance I helping me to understand the Swedish Educational System and helping to transform the questionnaire materials from English into Swedish. Finally, I would like to thank Mobilisering mot Narkotika (Mob) for the funds that made this study possible, and for laying the initial groundwork for it to take place. The universities also contributed to the financing of the study by contributing valuable services and materials in kind, thus keeping the overall budget to a level that was possible to reach.

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Executive Summary This report presents the results of the Alcohol, Drugs and Student Lifestyle Study (ADSL), that was conducted in the fall of 2003, and funded by Mobilizering mot Narkotika (Mob). The data represents responses from 4575 undergraduate university students from four universities across Sweden: The University of Kalmar, Lund University, Umeå University and Växjö University. Students from these four sites were randomly selected for participation using the university registration database (LADOK), and a response rate of 70.0% was achieved. This study focuses on student alcohol and other drug use, problems experienced as a result of alcohol/drug use, attitude towards use, and policies for the control of drug use. In doing so, it provides details about the use and context of drug use within the university environment. Although the results of this study are not generalizable to all universities across Sweden, they can ultimately assist in the development of programs and policies for prevention and treatment. Prevalence of Drug Use • 27.1% of the students had used an illicit drug at some point in their lives, this figure

decreases to 9.8% in the 12 months prior to the survey, and 4.5% during the first few months of the fall 2003 school term. These figures do not include the use of prescription drugs irrespective of physician prescription.

• A higher percentage of the students reported using drugs, if prescription drug abuse was

included in the definition. Such use of prescription drugs was to be recorded only if they were taken outside of a doctor’s orders, and not precisely as prescribed. 15.4% of the students reported using prescription drugs in this manner during their lives, 9.1% within the last 12 months, and 6.9% during the school term. Thus raising total drug use prevalence to 36% lifetime, 17.3% 12 month, and 10.8% during the term.

• Cannabis was the most commonly reported drug at 25.3% use during the lifetime, 8.9%

during the prior 12 months, and 3.2% during the term. Amphetamines were the second most frequently used drug, at 4.1%, 0.8% and 0.3% respectively; followed by ecstasy at 3.2%, 0.9% and 0.3% respectively.

• Few students were regular consumers of drugs, data suggest that the large majority have

only experimented lightly. Of the students who had tried cannabis, 35% had used it only 1-2 times, and 73.6 % had used it 10 or fewer times, in total. Similarly, 45% of students who had tried amphetamines or ecstasy had used them only 1 or 2 times; 73% of amphetamine users and 76% of ecstasy users used them up to 10 times.

• There was variation in the prevalence of illicit drug use by university. Students at Lund

were more likely to use cannabis, amphetamines and ecstasy than were students at any of the other sites. Students at Kalmar were the least likely to have tried cannabis.

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• Males and students aged 20-24 reported higher rates of use of all drugs, and cannabis in particular. During the prior 12 months, 12.2% of males used cannabis compared with 6.9% of females (use of any drug except prescription drugs: males 13.4% and females 7,6%).

• Females reported higher rates of prescription drug use than males. 10.6% of females

reported prescription drug use in the prior 12 months compared with 7.3% of males. • Students studying Humanities, Social Sciences, Technology and Economics/business

reported the highest12-month rates of cannabis use. • Several school-related factors were associated with increased rates of all drug use and

cannabis use in particular. Compared with the 8.9% average rate of 12-month cannabis use, higher rates of use were reported by students who lived with roommates (15.4%) or in student corridors (14.9%); students whose primary income was via student loan (10.3%); students taking free-standing courses (10.7%) as opposed to being enrolled in a program; and those who had completed 40 educational credits or less prior to the fall term (12.6%).

• Students who had lived outside of the country just prior to beginning their current

education (23.9%) and those from the three largest cities in Sweden (11.7%) also reported higher rates of cannabis use in the 12 months prior to the study. In addition, students who had been guest students outside of the country during their education reported more current cannabis use (13.4%) than those who had not (7.8%); however, only 17.1% of the students who had been guest students elsewhere indicated that they had first tried drugs while abroad studying.

• 17% of students who had tried drugs had experienced harm related to their use in the past

12 months. This represents less than 2% of students overall. Further, 2.1% of students reported being a passenger in a car where the driver was known to be under the influence of an illicit drug, while just under 1% of students who had access to a car had driven under the influence of a drug (not including alcohol) during the school term in progress.

Non-use of Drugs • 64% of students had not tried illicit drugs even once. This number increases to 72.9% if

prescription drugs are not included in the estimate. 16.5% (of the 72.9%) of those that had not tried drugs indicated that they had a desire to experiment with one or more drugs. Students who had close family members or friends who had used drugs were half as likely (13.3%) as those without (26%) to want to experiment.

• The top 5 reasons endorsed by for remaining drug free were: drugs aren’t good for your

health (94.5%); one can become addicted (93.6%); I just don’t want to (92.4%); one could die (91.3%); and I don’t like how they influence one’s behaviour (82.2).

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Alcohol Consumption and Patterns of Use • 96% of students had consumed alcohol in the 12 months prior to completing the survey;

92.7% had consumed it since the beginning of the school term. In total, only 1.8% had been life-long abstainers.

• 33% of students reported binge drinking (drinking the equivalent of a bottle of wine at a

sitting) twice a month or more often. 55% had consumed this quantity at least once per month.

• Alcohol was consumed most frequently by students attending Lund, and least frequently

by students attending Umeå (75.2% versus 57% drank 2 or more times per month) University.

• Binge drinking at least twice monthly, was most common at Lund (38.4%) and Växjö

(37.0%) universities compared with Kalmar (32.2%) and Umeå (31.9%). • Students who binge drank at least 2 times per month were most likely to be male (46.8%

versus 28.9% for females); aged 20 to 24 years (42.4%); live with roommates (55.0%), in a student corridor (49.4%) or in their own apartment alone (41.9%); and have a higher disposable income than those drank heavily less often. These heavy drinkers were also more likely to have lived one of Stockholm, Göteborg or Malmö prior to attending school (45.4%). Students enrolled in economics/business (51.2%), technology (42.4%), law (42.1%), and the social sciences (40.6%) were the most likely to binge drink at least twice a month. Binge drinkers also reported having more confidants (a higher level of social support) than non-binge drinkers.

• 43% of current drinkers had experienced harm related to its use in the past 12 months.

This represents 41.5% of all students surveyed. The most commonly reported harms were related to the student’s physical health (26.3%) and financial situation (25.7%).

• 4.3% of students reported being a passenger in a car where the driver was known to be

under the influence of alcohol, and 1.5% of students who had access to a car during the fall 2003 term had driven under the influence alcohol during that time.

Attitudes towards Alcohol and Drug Use • Student’s alcohol ranked first in a list when students were asked about potential problems

on the student’s own university campus. Vandalism or theft of property ranked second, while student drug use ranked third. These were followed by sexual discrimination, sexual harassment, racism, and physical violence.

• 66% agreed, or strongly agreed, with the statement that alcohol is a larger problem in

Sweden than are other drugs. • 75% of students felt that drinking alcohol was a normal part of being a university student;

in contrast to only 7% who agreed that trying drugs is a normal part of life as a university student. More students at Lund felt that trying drugs was a normal part of the university students (10.4%), compared with the other sites (Kalmar 4.0%, Umeå 4.5%, Växjö 5.0%).

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• 70% of students felt that if it became permissible to use drugs, there would be a large

increase in their use. This finding was in contrast with the large number of non-drug users who indicated that they had no desire to use drugs, largely for health reasons.

• 90% agreed that the misuse of prescription medicines can be as dangerous as misuse of

other drugs. This percent did not differ vary depending upon whether the student reported misuse of prescription medications or not.

Policy • 88.2% of students indicated that they did not know if their university had a policy on

alcohol use. Similarly 90.9% did not know if there was a policy regarding illicit drug use. • 27% of students felt that the university administration should be doing more to control

students’ drug use. Students who had not tried drugs felt significantly stronger about this (30.4%) than students who had previously tried drugs (14.7%).

• Students where asked their opinion of what the University’s response to drug use on

campus should be. For a first offence of using cannabis on campus, students felt that the University should see that the individual receives counselling (66.8%), and 31% felt that the incident should be reported to the police. If the same person was caught a second time, students’ support of counselling decreased to 62.4% and 48.8% felt the police should bee called. However if an individual was caught selling cannabis on campus, students felt that the individual should be reported to the police (84.8%), and expelled from school (34.8%).

• Students who had tried drugs were more likely to indicate that the Swedish laws for drug

use were too harsh (16.4%) compared with students who had not tried drugs (3.2%); however, a large proportion of students in each group (38.5% and 37.5% respectively) had no opinion on the matter.

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Sammanfattning på Svenska I denna rapport presenteras resultat från en undersökning om Alkohol, droger och studentliv (ADSL), som genomfördes under hösten 2003. Materialet omfattar svar från 4575 universitetsstudenter som läste på grundnivå vid fyra svenska universitet: Högskolan i Kalmar, Lunds universitet, Umeå universitet och Växjö universitet. Deltagarna från dessa fyra städer hade blivit slumpmässigt utvalda med hjälp av skolornas databaser (LADOK) och svarsfrekvensen blev 70,0 procent. Studien fokuserar på studenternas bruk av alkohol och droger, problem upplevda som reslutat av detta bruk, attityder till bruket och kontrollåtgärder riktade mot bruket. På detta sätt ger den detaljerad information om kontext av drogbruket i universitetsmiljön. Även om resultaten inte kan generaliseras till alla svenska universitet, de kan ge underlag för utveckling av preventiva program och åtgärder samt behandling. Förekomst av drogbruk • 27,1 procent av studenterna hade testat någon otillåten drog vid något tillfälle under sin

livstid. Siffran sjunker till 9,8 procent när det gäller de senaste 12 månaderna före undersökningen och till 4,5 procent under de första månaderna av höstterminen 2003. Uppgifterna omfattar inte bruk av receptbelagda läkemedel, oavsett om de var utskrivna av en läkare eller ej.

• En högre andel studenter uppgav drogbruk när receptbelagda läkemedel inkluderades i

definitionen. Sådant bruk registrerades endast om dessa läkemedel användes utan läkarrecept eller på annat sätt än ordinerat av läkare. 15,4 procent av studenterna rapporterade sådant bruk av receptbelagda läkemedel under sin livstid, 9,1 procent under de senaste 12 månaderna och 6,9 procent under terminens gång. Det innebär en total förekomst av drogbruk bland 36 procent av studenterna under deras livstid, 17,3 procent under de senaste 12 månaderna och 10,8 procent under studieterminen.

• Cannabis var den vanligaste drogen, rapporterad av 25,3 procent när det gäller bruket

under livstid, 8,9 procent under de senaste 12 månaderna och 3,2 procent under terminen. Amfetamin var den näst vanligaste drogen, rapporterad av 4,1, 0,8 respektive 0,3 procent - följd av ecstasy, motsvarande 3,2, 0,9 respektive 0,3 procent.

• Få studenter använde droger regelbundet. Resultaten tyder på att en stor majoritet endast

har erfarenhet av experimentell användning. Bland de studenter som använt cannabis hade 35 procent gjort så endast en eller två gånger och 73,6 procent hade använt den totalt tio eller mer sällan. På ett liknande sätt, 45 procent av de studenter som hade provat amfetamin eller ecstasy hade gjort så endast 1 eller 2 gånger; 73 procent av dem som använt amfetamin och 76 procent av dem som använt ecstasy hade gjort så högst tio gånger.

• Variation kunde observeras i förekomsten av illegala droger mellan olika universitet.

Studenterna i Lund använde cannabis, amfetamin och ecstasy oftare än studenter från de övriga universiteten. Bruket av cannabis var lägst i Kalmar.

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• Män och studenter i åldrar 20-24 år uppgav högsta andelar när det gäller bruk av samtliga droger, i synnerhet bruk av cannabis. Under de senaste 12 månaderna hade 12,2 procent män provat cannabis jämfört med 6,9 procent bland kvinnor (bruk av samtliga droger förutom receptbelagda läkemedel: 13,4 procent bland män och 7,6 procent bland kvinnor).

• Fler kvinnor än män rapporterade bruk av receptbelagda läkemedel. Andelen gällande de

senaste 12 månaderna var 10,6 procent jämfört med 7,3 procent bland män. • Studenter som läste humaniora, samhällsvetenskap, teknologi och

ekonomi/marknadsföring uppvisade de högsta andelarna av cannabisbruk under de senaste 12 månaderna.

• Ett flertal skolrelaterade faktorer visade sig ha samband med högre förekomst av allt

drogbruk, cannabis i synnerhet. Jämfört med den genomsnittliga andelen som provat cannabis under de senaste 12 månaderna, 8,9 procent, har högre andelar rapporterats bland dem som bodde tillsammans med rumskamrater (15,4 procent) eller i en studentkorridor (14,9 procent). Motsvarande gällde studenter som fick sin huvudsakliga inkomst från studielån (10,3 procent) samt studenter som läste fristående kurser (10,7 procent) jämfört med dem som läste en linje. Andelen var också högre än genomsnitt bland dem som hade nått högst 40 högskolepoäng innan höstterminen (12,6 procent).

• Studenter som var bosatta utanför Sverige precis innan de påbörjade sin nuvarande

utbildning (23,9 procent) och de som kom från de tre största städerna i Sverige (11,7 procent) rapporterade också en högre förekomst av cannabisbruk under de senaste 12 månaderna. Också bland dem som under sin utbildning hade varit gäststudenter utanför Sverige fanns det relativt fler som uppgav att de hade provat cannabis under de senaste 12 månaderna (13,4 procent) jämfört med de som inte studerat utomlands (7,8 procent). Samtidigt rapporterade endast 17,1 procent bland dem som varit gäststudenter att de provade droger för första gången under sina utlandsstudier.

• 17 procent bland de studenter som hade provat droger hade under de senaste 12

månaderna upplevt problem relaterat till drogbruket. Det motsvarar mindre än två procent bland samtliga studenter. Vidare uppgav 2,1 procent att de hade färdats i en bil då de visste att föraren vad drogpåverkad, medan knappt en procent bland studenter med tillgång till en bil rapporterade att de själva hade kört under drogpåverkan (omfattar inte alkohol) under den pågående terminen.

Icke-bruk av droger • 64 procent av studenterna hade inte provat illegala droger ens en gång. Siffran ökar till

72,9 procent när receptbelagda läkemedel inte ingår i skattningen. 16,5 procent bland de som inte provat droger (d.v.s. de 72,9 procent) uttryckte att de någon gång hade haft lust att pröva en eller fler droger. Studenter som hade nära anhöriga eller vänner som hade använt droger var hälften så benägna (13,3 procent) att känt lust att prova jämfört med övriga (26 procent).

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• De fem vanligaste orsakerna som angivits när det gällde att förbli drogfri var: droger är inte bra för hälsan (94,5 procent), man kan bli beroende (93,6 procent), jag vill helt enkelt inte (92,4 procent), man kan dö (91,3 procent) och jag gillar inte hur de påverkar ens beteende (82,2 procent).

Alkoholkonsumtion och alkoholvanor • 96 procent av studenterna hade konsumerat alkohol under de senaste 12 månaderna före

genomförandet av undersökningen. 92,7 procent hade konsumerat alkohol sedan början av skolterminen. Totalt sett hade enbart 1,8 procent aldrig någonsin druckit alkohol.

• 33 procent av studenterna rapporterade intensivkonsumtion (binge drinking), d.v.s. att de

drack motsvarande en flaska vin vid ett och samma tillfälle, två gånger i månaden eller oftare. 55 procent hade druckit motsvarande denna mängd minst en gång i månaden.

• Alkohol konsumerades oftast av studenter vid Lunds universitet, och minst ofta av

studenter vid Umeå universitet (75,2 procent respektive 57 procent drack två gånger eller oftare per månad).

• Intensivkonsumtion minst två gånger per månad var mest vanligt vid Lunds (38,4 procent)

och Växjö universitet (37.0 procent), jämfört med Högskolan i Kalmar (32,2 procent) och Umeå universitet (31,9 procent).

• 46,8 procent av männen respektive 28,9 procent av kvinnorna dricker motsvarande en

flaska vin vid ett konsumtionstillfälle minst två gånger per månad. Av de i åldern 20-24 år har 42,4 procent uppgett intensivkonsumtion. 55 procent av dem som bor med rumskamrater, 49.4 procent av dem som bor i studentkorridor, 41,9 procent av de som bor ensamma i egen lägenhet har angett intensivkonsumtion. ”Intensivkonsumenterna” har också en högre disponibel inkomst än de som dricker mer sällan. Intensivkonsumenterna var också mer sannolika att ha bott i antingen Stockholm, Göteborg eller Malmö före sina universitetsstudier (45,4 procent). Studenter som studerade ekonomi/marknadsföring (51,2 procent), teknologi (42,4 procent), juridik (42,1 procent) eller samhällsvetenskap (40,6 procent) var de som i högst utsträckning drack motsvarande en flaska vin vid ett konsumtionstillfälle minst två gånger i månaden. Intensivkonsumenter hade fler personer som de kunde anförtro sig till än övriga alkoholkonsumenter.

• 43 procent av alkoholkonsumenterna hade upplevt skador relaterade till

alkoholkonsumtion under de senaste 12 månaderna. De motsvarar 41,5 procent av alla studenter i undersökningen. Den vanligaste skadan var relaterad till studentens fysiska hälsa (26,3 procent) och finansiella situation (25,7 procent).

• 4.3 procent av studenterna rapporterade att de varit passagerare i en bil där de vetat att

föraren varit påverkad av alkohol och 1,5 procent av studenterna som hade tillgång till bil under hösten 2003 hade kört under alkoholpåverkan under den tiden.

7


Attityder till alkohol- och droganvändning • Respondenterna rangordnade studenters alkoholbruk högst när de tillfrågades om

potentiella problem på det egna universitetsområdet. Vandalism/stöld av egendom rangordnades tvåa, därefter följde sexuell diskriminering, sexuella trakasserier, rasism och (fysiskt) våld.

• 66 procent av studenterna instämde helt eller delvis i påståendet att alkohol är ett större

problem än andra droger i Sverige. • 75 procent av studenterna ansåg att alkoholkonsumtion var ett normalt beteende för en

student vid ett universitet, i jämförelse med att enbart sju procent ansåg att prova droger var normal upplevelse när man är student på universitetet. Fler studenter vid Lunds universitet ansåg att prova droger var en normalt (10,4 procent) jämfört med de andra skolorna (Kalmar 4,0 procent, Umeå 4,5 procent, Växjö 5,0 procent).

• 70 procent av studenterna ansåg att om det blev tillåtet att använda droger så skulle

användningen öka kraftigt. Detta resultat var i motsägelse till att de flesta studenter som inte använde droger menade att de inte hade någon önskan att prova droger, främst p.g.a. hälsoskäl.

• 90 procent instämde i att missbruk av receptbelagda läkemedel är kan vara lika farligt som

missbruk av andra droger. Denna siffra varierade inte beroende på om studenten rapporterat eget bruk av receptbelagda läkemedel eller inte.

Policy • 88,2 procent av studenterna svarade att de inte visste om deras universitet hade någon

policy gällande alkoholkonsumtion. 91 procent visste inte om det fanns någon policy gällande otillåten droganvändning.

• 27 procent av studenterna ansåg att universitetsadministrationen borde göra mer för att

kontrollera studenternas droganvändning. Studenter som inte provat droger ansåg detta signifikant mer (30,4 procent) än studenter som provat droger (14,7 procent).

• Studenterna tillfrågades om hur de tyckte att skolan skulle agera i ett antal situationer

rörande droganvändning på universitetsområdet. För en förstagångsförseelse bestående av användning av cannabis på universitetsområdet ansåg 66,8 procent av studenterna att individen skulle få rådgivning och 31 procent ansåg att incidenten skulle rapporteras till polisen. Om samma person ertappades en andra gång, så minskade studenternas stöd för rådgivning till 62,4 procent och 48,8 procent ansåg att polisen skulle kontaktas. Om en person ertappades med att sälja cannabis till en vuxen person på universitetsområdet, ansåg studenterna att han eller hon skulle bli rapporterad till polisen (84,8 procent) och avstängd från skolan (34,8 procent).

• Studenter som hade provat droger var mer troliga att tycka att straffen för droganvändning

var för stränga (16,4 procent) jämfört med studenter som inte provat droger (16,4 procent). Inom båda grupperna var det emellertid många studenter (38,5 respektive 37,5 procent) som inte hade någon åsikt i frågan.

8


1. Introduction and Method Background Although there is a long history of national and student alcohol surveys in Sweden, there is limited information available regarding illicit drug use and abuse among university students. Information on the lifetime, 1-year, and 30-day prevalence of drug use by young adults has been measured (Guttormsson, Andersson & Hibell, 2004), students included; however, there have been no questions included which specifically address the campus environment, attitudes and related use of drugs. Results from the 2003 young adult drug use study conducted by Centralförbundet för alkohol- och narkotikauppylsning (CAN) have indicated that students between 21-24 years of age reported a higher prevalence of drug use lifetime drug use (24%) than did those the same age who were working (21%) (Guttormsson, Andersson & Hibell, 2004). Similarly current drug use (within the 12 months prior to study) was also higher for these students (11%) compared with similarly aged workers (5%). However, in both cases individuals in this age group who neither worked nor attended schools had the highest lifetime (29%) and 12-month (13%) prevalence of narcotic use. These figures suggest that narcotic use among university students is an issue in need of further study. The Alcohol, Drugs and Student Life Survey (ADSL) was designed to address the absence of University-specific issues related to drug use and its relation to alcohol consumption by current undergraduate university students. The survey provides us with information about rates and patterns of alcohol and other drug consumption, alcohol and drug related problems experienced, as well as students’ views about alcohol and drug use and how they relate to the campus environment. Objectives of the Study The overriding goal of the study was to inform local development regarding drug prevention and support. To meet this goal, this project had two primary objectives. The first was to obtain accurate point estimates of current drug use (defined as use within the 12 months prior to the study) and of lifetime drug use within University and Högskola in Sweden. The second goal of the study was to examine how students use or have used drugs differ from those who have not with respect to sociodemographic characteristics, lifestyle choices (including alcohol use), school-related variables, and drug-related attitudes and policies. These data, although non-representative of Sweden’s entire university and college environment, can provide some guidance for priority setting and program development in individual universities or at the national level. Methodology Sample Design The ADSL study employed a 2-stage selection of undergraduate students. Selection of the universities and colleges to be involved in the study was non-representative and was conducted by Mobilisering mot narkotika (Mob). Kalmar, Lund and Umeå were chosen for participation as they were among the six “försökskommumer” that Mob was supporting in

9


collaboration with the Alcoholkommittén, whose objective it is to support the development of evidence based and sustainable prevention at the local level. While Växjö was not among the communities involved in the “försökskommumer” initiative, the Alcoholkommittén has been active in doing work there. In choosing these sites, Mob also ensured that there was some geographical representation from the different regions of the country and across university/college size distribution. In the second stage of selection, a number of students enrolled in level A-D courses at each of the four sites were randomly chosen for participation by the local coordinators. Because of the wide diversity across sites in the undergraduate courses offered, students were selected randomly regardless of level of study, field or study and program involvement. All students, whether enrolled in a specific program or in free-standing courses, were eligible for participation. Random selection was completed using the student register (LADOK) in mid October, once the information was updated to include the fall 2003 enrolment. Minimal eligibility criteria were set for the selection of students for participation in order limit bias to the sample. Students had to be enrolled in courses in levels A through D and guest students were to be excluded, where possible, as it was unlikely that they would be able to read and write in Swedish. Ultimately, after selection and the first mailing it became known that we had inadvertently selected a number of students who were guest students at other universities during the fall 2003 term. Where this was known the student was also excluded from the sample, as his/her responses to the questions would not be reflective of current enrolment in the university/college in question. The number of students selected for participation in the study was calculated separately for each site. This was done to ensure that there was a large enough sample in each of the sites to be able to provide accurate point prevalence estimates for one year and lifetime drug use and allow the results to be interpreted with some degree of certainty. At the same time it was necessary to recognize that the number of students attending the universities and colleges diverged widely and that drawing large samples within small universities would require a disproportionate amount of local coordination. The minimum number of completed, returned questionnaires desired from each location was 500, for larger universities this number was increased to provide completed returned questionnaires representing 5% of the undergraduate student body. In order to ensure that we achieved these numbers, the smallest number of students to be selected was 758, and the largest was 2895. An over sample was chosen, from the three larges sites, in order to involve a greater number of current drug users in the study in order to provide a high level of confidence in describing the patterns of use and attitudes of drug using students. Each site provided a local contact person who was responsible for development of site-specific questions, reviewing study materials specific to their site, selecting the sample, tracking student participation and providing a liaison with the study office at Stockholm University. Contacts varied by site, and included individuals from health services, student unions/associations and administrative offices. Data Collection Data collection was conducted using a postal survey. This design was chosen after considering a number of alternatives including 1) self completion of survey within pseudo-randomly selected classrooms; 2) telephone survey; 3) Internet-based self-completed survey; 4) face-to-face interviews; and 5) mail survey. In making this decision, the main

10


consideration was how to obtain a random sample from within each school so that the estimates provided would be reliable and reproducible. In order to do this, not only should the sample be random, but the response rate should be over 65% and be unbiased. LADOK administration personnel indicated that the student-contact information was most complete for address as opposed to telephone or e-mail; thus, face-to face interviewing and mail options were preferred. Although response rate is usually highest in surveys using face-to-face interviews (Mangione, 1995), it is not assured that this would be the case with this university-based sample. Drug use is an illegal behaviour and students could fear expulsion from school if it their use was discovered. Thus, they might be less likely to agree to be interviewed by someone who is there on-behalf of the university as opposed to providing non-personally identifying information via post. The costs of face-to-face interviews also proved to be prohibitive. Thus a postal survey was chosen. Mail Procedures Studies have shown that mail surveys, if done well, can obtain as high a response rate as telephone or face-to-face interview techniques (Edwards et al., 2002; Mangione, 1995; Trinkoff & Storr, 1997). Some of the techniques that this study used to optimize the response rate included: 1) Coordinating university – The study was directed by researchers located at Stockholm University, which was not one of the four participating sites. All completed questionnaires were sent directly to Stockholm University, whereas, the names of students sampled to participate were only handled by the universities/college. As a result, anonymity of response was guaranteed as names and responses could NOT be matched. 2) Repeat mailings – There were four study mailings, each approximately 2 weeks apart. When possible, mailings occurred midweek so that materials would be received just in advance of the weekend; however, this was not always possible in each location. The first and third mailings included full-packets of material, the second and fourth consisted of a reminder postcard (see Appendix A). The full packet included an introductory letter on university/college letterhead, a questionnaire, a business reply (svarspost) envelope and a response card. 3) Response card – The student was directed to send their completed survey, which had neither identifying features nor an identification number directly to Stockholm University in the envelope provided. At the same time, if they wanted to be eligible for a draw for prizes respondents could choose to send their response card to their home university. The response card identified the person, and by sending it in, the student indicated that they had taken part and thus would be sent no additional reminders about the study. However, the introductory letter indicated that it was not possible for either Stockholm University nor their home university to link response cards and the completed surveys together, thus maintaining anonymity of response and allowing the researchers to save money on printing, postage and allowing the individual to be included in a draw for prizes. A sample response card can be seen in Appendix A. 4) Incentives – The study included incentives for participation. Due to the prohibitive cost of providing pre-paid gifts to each of the 6539 students selected for participation, it was determined that there should be a draw for prizes. Each of the four sites gave away a first prize of a gift certificate for a bicycle valued at 5000:- SEK. Second prize was a movie

11


theater ticket. The number of tickets given away per site was dependent upon the sample size. Tickets were sent to 5% of the respondents who returned their response card to their home university (Lund 95, Umeå 60, Växjö 35, Kalmar 25). While it is possible that someone who sent in a response card did not actually complete the questionnaire, this is remote, as in the literature (Mangione, 1995, Trinkoff & Storr, 1997) as well as in this case fewer response cards were received than completed questionnaires, as some students preferred not to inform their university regarding whether they had participated or not. 5) Endorsement by a recognized authority – The one-page introductory letter that was sent out in the initial questionnaire packet was sent on professionally produced letterhead provided by the university/college. This letter explained the purpose of the study and why it was important for chosen students to participate, how names were selected, the function of the response card, maintenance of anonymity and confidentiality, and provided contact information for the Study Director at Stockholm University as well as a local coordinator in most cases. Participation Rate One university that Mob initially approached was unwilling to participate in the study. The remaining four participated. Given that this study had not intended to provide results that were representative of the entire Swedish university/college population, there is no further reference to the refusal by this site and how its exclusion might have changed the findings reported herein. Sites were initially asked to select a specific number of names for inclusion in the study. This number was chosen to meet a minimum number of completed questionnaires (5% of students or a minimum of 500), assuming a worst-case scenario of a 60% participation rate. In particular the number of people selected from Lund was 2923, with an additional 1946 from Umeå, 1077 from Växjö, and 769 from Kalmar. Of those selected, there were a small number removed because they were found to be duplicates, students studying outside of their home university or doctoral students. As seen in Table 1.1 the final net sample sizes were 2895, 1861, 1024 and 758 respectively. Table 1.2 shows the reasons for removing students from the gross sample by study site. Since students were only removed from the gross sample if mail was retuned via the post as undeliverable, or if students (or their families) made contact with study personnel, the number of students classified as ineligible may be an underestimate. The overall response rate was 70.0%, with similar response across sites. Table 1.1 shows the actual response rate by site.

Completed questionnaires were sent into Stockholm University rapidly during the first 2 weeks, prior to the first reminder postcard. Within 14 days of the first mailing 72.6% of the questionnaires that were ultimately received, had been received by researchers at Stockholm University (50.8% of those sent out to the net sample). This rate of return was consistent across sites; specifically by 14 days, Kalmar, Lund, Umeå and Växjö had returned 49.9%, 52.7%, 49.5% and 48.5% respectively. In all locations the rate of return diminished appreciably with each reminder mailing (see Figure 1.1).

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Table 1.1 Response Rate University / Högskola Kalmar Växjö Umeå Lund Total

Gross Sample 769 1038 1907 2923 6637

Net Sample 1 758 1024 1861 2896 6539

Questionnaires returned that were not included in the analysis 2

0 1 2 2 4

Completed analysed Questionnaires

547 702 1304 2022 4575

Response Rate 1 72.1% 68.6% 70.1% 69.8% 70.0%

1 The net sample excludes individuals who could not read/write Swedish, were out of the country during the data collection period, who had no current address in the computer, known doctoral students and duplicates. The response rate is calculated as completed (non falsified) questionnaires / net sample x 100. 2 Questionnaires that were clearly falsified, these are included in the net sample, but are not counted as completed in the response rate. Table 1.2 Reasons for Removing Students From The Gross Sample University / Högskola Reason for Removal From Gross Sample

Kalmar Växjö Umeå Lund Total

No correct address 8 13 41 24 86

Living out of the country (guest student elsewhere)

2 1 1 2 6

Could not read/write in Swedish 1 0 0 1 2

No longer studying at the university/college

0 0 2 0 2

Doctoral student 0 0 1 0 1

Duplicate selected 0 0 1 0 1

Total Removed from Gross sample

11 14 46 27 98

Questionnaire Content The questionnaire was developed to be relatively comparable with the national telephone survey of young adults, aged 16 to 24, (Guttormsson, Andersson & Hibell, 2004), which was conducted by telephone interview in the spring of 2003. However, this questionnaire asked more in-depth questions with respect to drug use and its occurrence on college and university campuses in Sweden. The questionnaire was developed primarily by researchers located at Stockholm University; however, local coordinators did have opportunity to add to, or modify, questions to suit the needs and interests of their site.

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Figure 1.1 Receipt of Questionnaires

0

500

1000

1500

2000

0 1 2 3 4 5 6 7 8 9 10 14

Week #

LundUmeåVäxjöKalmar

# Questionnaires

Mail-out weeks: 0, 2, 4, 6

The questionnaire was pilot tested (except for site-dependent questions) at Stockholm University using a convenience sample of undergraduate volunteers, and modifications were made to several of the questions prior to their use in the main study. The 20-page questionnaire was designed with nine sections. In order of appearance, the sections included:

• Background Information • Health and Lifestyle • Alcohol, Tobacco and Drug Use • Questions for non-drug users • Sources of Information, Help and Support’ • Perceptions of Drug Use in General • Attitudes • Policy • Site-specific Questions

Data Analysis The purpose of this report is to provide a description of the alcohol and drug situation in the four selected sites, both individually and in total. In order to accomplish this, estimates are provided as simple percentages. The further description of those who have tried drugs, those

14


who use regularly and those who have never tried is conducted using bivariate cross-tabulations and chi-square statistics. As this is a preliminary report only, there is limited use of multivariate statistics, such analyses will be the focus of future manuscripts. In limited instances, this report does comment on whether the differences seen between sites are significantly different from one another. Where this is done, the data have been standardized across site by age and gender. This was necessary because age and gender are both strongly related to the use of alcohol and drugs and they also differed by study (see chapter 2). The standardized percentages are not presented in this document, so as not to confuse the reader. One limitation of this study is that it was not possible to weight the data to ensure that the estimates provides for each site are representative of all undergraduates in the university. It was not possible to obtain accurate data from each site with respect to age, sex and program enrolment in order to develop weights for all locations. With a 70% response rate there is a potential for biased results. However, seeing as the drug use rates are as high or higher than other studies have indicated in similarly aged populations, it is unlikely that we have underestimated the prevalence of drug use substantially. Core Measures Used in this Report Each chapter in this report describes specific drug-related outcome measures, these measures will be described more fully as they are discussed in detail. However, there issues relating to question time frames and general terminology that are of importance throughout the entire report and thus are outlined in more detail here. Alcohol, Tobacco and Other Drug Use The term ‘drug’ was used in the survey questionnaire, and is used in this report, to refer to the consumption of any illegal or prescription drug, other than alcohol and tobacco, used in a manner NOT as prescribed by a physician. Over the counter preparations were not to be considered drugs, nor were prescription drugs that were taken as prescribed by a physician. A detailed list of the types and classification of drugs of interest in this enquiry can be seen in Table 1.3. This list was included in its entirety in the questionnaire inside back cover for easy reference by survey participants when they were completing the questionnaire. Drug use was measured in this study using three time frames in effort to allow comparisons to be made with results from other studies. As a result, a number of other questions throughout the survey have also been asked using similar time frames to ensure that analysis remains meaningful. The three time frames that have been used are lifetime, last 12 months, and during the current school term. The school term (fall 2003) was of importance as the universities/colleges would certainly be interested in whether and how often drugs were being used by students while students were in attendance. However, given the fact that students completed the questionnaire from two to four months into the fall school term (with more respondents completing the survey earlier than later) the point estimates for this measure of drug use can not be directly compared to the commonly asked time frame of use within the past 90 days.

15


Table 1.3 Classification of Tobacco, Alcohol and Other Drugs Catagory list A Tobacco Cigarettes, cigarillos, cigars, pipes, snus and chewing tobacco B Alcohol Light beer (folköl) , medium and strong beer, spirits, wine, cider

snaps, brännvin and alcopops C Cannabis Hash, hash oil, marijuana, afgan, cannabis, grass, marock, pot,

weed D Amphetamines Benzedrine (bennies), dexedrine, methamphetamines, speed,

tjack E Ecstasy Ecstasy, Extacy, X, E, MDMA, PMMA, F Rohypnol Rohypnol G Heroin “Chasing the dragon”, fentanyl aka / ”China white”, opium, smoke

heroin, white heroin H GHB GBL, gamma-hydroxy-butyrate, gobbe, liquid ecstasy, pro-G,

scoop, easy lay I Cocaine Snow

* do not include crack or ”free base” cocaine J Other central nervous

system (CNS) stimulants Betelnöt, Crystal meth (ice), fenmetrazine, fenmetralin, kat, khat, metyfendiat, ritalin

* do not include amphetamines, cocaine or crack K Hallucinogenic mushrooms Only hallucinogenic mushrooms, magic mushrooms

L Pain killers Citodon, codine, darvocet darvon, dilaudid, distalgesic, fortalgesic, hydrocodone, ketobemidon, ketogan, moraphine, oxycontin, percocet/percodan, petidin, råopium, treo comp, vicodin/lortab/lorcet , m.m.

* do not include methadone, buprenorfin or subutex M Sedatives, and

tranquilizers Alopam, alpralid, apodorm, benzodiazapines (bens), dormicum, diazepam, dumozolam, flunitrazepam, halcion, librium, mogadon, nitrazepam, oxazepam, serepax, sobril, stesolid, stilnoct, temesta, triazolam, valium, m.m.

* inkluderar inte GHB eller rohypnol N Anti-depressants Prozac, paxil, zoloft

O Other hallucinogens Acid, angel dust, DMT, LSD, meskalin, PCB, peyote, psilocybin,

trip, ketamin * inkluderar inte ecstasy eller svampar

P crack “Free base” cocaine Q Steroids (doping) Anabolic steroids, testosterone, growth hormone

R Other drugs other illegal drugs not already included above, sniffing

preparations (e.g., gas, paint thinner, etc.), methadone, buprenorfin or subutex, etc.

Missing Data Overall, item non-response was low. In particular, only 16 people (0.35%) did not answer the drug use questions.

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The questions that received the highest rate of non-response were place of birth, mothers place of birth and fathers place of birth. These questions were left blank in 26.6% of the completed questionnaires. It is believed that a particularity in the formatting of the questionnaire caused this question to be left blank in the majority of the cases, rather than the students withholding information. In the pilot test, these questions were answered by 100% of the volunteer respondents, even though not all were born in Sweden with Swedish heritage. The format of the questionnaire did change slightly between the pilot test and the main study, causing some questions to shift in their location on the page. The changes left these three questions on the right hand column of the page, a column that did not continue all of the way down to the bottom of the page. Thus, if a respondent were following down the left hand side of the page, and not reading the questions numbers, these questions could be easily missed. The questions with the second highest level of missing data were those in the sources of information, help and support section. Almost all of the 10.2% of the participants who left this section blank were individuals who had never tried drugs (433/466 people). It is likely that they suspected that this section did not apply to them, although there were no directions to this effect specifically stated in the instructions. The final question area with a high rate of non-response was postal code. This was missing among 4.9% of participants. Some individuals wrote in their questionnaire that they felt that this information was too identifying for them to provide, others just left the space blank, presumably for the same reason.

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2. Sample Characteristics This chapter provides basic background information on the students who agreed to participate in the study. This information is broken down into four main areas: age and sex, living situation while growing up, current social status and current educational situation Age and Sex Distribution of the Students Age and sex are typically both strongly related to both alcohol and drug use. The age and sex composition of this sample can be seen in Table 2.1. Table 2.1 Age and Sex of the Study Sample, by Site

University / Högskola Characteristic Kalmar n=547 %

Växjö n=702 %

Umeå n=1304 %

Lund n=2022 %

Total n=4575 %

Sex Male Female

31.4 68.6

39.0 61.0

39.9 60.1

39.4 60.6

38.5 61.5

Age group 16 – 19 20 – 24 25 – 29 30 – 34 35 and older

3.7 54.2 18.7 7.5 15.9

0.9 55.6 18.1 18.4 7.0

0.6 58.0 33.9 6.0 1.5

5.3 56.9 21.7 6.5 9.6

3.1 56.7 24.2 8.3 7.7

Sex and age Male 16 – 19 Male 20 – 24 Male 25 – 29 Male 30 – 34 Male 35 and older Female 16 – 19 Female 20 – 24 Female 25 – 29 Female 30 – 34 Female 35 and older

0.7 16.3 9.2 2.0 3.1 3.0 37.9 9.6 5.4 12.8

0.3 20.8 8.7 7.3 1.9 0.6 34.8 9.4 11.1 5.1

0.2 21.5 15.7 2.2 0.5 0.4 36.5 18.0 3.9 1.1

1.6 24.0 9.8 1.9 2.4 3.7 33.1 11.9 4.5 7.1

0.9 21.9 11.2 2.8 1.9 2.2 34.9 13.0 5.5 5.7

The sample from Kalmar contained a higher proportion of females than the samples from the other sites (p=0.0038). The sample from Umeå was comprised of the youngest students (p<0.0431), with Lund, Växjö and Kalmar each progressively older. As a result of these differences in such fundamental demographic variables, when comparisons are made in this report between sites and with respect to alcohol and drug use, the statistics from age and sex standardized comparisons are reported. Although we cannot determine whether this age/sex composition is substantially different from that in each of the participating universities, data from Statistika centralbyrån (SCB) in Sweden documents that more females than males are currently, and have recently been, enrolled in Swedish universities (SCB 2003; SCB, 2004a; SCB 2004b). That said, it is likely

18


that we still we have an over-representation of women, the size of which we are unable to estimate. Living Situation Prior to Age 18 The circumstances of an individual’s growth and development, in particular the stability of the family environment, have been linked to the likelihood of early initiation into alcohol consumption and to the use of drugs. This study was limited, by space, in terms of the number of questions that could be asked about participant’s childhood and thus focused on four areas of interest:

• Parental presence in the home prior to the age of 18 • Level of involvement with parents, if parents were living separately • Special living circumstances prior to the age of 18 • Ethnicity (country of birth and parents’ birth countries)

Table 2.2 outlines the living situation of participants, before they reached the age of 18. Roughly 80% of participants lived with both parents while they were growing up. Another 11% lived primarily with one parent but reported seeing (or living with) the other parent often or always during that time. Another 6% lived with one but reported that they saw (or lived with) the other parent only sometimes or not at all. The number of people who reported that they had little or no stability wile growing up—by indicating that they did not have even one parent that they lived with often or always—was very low at 0.5%. These figures were stable cross study sites. Students also were asked whether they had lived in a number of “special” circumstances outside of the traditional family situation while growing up. A small percentage of students (5.1%) indicated that they had lived in one or more of these situations prior to the age of 18. The most common of these special circumstances were 1) living on one’s own or with roommate without a guardian present (2.5%); 2) living with other relatives (2.2%); 3) staying at an internatskola (0.5%); 4) living in a foster home (0.5%); and 5) living in a care, treatment or detention facility (0.1%). A further 1.0% indicated that they lived away from parents in some other type of setting. Students at Umeå were most likely to have lived in special circumstances (p=0.0060, and least likely to have lived with both parents (p=0.0140), using age-sex standardized data. Students from Lund were the least likely to have lived in special circumstances (p=0.0060). Students’ country of birth was missing in 26.6% of the completed questionnaires, thus it is impossible to report the ethnic background of the respondents with any degree of accuracy. However, 91.5% of those who did respond to the question reported being born in Sweden. Similarly, of those reporting their parents’ countries of birth, 80.6% reported having both parents born in Sweden, and an additional 8.7% indicated that one of their parents was born within Sweden. These figures are not substantially different that which would be expected for university students in Sweden on the whole (SCB 2001). Once standardized, students from Växjö and Lund were slightly more likely to have parents born outside of Sweden (p=0.0326).

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Table 2.2 Living Situation of the Study Sample Prior to Age 18, by Site

University / Högskola Living Situation Kalmar n=547 %

Växjö n=702 %

Umeå n=1304 %

Lund n=2022 %

Total n=4575 %

Parental living situation, prior to the age of 18 Lived with both parents Lived with one, saw other often or always Lived with one, saw other irregularly or not at all Adopted No or little stability Missing

78.3 11.5 7.1 1.7 0.7 0.7

81.3 9.8 5.8 1.9 0.3 0.9

79.0 12.4 5.8 1.2 0.6 1.0

79.7 11.0 6.2 1.3 0.3 1.5

79.6 11.3 6.1 1.4 0.5 1.1

Lived in special circumstances 1 Yes

5.7

4.8

6.6

4.6

5.1

Place of birth Sweden Other Nordic country Western Europe Eastern Europe Middle east Asia Oceania North America South America Africa missing 2

68.0 0.7 1.3 1.4 0.2 1.8 0.2 0.4 0.2 0.0 25.8

62.2 0.7 1.3 1.9 0.3 1.4 0.0 0.0 0.4 0.0 31.8

70.4 1.1 0.7 0.3 0.6 1.2 0.0 0.1 0.4 0.1 25.1

66.6 1.1 1.1 2.3 0.6 1.2 0.1 0.3 0.8 0.2 25.8

67.2 1.0 1.0 1.4 0.5 1.3 0.1 0.2 0.6 0.1 26.6

Parents place of birth Both in Sweden One in Sweden Neither in Sweden Don’t know missing 2

60.7 5.8 6.8 0.6 26.1

56.5 3.7 8.0 0.0 31.8

63.0 6.9 4.8 0.1 25.2

57.4 7.2 9.4 0.1 25.9

59.2 6.4 7.6 0.2 26.6

1 Special Circumstances include ever having lived in any of the following places prior to the age of 18: relatives other than parents or adoptive parents, foster home, boarding school, treatment or other care institution, jail, or living on one’s own, with or without a roommate. 2 These questions were left blank by 26.6% of respondents. A peculiarity in the format of the questionnaire suggests that these questions were omitted primarily by accident rather than as a result of respondents refusing to answer them. Students who were born outside of Sweden were most likely to come from outside of the Nordic countries. Of those who answered the ethnicity questions, the top five answers indicated that 2.0% were born in Eastern European countries, 1.8% were born in Asia, 1.4% in Western European countries, 1.4% in other Nordic countries, and 0.8% in South America. Current Social Status Information on the students’ current social and economic status is located in Table 2.3. Approximately 30% of students lived alone in their own apartments. The next most common

20


living situation was with a partner and no children (26.6%) followed by living with both a partner and child(ren) (16.7%). Living in a student corridor was common (13.2%); however, it was also one of the forms of living that varied the most by site. Where corridor living was more common (e.g., Umeå) students were less likely to have their own apartment, thus it is likely highly dependent upon the quantity and type(s) of student housing offered by the university/college. Students at Lund and Umeå were less likely than those at Kalmar and Växjö to live with children, even after standardization by age and sex (p<0.0001). Table 2.3 Current Student Social Status, by Site


Växjö n=702 %

Umeå n=1304 %

Lund n=2022 %

Total n=4575 %

Current living situation Alone – apartment Student corridor With roommates With parents Partner and children Partner and NO children Children and NO partner Other

24.9 13.2 3.9 8.2 16.7 26.2 2.9 4.0

36.9 11.3 3.9 6.3 13.5 24.5 1.3 2.3

24.9 22.2 12.5 3.1 5.4 29.2 0.5 2.2

29.1 21.1 8.3 11.1 7.8 18.9 1.1 2.6

29.9 13.2 3.8 8.2 16.7 26.2 2.9 4.0

Main form of income Student loan Work Loan and work Stipend Parents Other

69.8 12.8 3.9 0.0 7.1 6.4

73.5 12.0 3.3 0.0 6.6 4.6

82.5 6.1 2.2 0.5 4.1 4.6

72.9 9.0 2.3 0.5 9.0 6.3

75.3 9.1 2.6 0.4 7.0 5.6

Monthly disposable income 0 – 499 SEK 500 – 999 1000 – 1499 1500 – 1999 2000 – 2999 3000 or more

19.1 27.2 18.9 15.2 10.3 9.3

13.8 28.0 22.6 13.0 12.5 10.1

13.5 22.0 21.7 18.4 14.6 9.8

13.6 22.8 23.3 15.0 14.5 10.8

14.2 23.9 22.2 15.7 13.7 10.3

Where lived before starting at current university In city where school is located Stockholm Malmö / Lund Göteborg Other large city (>90,000) Small city (27,000 – 89,999) Town (<27,000) Farm Outside of Sweden

35.8 6.6 0.7 2.6 5.7 18.1 15.4 13.5 1.6

30.8 4.3 2.3 4.0 8.0 18.4 15.1 15.0 2.1

24.5 6.8 0.9 3.6 9.5 23.8 13.7 12.7 4.5

37.2 5.6 -- 3.5 9.8 16.7 12.2 11.6 3.4

29.3 5.8 3.6 3.5 9.0 19.2 13.5 12.7 3.4

A large majority of the students obtained their monthly incomes via student loan (75.3%). After age-sex standardization, students from Umeå were more likely to obtain funds this way, and those from Kalmar and Växjö were more likely to obtain their income through employment (p<0.0001).

21


Disposable income was not large for these students. Over 50% reported a monthly disposable income of less than 1500 SEK after monthly necessities were paid for. The level is relatively consistent across sites; however, students at Kalmar do have slightly less to spend (p=0.0276). Students who attended Umeå University were less likely to have lived in the city before beginning their education there (24.5%) compared with 30.8% and higher at the other sites. However, over 60% of the students relocate or travel distances for their education in each site and therefore issues related to student relocation and adjustment are an important consideration for all sites. Students were also asked whether they were working at the same time as they were attending courses (not seen in Table 2.3). The majority did not work during the school term (66.0%); however, 4.2% did indicate that they worked full-time, and 29.8 indicated that they worked part-time in addition to their studies. Even after standardizing by age and sex, students at Kalmar and Växjö were the most likely to work full-time, and those at Umeå were the least likely to work and study simultaneously (p<0.0001). Students’ Current Educational Situation Students were asked a number of questions regarding their College/University education, the results of these questions can be seen in Table 2.4. Most students (75.8%) indicated that they were enrolled in a program of study at the time of the survey. This differed by site, with students at Umeå being most likely to be enrolled in a program and those at Lund to be the least likely (p<0.0001). In addition to being most likely to be enrolled in a specific program of study, Umeå students were also more likely than those at other sites to indicate that they were studying to write a particular exam (p<0.0001). The areas of study indicated by the students varied widely by site, as expected. Overall, the three most common fields of study were technology, economics/marketing (business) and social science. Table 2.4 shows how the areas of study differ by site. Students were asked about how many points they had completed prior to the current term of study (fall 2003). They were asked about this in 2 ways, how many points they had completed at their university/college, and how many points they had completed overall, at any university/college. These answers to these questions provide an overview of how long the student has been studying. A small percentage of the students (15.5%) had never received any points prior to answering the survey. A slightly higher percentage (21.4%) had not received any points from their current school. Overall, the students who responded to the survey from Kalmar and Växjö were earlier in their academic careers than students at Umeå and Lund, even though students at Kalmar were older than those at the other sites. Unfortunately, students were not asked two additional questions of interest: 1) what level they were currently studying at (e.g., A, B, C or D) and 2) how many points had they accumulated that could count towards the exam for which they were studying. Neither of questions about points completed can be directly transformed to answer the latter two questions.

22


Table 2.4 Educational Characteristics of the Sample by Site


Växjö n=702 %

Umeå n=1304 %

Lund n=2022 %

Total n=4575 %

Course of study Program Free-standing courses

79.1 20.9

75.5 24.5

85.1 14.8

69.1 30.9

75.8 24.2

Studying for an exam (degree) Yes

79.1

77.8

87.8

81.6

82.4

Area of study Economics/marketing Health (including Medical) Law Humanities Natural Sciences Teaching Police Social Science Social Work Technology Other

19.9 7.9 0.0 7.4 14.1 19.1 0.0 6.3 4.2 9.6 11.4

19.9 4.2 0.0 10.8 2.2 20.5 4.9 18.7 3.7 9.0 6.0

9.3 17.8 2.3 7.4 11.8 14.1 2.3 12.4 4.9 11.2 6.5

12.6 10.0 6.0 14.5 9.7 1.7 0.0 11.9 5.4 21.3 7.0

13.7 11.1 3.3 11.0 9.7 10.2 1.4 12.4 4.9 15.1 7.2

Academic points from current school 0 1 – 40 41 – 80 81 or more

28.2 25.9 18.8 27.1

24.2 27.5 22.9 25.4

15.1 23.7 23.2 38.0

22.8 23.9 17.4 35.9

21.4 24.6 20.1 22.9

Total number of academic points 0 1 – 40 41 – 80 81 or more

20.1 23.5 20.3 36.1

17.4 26.7 21.8 34.1

10.5 19.6 23.4 46.5

16.8 20.1 16.7 46.4

15.5 21.4 19.8 43.3

Average status, last year Godkänd or better Under godkänd Didn’t study last year No response

78.2 0.6 20.3 0.9

79.5 0.3 19.9 0.3

86.4 1.2 11.6 0.2

82.2 0.6 16.2 1.0

82.5 0.7 15.9 0.8

Live in student region 1 High Medium Low/no Missing 2

18.6 39.7 37.1 4.6

25.1 36.0 31.3 7.6

54.4 18.3 23.3 4.0

12.2 38.3 44.4 4.8

27.1 32.4 35.5 5.0

1 For the purpose of this study, a high-density student region, is defined as a post code reported by 40 or more students; a medium-density student region has between 15 and 39 students from the study living in it. 2 The post code question was left blank likely in order for individuals to feel that their identity was preserved. Different programs, faculties, and courses of study at the chosen sites have markedly different traditions in how the students are graded for their achievements. In this survey, we asked what the individual’s “average” grade was in their last year of study (including gymnasium for students who were in their first year of University/college study). The response categories provided were: 1) distinction or very good (väl godkänd eller mycket väl godkänd), 2) acceptable (godkänd), 3) not acceptable (underkänd) and 4) I did not study at all last year. Several participants circled acceptable (godkänd) and indicated that their program of study

23


offered no possibilities to receive higher grades, other individuals indicated that there program of study gave no grade standing at all. Thus, in order to be as inclusive as possible the grades were collapsed into pass, fail, didn’t study last year, and no response. Overwhelmingly, those who had studied in the year prior to the survey administration received a passing grade. Each site had a fail rate of 1% or lower. The variable “live in a student region” was developed for this study to aid in the examination of the relationship between student density and alcohol and drug use. It was created using the postal code reported by the student. No response could be determined for the 4.9% of cases where no postal code, or insufficient information, was provided. However, one could make an assumption that in areas where there were known to be large numbers of students living (e.g., student corridors or housing complexes) participants would be less likely to feel that they could be identified by their postal code and thus more likely to provide the information in the survey. Therefore those individuals who have provided insufficient information may be assumed to live in medium or low student density areas. Postal codes that were reported by 80 or more survey participants were judged to represent a high-density student region. Medium density was defined as 20 – 79 students living reporting the postal code. Low density included any postal code that was reported 20 or fewer times in this survey. Using this definition, 27% of the students in the survey lived a high student-density area, 31% lived in medium and 35% live in low student density areas. This differed greatly by site (see Table 2.4). Substantially more Umeå students lived in high student-density areas than at any other site, this was followed by Växjö, Kalmar and Lund respectively. Students were asked to indicate whether they were full-time, half-time or quarter-time students. The great majority indicated that they studies full-time (94.5%) followed by part-time (4.3%) and quarter-time (1.2%). This did not differ significantly by site. Two percent of the students indicated that they were studying via distance education. They were located at Kalmar (5.7%), Växjö (3.2%) Umeå 1.5%, and Lund (1.0%). Participation In Activities at the University Students were asked about their participation in various interest activities held both at and away from the university. Figure 2.1 shows the participation rate for activities that occurred on campus only. Students, in general were most likely to participate in party-type events (pubs, raves/clubs, parties, and informally hang out with friends in cafes etc.). Extracurricular academic events such as workshops and seminars were the second most common type of event attended by students, followed closely by involvement in Nations and program or associations, and finally athletic and other interest groups (e.g., canoe club, etc). Involvement in university-located activities was relatively consistent across the study sites. However, after age-sex standardization, participation in pubs/parties and athletics/hobbies were most common at Växjö (p<0.000); participation in academic activities was most common at Lund (p<0.0001); and involvement in nations and other associations was least common at Umeå (p<0.0001). Throughout the report, the background characteristics presented in this chapter will be referred to in order to describe the students in the study sample with respect to their alcohol and drug use.

24


Figure 2.1 Participation in Activities on Campus (current term)

0

10

20

30

40

50

60

Pubs/Fests Athletics Academics Nations

KalmarVäxjöUmeåLund

/Hobbies/Hobbies /Associations/Associations

* * P<=0.0001P<=0.0001

**

**

**

**

Percent

25


3. Prevalence of Alcohol and Tobacco Use In this chapter we consider the use of legal mind-altering substances including alcohol and tobacco. Use of Tobacco Products Participants were asked about their use of any tobacco products including cigarettes, snus, cigars, cigarillos, and pipes. Due to space limitations in the questionnaire these items were not asked about individually, therefore this report cannot differentiate between the two primary forms of tobacco used in Sweden–cigarettes and snus. Overall, current daily tobacco use was reported by 16.9% of participants (see Table 3.1). This figure was consistent across sites after standardization by age and sex. Occasional use of tobacco was reported by an additional 16.9% of participants; although, this prevalence was not consistent across sites. Individuals from Växjö were most likely to use tobacco occasionally and those attending Kalmer were the least likely to currently be occasional users (p<0.0001). Lifetime use of tobacco was consistent across sites, with 30.7% indicating that at some point in their lives they were daily users of tobacco. The mean age of initiation of daily use was 16.7 years (SD=2.7). This occurred significantly earlier in Kalmar and Växjö than in Umeå and Lund. Table 3.1 Percentage of Students Reporting the Use of Tobacco1 Products, by Site (n=4571)

University / Högskola Kalmar n=547 %

Växjö n=702 %

Umeå n=1304 %

Lund n=2022 %

Total n=4575 %

Current use Daily Occasionally

17.4 13.2

16.9 19.1

17.6 16.6

16.3 17.4

16.9 16.9

Lifetime use Daily

30.3

31.5

30.6

30.5

30.7

Mean age (sd) of initiation of daily use

16.2 (2.5) 16.1 (2.5) 17.1 (2.9) 16.9 (2.6) 16.7 (2.7)

1 Tobacco use was defined as use of any of the following products: cigarettes, cigarillos, cigars, pipes and snus. The use of tobacco by study participants has been examined in relation to a small number of personal and educational characteristics including sex, age, current living situation, whether the student was located in a high student-density area, enrolment into a program of study, and the number of academic points completed at their present university. While not nearly exhaustive of the personal and educational characteristics presented in Chapter 2, this selection provides an overview of how smoking rates fluctuate with one’s age sex and one’s educational situation.

26


Table 3.2 Percentage of Students Reporting the Use of Tobacco1 Products, by Sex, Age and Current Living Situation, and Number of Academic Points (n=4571)

Percent Reporting: Current Daily Use

Current Occasional Use

Lifetime Daily Use

Sex Male Female

**** 23.4 12.8

* 16.1 17.3

**** 36.1 27.3


**** 11.3 15.2 19.5 18.3 20.4

**** 18.6 19.0 16.9 10.6 7.3

**** 16.4 25.4 34.8 39.6 51.6


*** 20.1 14.7 21.2 7.7 20.8 13.9 23.5 23.3

*** 17.2 22.3 21.2 15.9 9.3 14.6 13.7 13.3

**** 31.3 26.7 31.6 15.9 47.1 30.3 51.9 32.5

Live in a student region High Medium Low/no

* 14.6 16.9 17.9

* 19.4 17.5 14.1

*** 25.9 30.4 33.7


16.2 18.9

17.2 15.6

**** 29.1 35.2

Academic points form current school 0 1 – 40 41 – 80 81 or more

*** 19.5 18.6 17.1 13.9

*** 17.2 18.5 16.8 15.7

*** 32.7 34.5 28.9 27.8

1 Tobacco use was defined as use of any of the following products: cigarettes, snus, cigars, cigarillos, and pipes. * p<0.05, ** p<0.01, *** p<0.001, **** p<0.0001 Male students (23.4%) were more likely than females (12.8%) to report current daily tobacco use. This was also the case with the daily use of tobacco at some point within the student’s lifetime, males were more likely to have used daily (36.1%) than were females (27.3%). Females were, however, just as likely as males to use tobacco on an occasional basis. The occurrence of current daily tobacco use increased with student age, whereas the occurrence of current occasional tobacco use decreased with age. By adding the first two columns of Table 3.2, it can be seen that the prevalence of current use of tobacco peaks in the 25 to 29 year age group, with 36.4% indicating that they were at least occasional users of tobacco at the time of the study. Lifetime daily use was also related to age, with older students reporting more daily use of than younger students. Students living with their parents (7.7%) were the least likely to be daily users of tobacco, whereas those living with children (23.5% with not partner, 20.8% with partner), alone in

27


their own apartments (20.1%) or with roommates (21.2%) were most likely to be daily users. Similar trends were also seen with lifetime daily use. Students living with children were the least likely to be occasional users of tobacco. Although the number of students that reported living with a partner and no children is low (n=52) and the estimate is therefore not highly reliable, there were 412 students who reported living with a partner and children, so the strength of that estimate is strong enough to support increased daily use of tobacco amongst students with children. Students living in areas of high-student density were least likely to use tobacco daily (current use: 14.6%, lifetime use 25.9%) and most likely to use it occasionally (19.4%) when compared with those living in low student-density areas (17.9%, 33.7% and 14.1% respectively. Enrolment in an academic program was unrelated to current tobacco use patterns; however, it was related to lifetime daily use. Students enrolled in a program were less likely to have used tobacco daily during their lifetimes (29.1%) than those enrolled in free-standing courses only (35.2%). Progression in academics was also related to current and lifetime tobacco use. As the number of points completed at the current university increased, the daily use of tobacco decreased. It decreased from 19.5% for students with zero points, to 13.9% for students with 81 or more points prior to the fall 2003 school term. The trend with occasional use can be seen to run in the opposite direction. Lifetime tobacco use was most prevalent among students having accumulated between one and 40 points prior to starting the term. Alcohol Consumption and Drinking Patterns Alcohol was consumed by an overwhelming majority of the students surveyed. Only 4% of students had abstained from drinking alcohol completely in year prior to the survey, and just over half of those (2.2%) had abstained throughout their entire lifetimes. Figure 3.1 shows at what age students had taken their most recent drink, for those who had consumed alcohol in the last year (n=4444). Almost a quarter of the students who were not abstainers (73.7%) had consumed alcohol within the week prior to the study. Another 16.8% had a drink in the three weeks prior to that, and another 2.2% since the term started. Therefore, a total of 92.7% of drinkers (90.6% of all students) had consumed alcohol since the school term began. When asked how often, on average, students consumed alcohol, the following results were obtained (see Table 3.3). Ten percent of students drank two or more times per month, and a further 56.6% drank between two and four times per month. This rate was highest in Lund and lowest in Umeå (p<0.0001). Drinking patterns involve dimensions such as the frequency of alcohol use, and the frequency of heavy (binge) drinking, and beverage preference. Binge drinking has been defined as consisting of drinking 5 or more drinks in one sitting (occasion). In terms of volume of alcohol consumed, this equates to about 1-75cl bottle of while, or 5-6 (25 cl) shots of spirits, or 4 cans of strong beer, or 6 cans of light beer. Fifty-five percent of student reported binge drinking at least once a month. CAN identifies high-consumers of alcohol as those who drink this quantity of alcohol at least two times pre month or more frequently. According to this

28


definition 35.6% of this student sample are high consumers. Once standardized by age and sex, students at Växjö (37.0%) and Lund (38.4%) report higher levels of binge drinking than either of the other two sites (Kalmar 32.2%, Umeå 31.9%) (p<0.0001).

Figure 3.1. How recently did students have their last drink?

2,2 3,3%%

16,8 in the last week

in the last month

since the term started

in the last year

%73,7

%

N=4444

Using a second measure of binge drinking from th ture s m ser an

e at 55% of students are drinking 5 or more drinks On ain, u is m ore nts a and

vily at least once a month 004)

estimate of potentially harmfu ing p s is th of th ber o es a mber of times the person reports drinking. A higher proportion

a person’s drinking frequently leads to heavy drinking, a lower indicates that t ividu ely dr ore than 5 drinks on an

ould indic t 65% of the ind l’s dr occa drinking 5 or more drinks.

can see s meå were more rink heavily, and those from Lund were least likely to drink heavily. However,

nce standardized by age and sex, the only site that stands out from the rest is Lund

e-to-drinking ratio is not ised as high as we see at the other sites.

e litera , which i ore con vative ththe CANs twice a month estimate, w

a month. see th

per occasion at least once ce ag sing th easure m stude t LundVäxjö are drinking hea (p<0.0 . A final l drink attern e ratio e num f timperson binge drinks to the nu(closer to 1) indicates thatproportion (closer to 0) he ind al rar inks moccasion. A ratio of 0.65 w ate tha ividua inking sionsinvolved In the last row of Table 3.3 welikely to d

that when drinking, the student from U

o(p<0.001). The prevalence of heavy drinking is highest at Lund, but because the prevalence

f drinking (in any amount, large or small) is also highest their bingora

29


Table 3.3 Frequency of Alcohol Consumption and Binge Drinking by Site (n=4537)

University / Högskola Alcohol Consumption Kalmar n=547 %

Växjö n=702 %

Umeå n=1304 %

Lund n=2022 %

Total n=4575 %

Frequency of alcohol consumption 2 or more times per week 2 to 4 times per month

6.3 55.4

11.5 55.7

3.6 53.4 38.3 4.7

15.5 59.7 21.4 3.4

10.4 56.6 29.0 4.0

Once a month or less often Never

33.4 4.9

30.3 3.5

Frequency of binge drinking1

1

2 or more times per week 2 to 4 times per month Once a month or less often Never

2.2 30.0 51.0 16.8

2.8 34.2 48.6 14.4

1.2 30.7 54.2 13.9

4.5 33.9 46.1 15.5

3.0 32.6 49.4 15.0

Binge drink at least monthly 51.2 56.5 54.1 56.0 55.0

Ratio of binge drinking to any drinking

0.50 0.51 0.55 0.45 0.49

1 Binge drinking is equivalent to drinking a bottle of wine on one occasion. In terms of volume of alcohol consumed, this equates to about 1-75cl bottle of while, or 5-6 (25 cl) shots of spirits, or 4 cans of strong beer, or 6 cans of light beer. Drink preference was measured by one question that asked the student to indicate the type of alcoholic beverage they would typically prefer to drink, if they were given a choice. The most popular choice of beverage was wine (30.9%) followed by strong beer (22.7%), a combination of drinks (22.4), cider (12.2%) and spirits (4.5%). Fewer than 3% preferred any of the following beverage types: alcopops, folköl fortified wines or other options. There were no significant differences in the ranking of the top four beverage choices by study site. Risk Factors for Weekly Drinking and Binge Drinking Individual Characteristics Drinking frequency and binge drinking was examined in relation to a number of potential risk factors, including sex, age, living situation, income, and physical and mental health status (see Table 3.4). The majority of these risk factors were predictive of the three outcome variables. Males drank more regularly than women (46.6% versus 36.0%), and binged at almost twice the rate of women (46.9% versus 28.9%). As a result, the ratio of men’s binge occasions to drinking occasions was also significantly higher than women’s.

30


Table 3.4 Individual Characteristics That Increase the Risk of Drinking Weekly and Binge Drinking by Students (n=4537)

Characteristic Drank Weekly

%

Binge Drank1

Twice a Month or More Often

%

Ratio of Binge Drinking to

Drinking Occasions

Sex Male Female

**** 46.6 36.0

**** 46.9 28.9

**** 0.58 0.43


** 36.0 41.0 39.9 29.5 40.6

**** 33.8 32.4 35.1 15.8 11.6

**** 0.47 0.55 0.49 0.32 0.21


**** 44.4 48.3 49.9 29.8 32.6 31.5 17.3 47.5

**** 41.8 49.4 55.0 27.2 11.2 24.6 9.6 36.1

*** 0.53 0.57 0.60 0.43 0.27 0.44 0.36 0.46


40.5 41.7 33.9 62.5 38.9 34.4

**** 38.2 27.5 29.5 37.5 38.2 17.4

**** 0.52 0.38 0.44 0.39 0.49 0.34


**** 24.6 36.9 41.2 46.1 45.9 52.3

**** 15.6 30.1 39.7 48.2 48.4 51.0

0.36 0.45 0.52 0.55 0.56 0.60

Physical health status Very Good Good Ok Rather Poor Very Poor

* 43.2 42.0 37.2 35.6 34.6

**** 54.6 57.0 54.5 48.1 30.8

*** 0.49 0.49 0.49 0.45 0.43

Psychological health status Very Good Good Ok Rather Poor Very Poor

39,9 42,2 39,7 34,2 39,1

53.8 56.8 54.1 54.8 49.3

0.49 0.49 0.48 0.50 0.52

Social support At present, how many people do you have that you feel you could comfortably confide in? 0 1-2 3-5 6 or more

**** 43.8 33.5 40.8 44.3

**** 37.5 45.0 56.5 61.7

*** 0.43 0.43 0.50 0.51

1 Binge drinking is equivalent to drinking a bottle of wine on one occasion. In terms of volume of alcohol consumed, this equates to about 1-75cl bottle of while, or 5-6 (25 cl) shots of spirits, or 4 cans of strong beer, or 6 cans of light beer. * p<0.05, ** p<0.01, *** p<0.001, **** p<0.0001

31


Age was unrelated to drinking frequency, except for individuals aged 30 to 34 years, who reported drinking less often. The frequency of binge drinking, however, did decrease with age. Students living in their own apartments (44.4%), student corridors (48.3%), and those living with roommates (49.9%), drank more often and were more likely to binge that those living in other circumstances. Students with children were less likely to drink heavily (11.2% and 9.6%), and slightly less likely to drink regularly (32.6% and 17.3%). While main type of income was not related to frequency of drinking, it was related to the amount consumed by students. Those who received their main income from work—with (27.5%) or without additional student loan (29.5%)—reported participating in binge drinking less frequently. Physical health was related to both frequency and quantity consumed. Students in good physical health drank more often than those in poor health and they drank in significantly greater volumes. Mental health was not related to either drinking quantity or frequency; however, having a greater number of people to confide in was. This may indicate that having a greater number of confidants meant having more close friends nearby, and thus more social events and opportunities to drink. Pre-University Factors A number of factors that occurred in students’ lives before they attended university also were related to their alcohol consumption while studying (see Table 3.5). Students who moved to attend University from Stockholm, Göteborg or Malmö/Lund reported drinking more often (53.2%) and in greater quantities (45.4%) than students from smaller cities and towns or who had lived in the university town before school began. Home stability, prior to the age of 18, was not significantly related to weekly drinking. A test for trend (not shown) does indicate that with decreasing home stability the likelihood of drinking weekly increases, almost to the point of significance (p=0.059). Students who lived in special circumstances prior to the age of 18 were less likely to drink often (31.9%), or to binge drink often (29.6%). University-related Characteristics Course of study, involvement in activities on-campus, and progress through school were also of interest in relation to students drinking patterns (see Table 3.6). While enrolment in free-standing courses was related to increased frequency of drinking (43.4% versus 38.9%), enrolment in a program of study was related to frequency of heavy drinking (36.9% versus 32.6%). Thus, students enrolled in a program of study were binge drinking on 50% of their drinking occasions, significantly more than those in enrolled in free-standing courses (43%). Students enrolled in Economics/marketing, Law, Social Science and Technology courses were most likely to drink often and heavily. Those enrolled in Police studies and Teaching drank least often and in smaller quantities. Completion of courses and progression through one’s studies was not related to frequency of drinking; however, students who were earlier in their course of study (had accumulated fewer academic points) were more likely to binge drink. Full-time students binged during about 50% of their drinking occasions, whereas part-time students did during only about a third of their drinking occasions. This is possibly related to work status as well. Students who lived in high student-density areas drank heavily in more of their drinking occasions. Participating

32


in activities on-campus raised the frequency and quantity of alcohol consumed. The only type of activity that did not increase the intoxication to occasion ratio was involvement in training and hobby-related activities. Students who had studied outside of Sweden drank more often (50.6%) than those who had not (37.7%), and also had spent a larger portion of their drinking occasions binge drinking (0.50% versus 0.44%). Table 3.5 Pre-university Factors That Increase the Risk of Drinking Weekly and

Binge Drinking by Students (n=4537) Pre-university Factors Drank Weekly

%

Binge Drank1 Twice a Month or

More Often %

Ratio of Binge Drinking to Drinking Occasions

Where lived before starting at current university In city where school is located Stockholm, Malmö / Lund or Göteborg Other city (>27,000) Small town or farm Outside of Sweden

**** 37,0 53,2 41,3 35,4 43,5

**** 27.5 45.4 39.9 36.4 35.1

** 0.42 0.48 0.54 0.52 0.48

Parental living situation, prior to age 18 Lived with both parents Lived with one, saw other often or always Lived with one, saw other irregularly or not at all Adopted No or little stability

40,7 38,3 37,3 36,5 33,3

* 36.5 33.3 30.9 38.1 42.9

* 0.49 0.49 0.45 0.50 0.48

Lived in special circumstances prior to age 18 1 Yes No

** 40,5 31,9

* 36.2 29.6

* 0.49 0.47

1 Binge drinking is equivalent to drinking a bottle of wine on one occasion. In terms of volume of alcohol consumed, this equates to about 1-75cl bottle of while, or 5-6 (25 cl) shots of spirits, or 4 cans of strong beer, or 6 cans of light beer.1 Special Circumstances include ever having lived in any of the following places prior to the age of 18: relatives other than parents or adoptive parents, foster home, boarding school, treatment or other care institution, jail, or living on one’s own, with or without a roommate. * p<0.05, ** p<0.01, *** p<0.001, **** p<0.0001 Stress from school can also be related to students drinking patterns. Three measures were used in this study to measure three different types of stress: autonomy, pressure and satisfaction (see Table 3.6). Each of these measures was created from a number of statements to which the student indicated their level of agreement or disagreement. Autonomy was comprised of three statements:

“At school, I have very little freedom to decide which courses I would like to take,”

“I take a wide variety of interesting courses” and

“I have a lot of input about the speed at which I complete my studies.”

33


The pressure measure was comprised of four statements:

“I feel constantly under strain,”

“ I am not asked to do an excessive amount of studying,”

“I have enough time to get my assignments and studying done” and

“I can always rely on other students for support when things get rough at school.”

The final measure, satisfaction, was comprised of three statements:

“I gain a sense of accomplishment through my education,”

“My education will help me to get a good job” and

“You can generally trust me to do well in school.”

It is generally believed that it is better to have high levels of autonomy and satisfaction, but lower levels of pressure for better student mental health. In this study we found that Students under less pressure and with lower higher autonomy drank alcohol more frequently (42.1% and 41.7% respectively) . Perhaps low pressure was related to more frequent drinking because it allowed people more free time to socialize. These same students also drank more when they were drinking, and thus had higher intoxication to occasion ratios compared to students with under high pressure and with low autonomy. This result suggests that these students are drinking more for enjoyment than to escape. Beverage Preference Students who preferred to drink strong beer (52.8%), spirits (52.0%) or a combination of different drinks in one sitting (43.2%) reported more binge drinking than students who preferred other beverage types (fortified wines 35.4%, folköl 31.0%, wine 30.0%, cider 19.7% other 21.0%) (p<0.0001). Students who preferred strong beer were also the most likely to drink weekly (52.3%), although the variation with drink preference was not as large as with binge drinking (combination 45.9%, wine 43.9%, folköl 42.9%, spirits 41.8%, fortified wines 31.8%, cider 16.3% other 24.7%).

34


Table 3.6 University-Related Factors That Increase the Risk of Drinking Weekly and Binge Drinking by Students (n=4537)

University-Related Factors Drank Weekly

%

Binge Drank1 Twice a Month or

More Often %

Ratio of Binge Drinking to Drinking

Occasions Course of study Program Free-standing courses

** 38.9 43.4

*** 36.9 32.6

** 0.50 0.43


**** 50.4 36.6 50.3 43.3 31.8 26.6 18.8 44.4 37.4 41.6 42.8

*** 51.2 28.8 42.1 28.1 28.0 26.7 23.4 40.6 34.0 42.4 33.0

*** 0.60 0.46 0.48 0.36 0.44 0.50 0.54 0.51 0.46 0.54 0.43


41.8 41.9 36.7 39.7

**** 58,3 57,1 58,1 49,7

**** 0.52 0.51 0.53 0.43

Study full-time Yes No

39.8 43.9

**** 36.6 22.3

**** 0.49 0.34

Live in student region High Medium Low/no

**** 38.9 47.6 32.9

*** 40.2 41.9 26.7

** 0.56 0.51 0.42

Participate in activities on campus Pubs and parties **** Athletics and hobbies **** Extracurricular academics **** Nations and associations**** None of the above

46.6 46.3 46.3 48.9 32.0

46.1 43.7 42.3 47.6 38.3

0.52 0.39 0.51 0.55 0.45

Studied outside of Sweden in gymnasium or university Yes No

**** 50.6 37.7

37.1 35.6

**** 0.50 0.44

Course Pressure Low High

*** 42.1 36.6

**** 39.4 30.1

**** 0,52 0,45

Course Autonomy Low High

** 37.3 41.7

* 33.9 37.1

0,49 0,50

Course Satisfaction Low High

43.8 39.8

36.9 35.8

* 0,53 0,49

1 Binge drinking is equivalent to drinking a bottle of wine on one occasion. In terms of volume of alcohol consumed, this equates to about 1-75cl bottle of while, or 5-6 (25 cl) shots of spirits, or 4 cans of strong beer, or 6 cans of light beer. * p<0.05, ** p<0.01, *** p<0.001, **** p<0.0001

35


Multivariate Risk Factors for Binge Drinking In order to gain a more thorough understanding of the main predictors of university student binge drinking, a multivariate logistic regression was conducted. Each of the risk factors identified in the bivariate analyses in this chapter was assessed for retention in the model. Ultimately, since many of them were related, some had to be removed because they were too similar to have in the model, and others were no longer significant risk factors once they were all examined together in one analysis. The resulting model (seen in Table 3.7) identifies the main risk factors predicting bi-weekly binge drinking. Males were twice as likely to binge drink (OR=2.02) as females. Students aged 20-24 were 80% more likely, and those aged 25-29 were 62% more likely to binge drink than students over the age of 35 years. Students who lived alone, in a student corridor or with roommates were more than two times as likely to binge drink as those who lived with their parents or with a partner and/or children. As monthly disposable income went up 1000 SEK per month, students were 20% more likely to binge drink. Similarly, for every two confidants that students had, they were an additional 16% more likely to binge drink biweekly. Students whose main form of income was via work were only 70% as likely to binge drink as those who were supported by their parents, and since there was no statistical difference between those on student loan and those who obtained money from their parents, students who lived off of their work income were about 30% less likely to binge drink as students on student loan or stipend as well. Students who lived in any of Stockholm, Malmö or Göteborg, prior to beginning their education at the university were almost 40% more likely to binge drink biweekly as those who lived within the city where the school is located. Students who studied Economics, Social Sciences, Social work and technology courses were at increased risk of binge drinking compared to students in other areas of study. In addition, as students progressed further into their studies, their risk of binge drinking decreased by 12% for every additional 40 credits that the student completed. Students who attended parties and pubs on campus were 75% more likely to binge drink compared with those who did not. Similarly, students who were involved in Nations and associations on campus were also at increased risk of binge drinking. They were 27% more likely to binge drink bi-weekly than were students who were not involved in such associations. Students who felt under high academic pressure were 20% less likely to binge drink than those who reported that they were under low academic pressure to complete their work. Finally, once all of these factors were controlled for, students at Umeå University were 20% less likely to binge drink as students at the other universities in this study.

36


Table 3.7 Multivariate Logistic Regression Identifying Risk Factors for Bi-weekly Binge Drinking Among Students (n=4512)

Characteristic Odds Ratio

95% Confidence Interval

Sex Female [REF] Male

1.00 2.02

1.74 - 2.35

Age Group 16 - 19 years 20 - 24 25 - 29 30 – 34 35 and older [REF]

1.33 1.81 1.62 0.84 1.00

0.78 - 2.26 1.27 - 2.56 1.13 - 2.31 0.54 - 1.30

Current Living Situation With Parents [REF] Alone, in Student corridor or with roommates With partner and or children

1.00 2.18 1.02

1.61 - 2.94 0.74 - 1.39

Main form of income Parents [REF] Student loan or stipend Work (with or without load as well)

1.00 1.10 0.70

0.83 - 1.44 0.50 - 0.96

Monthly disposable income 1.19 1.14 - 1.24

Social Support 1.16 1.05 - 1.28

Where lived before starting at current university In city where school is located [REF] Stockholm, Malmö / Lund or Göteborg Small town or city Outside of Sweden

1.00 1.38 1.03 0.97

1.09 - 1.74 0.86 - 1.22 0.65 - 1.45

Area of Study Economics/marketing Social Science Social Work Technology Other [REF]

1.85 1.42 1.78 1.41 1.00

1.37 - 2.49 1.04 - 1.92 1.68 - 2.65 1.25 - 1.75

Academic points from current school 0.88 0.82 - 0.93

Participate in activities on campus Pubs and parties No Pubs and parties [REF] Nations and associations No nations and associations [REF]

1.76 1.00 1.27 1.00

1.49 - 2.05 1.18 - 1.47

Course pressure Low [REF] High

1.00 0.80

0.69 - 0.93

University Umeå Other universities [REF]

0.69 1.00

0.58 - 0.81

[REF] identifies the reference group where dummy variables have been used.

37


Multivariate Risk Factors for Weekly Drinking A second logistic regression was conducted in order to gain a more thorough understanding of the main predictors of weekly drinking among university students. Each of the risk factors identified in the bivariate analyses in this chapter was assessed for retention in the model. The resulting model (seen in Table 3.8) identifies the main risk factors predicting bi-weekly binge drinking Males were 50% more likely to drink weekly than females. Students who lived alone, in a student corridor or with roommates were almost twice as likely to drink weekly as whose who lived with their parents. Students with partners or children were 14% more likely to drink weekly than those living with their parents. Students who lived in Stockholm, Göteborg or Malmö/Lund were 45% more likely to drink weekly; however those who lived outside of Sweden were 20% less likely to drink weekly than those who had lived in the same town as the university prior to starting their studies there. When controlling for other factors n the model, weekly drinking was more common amongst older students. Students in age groups below the age of 35 were only about 50% as likely to drink weekly as those who were older. Students who had lived in special circumstances prior to turning 18 years old also had decreased odds of drinking weekly. In addition, students who were enrolled in a program of study were 15% less likely to drink weekly as those enrolled in free-standing courses. Students enrolled in economics and business were 40% more likely to drink weekly than were students in other programs. Living in medium and high student-density areas were related to a 27 to 38% increase in weekly drinking as was participating in parties and pubs on campus (55% increase) and being active in nations and other associations (25% increase over those who were not active). Students who had studied outside of the country during their either gymnasium or university years were 50% more likely to drink weekly than those who did not. Drinking was less frequent when students were under additional pressure due to their coursework. Under high pressure, students were 15% less likely to drink weekly or more often. Course satisfaction was also related to less frequent drinking. Finally, students at Lund University had a 61% greater likelihood of drinking weekly when compared to students at Kalmar. Students at Umeå University were only two-thirds as likely to drink weekly, as were students from Kalmar. Students at Växjö neither drank more or less often.

38


Table 3.8 Multivariate Logistic Regression Identifying Risk Factors for Weekly Drinking Among Students (n=4512)




1.00 1.50

1.30 1.73


0.45 0.54 0.58 0.49 1.00

0.27 - 0.74 0.41 - 0.72 0.44 - 0.78 0.35 - 0.70


1.00 1.95 1.35

1.43 - 2.64 1.09 - 1.83

Monthly disposable income 1.14 1.08 - 1.19



1.00 1.45 0.80 0.79

1.15 - 1.82 0.67 - 0.96 0.53 - 1.19

Lived in special circumstances before the are of 18 1 Yes No [REF]

0.78 1.00

0.58 - 1.10

Course of Study Program Free-standing courses [REF]

0.85 1.00

0.72 - 0.95

Area of Study Economics/marketing Other [REF]

1.39 1.00

1.14 - 1.69

Live in Student region High Medium Low [REF]

1.27 1.38 1.00

1.03 - 1.56 1.16 - 1.64

Participate in activities on campus Pubs and parties No Pubs and parties [REF] Nations and associations No nations and associations [REF]

1.55 1.00 1.25 1.00

1.32 - 1.81 1.06 - 1.46

Studied outside of Sweden in gymnasium or university Yes No [REF]

1.49 1.00

1.24 - 1.78

Course pressure Low [REF] High

1.00 0.85

0.73 - 0.98


1.00 0.77

0.58 - 1.01

University Kalmar [REF] Växjö Lund Umeå

1.00 1.23 1.61 0.67

0.94 - 1.60 1.28 - 2.02 0.52 - 0.86

[REF] identifies the reference group where dummy variables have been used. 1 Special Circumstances include ever having lived in any of the following places prior to the age of 18: relatives other than parents or adoptive parents, foster home, boarding school, treatment or other care institution, jail, or living on one’s own, with or without a roommate.

39


4. Prevalence and Context of Illicit Drug Use Prevalence of Drug Use Cannabis was used by far more students than any other drug, with 25.4% of students having tried it during their lives, 8.9% having used it in the last 12 months, and 3.2 during the course of the fall school term. Students reported the use of amphetamines as the second most common drug used, with 4.1% using them lifetime, 0.8% using them in the last 12 months, and 0.3% using them during the term. Ecstasy use was slightly less common than that of amphetamines (with 3.2% lifetime and 0.9% 12-month, and 0.3% prevalence rates). Very few students reported doping (0.5% lifetime, 0.3% 12 month, and 0.2% fall term prevalence rates), and 7.4% of students indicated that they had taken some other form of illegal drug during their lives, 2.0% in the last 12 months and 0.2% took another illegal drug during the course of the fall term. In total, 27.1% of students reported using any illicit drug during their lives (see Figure 4.1). This differed by site, with students at Lund reporting significantly more drug use (33.1%) and Kalmar reporting significantly less use (17.5%), than students at Umeå (24.5%) and Växjö (22.4%) (p<0.0001). In the last year, 9.6% had used an illicit drug, and trends by site followed the same patter as for lifetime drug use. Most of the students using these drugs have also used cannabis (94% of those who had tried any drug in the their lives, and 93% of those who had used on in the past year).

Figure 4.1 Use of Any Drug, by Site (Excluding Prescriptives)

17,5

22,3624,54

33,02

27,11

6,037,55 8,1

12,69,76

3,33 4,873,28

5,48 4,5

0

5

10

15

20

25

30

35

Kalmar Växjö Umeå Lund Total

LifetimeYearTerm

% Having Used% Having Used

****

* * p<=0.0001p<=0.0001

40


Prescription Drugs For drugs that can be sold as legal over the counter drugs or by prescription from a physician, our definition of a drug indicated that students should only report prescription drugs that were taken without a valid prescription and those that were used in a manner NOT as prescribed by the physician. Over the counter preparations were not to be considered drugs, nor were prescription drugs that were taken as prescribed by a physician. Using this definition, prescription drugs (painkillers, sedatives, tranquilizers, anti-depressives, and rohypnol) were used by 15.4% of students during the course of their lifetimes, 9.1% in the last 12 months, and 6.9% of students during the fall term. These rates are somewhat higher than expected, and a small number of people did write in the margin of the questionnaire that they were taking the drug as prescribed. In cases where this was noted in the margin, the respondent’s answer was changed to indicate non-use. However, if other students also included drugs that they were taking as prescribed by physician, having missed our instruction, we could be over-estimating the rate of ‘recreational’ prescription drug use. Adding the use of prescription drugs to that of other drugs, we see that a total of 36% of students had used a drug (other than alcohol and tobacco) during their lives (see Figure 4.2). When comparing the four universities, this time Kalmar (26.4% lifetime, 12.7% 12 months) was the only location where drug use was significantly different from the others. Kalmar’s prevalence of drug use, including prescription drugs, did not differ from the other sites for the prevalence of use during the fall term (9.5% versus 12.8%, 9.3%, 9.5%).

% Having Used% Having Used

Figure 4.2 Use o , te (INclu rescriptivf Any Drug by Si ding P es)

26,383031,38

34,04

12, 13,47 15,38

21,015

9, 9,318

810

15

25

35

Kalm Växjö Umeå und tal

41,44

364045

LifetimeYear

7317,2

9,5 4612,

10,

05

1

20

ar L To

Term

**

p<=0.0001p<=0.0001

* *

41


University Specific Prevalence Rates Table 4.1 shows a closer examination of the three most common types of drugs by univsite (see Table 4.1). Once standardized by age and sex, students at Lund have used cannabis more than students at the other sites during each of the three time periods, whereas stKalmar have reported less use during their lifetimes and the last 12 months only.

ersity

udents at

able 4.1 Prevalence of Use, for the Three Most Regularly Used Categories of Drugs, by Site T (n=4559)


Växjö n=702 %

Umeå n=1304 %

Lund n=2022 %

Total n=4575 %

21,3

32,4

25,3

Cannabis Lifetime ****

17,4

22,0

Last year **** Current term1 *

5,9 2,8

7,7 5,4

6,9 1,8

12,0 4,0

8,9 3,2

Amphetamines Lifetime **** Last year Current term1 **

1,8 0,4 0,0

4,4 1,2 0,5

3,8 0,3 0,3

5,4 1,2 0,4

4,1 0,8 0,3

Ecstasy Lifetime *** Last year **

1,3 0,1

2,6 0,1

2,5 0,7

4,7 1,4

3,2

Current term1 *** 0,1 0,0 0,2 0,6 0,9 0,3

1 The actual length of time in this period varies between 2 and 4 months, depending upon when questionnaire was completed by the participant With respect to lifetime amphetamine use, students at Lund were more likely to have tried them, and students at Kalmar less likely to have tried them. For 12-month prevalence, students at Lund were most likely to have used them. Although it would appear by looking aTable 4.1 that Lund also has the highest prevalence of use during the fall term, once tandardized for ag

t

e and sex, students at Umeå were most likely to have used amphetamines uring that period (p<0.0001). Students at Kalmar reported no use of amphetamines during e fall of 2003.

The rate of ecstasy use was highest at Lund during all three time periods and lowest at Kalmar for the lifetime period only. Students at Växjö reported no use of ecstasy during the fall of 2003. Context and Details of Cannabis Use Lifetime, marijuana use was slightly more common than hash use by the students. Marijuana alone was used by 27.8% of students who had reported using cannabis, 21.8% used hash only, and the remaining 50.4% had used both. The mean age of debut of cannabis use was 19.0 years (SD 2.6). Students started hash use at a younger age (mean 18.2 years, SD 2.3) than the started marijuana use (means 20.3 years, SD 2.6) (p<0.0001). Slightly more than half (52.4%) of the students had tried cannabis the first time while feeling under the influence of alcohol, less than 1% had been under the influence of another drug at the time. Although 25.4% of students had tried cannabis during their lives, few students were regular consumers of drugs; data suggest that the large majority have only experimented lightly. Of

sdth

42


the students who had tried cannabis, 35% had used it only 1-2 times, and 73.6 % had used it 10 or fewer times, in total. Similarly, 45% of students who had tried amphetamines or ecstasy had used them only 1 or 2 times; 73% of amphetamine users and 76% of ecstasy users used them as many as 10 times. See further details of the number of times cannabis was used, by site in Figure 4.3.

Figure 4.3 Number of Times Cannabis Has Been Used, by Site - Lifetime

0102030405060708090

100

Kalmar Lund Umeå Växjö Total

100 or more41 - 99 times11 - 40 times5 - 10 times3- 4 times1 - 2 times

# times used # times used

**

Percent

tudents who had used cannabis during the 12 months prior to the survey were asked

weekly or more often during the year, with less an 1% reporting daily use. A large majority indicated that they had only used it less than

three larges cities, 11.1% received it in a nearby town, 9.0% indicated that they had otten their cannabis in the university area, and 22.6% indicated that they got it is some other

* * p<=0.0001p<=0.0001

Sadditional questions about the context of their use. Few cannabis users (7.5%) indicated thatthey had used cannabis orally (i.e., in tea, brownies or other food); however 1.3% indicated that they had only consumed it in this manner in the past 12 months. Only 6.0% of the students indicated that they had used cannabisthonce a month (79.5%); 29.7% indicating that they had only used it one time. Passing a joint (cannabis cigarette) around to others present is a common form of using this drug, 85% of the students who had used cannabis in the last 12 months had been invited by others to use. A smaller percentage had bought their own cannabis (34.7%) and growingone’s own was even less common (1.31%). When asked where the students got their cannabis, 37.7% indicated in the same city as the university, 35.8% had gotten it from outside of the country, 22.1% got it from one of Sweden’sg

43


location (multiple responses were possible). Some differences did exist by university. Students from Växjö were more likely to get their cannabis in the university area. StudentsLund were most likely to get their cannabis from outside of Sweden, or in one of Sweden’s three largest cities (likely Malmö). Students at Umeå were most likely to report gettincannabis in Umeå. Finally, students at Kalmar were more likely to get theirs from an “othelocation. Students were asked where they typically used cannabis during the 12 months prior to the survey. The most frequently reported response was at friends home (64.8%), followed by home (43.3%), outdoors (31.6%), outside

at

g their r”

of Sweden (23.5%), on vacation in Sweden (8.9%), nd at a club or bar (6.7%). Very few people indicated that they used cannabis at the

nd at the niversity (12.8%). Students at Lund were most likely use at home (45.9%) as were students

.6% mer

Responses to questions regarding control over, nd fear of consequences of, cannabis use are shown in Table 4.2. A majority of students fel re in control of their use, and felt

ages of use outweighed the disadvantages. In addition, less than 20% indicated

s

d students’ use of harder drugs. Table .3 shows the age of debut for each of the substances. Students’ first experience of getting

drunk (15.8 years) predated daily tobacco use (16.7 years); however, had we asked about initiation of occasional tobacco use, it likely would have predated the first experience of intoxication. Amphetamines and ecstasy were the only harder drugs included these questions due to the expected low frequency of consumption of other drugs. However, it is clear that the age of debut for these drugs occurred later in life for these two drugs (19.9 years and 20.4 years respectively) than for marijuana (19.0 years).

auniversity (2.1%), at a rave or party (2.1%), or at work (1.1%); A further 7.8% of students indicated that they used cannabis in an “other” location. Some differences did exist by university. Students from Växjö were more likely to use at a friends home (74.5%) auat Umeå (44.3). Finally, students at Kalmar were more likely to use outdoors (41.4%) or to have used it outside of Sweden (34.5%). When asked during which period in the last year did they used cannabis the most often, 44indicated that they used it most often in the term prior to the summer, followed by the sum(38.7%). Only 16.7% indicated that they had used it most since the fall term began.

at that they we

that the advantthat they had fears about being arrested by the police, or experiencing negative health or mental health consequences resulting from their use of the drug. When only examining students who had used cannabis more than 40 times (n=72), the results were somewhat lesskewed to the positive, but the shifts were barely significant.

Age of Debut The use of tobacco, alcohol and softer drugs predate4

44


Table 4.2 Agreement with Statements About Control over Cannabis Use, and Fear of

Consequences (n=381) Statement Agree

strongly %

Agree Somewhat %

Disagree Somewhat %

Disagree Strongly %

I have full control over my use of marijuana/hash 94.0 5.2 0.5 0.3

The benefits of my marijuana/hash outweigh the disadvantages 20.2 27.4 25.8 26.6

I worry that my physical health will be influence by my use of marijuana/hash 7.4 11.6 15.2 65.8

I worry that I will be arrested by the police if I continue to use marijuana/hash 5.0 11.3 18.6 65.1

I worry that my mental health will be influence by my use of marijuana/hash 7.9 11.6 19.2 61.4

Table 4.3 Age of Debut First time the participant … Mean

age (SD) Range n

Used tobacco daily 16.7 (2.7) 8 - 30 1391 Became drunk (berusad) 15.8 (2.2) 8 - 30 4332 Tried cannabis 19.0 (2.6) 12- 26 1148 Tried amphetamines 19.9 (2.8) 12-26 185 Tried ecstasy 20.4 (2.1) 12-26 143

Context and Details of Amphetamine and Ecstasy Use The frequencies of use of amphetamines and ecstasy are reported in Figure 4.4. As with cannabis, few students had used either of these drugs more than 10 times. Forty-five percent of students who had tried either amphetamines or ecstasy had used them only 1 or 2 times; 73% of amphetamine users and 76% of ecstasy users had used them as many as 10 times. Similar questions were asked about the context of amphetamine and ecstasy use as were asked of cannabis; however since the numbers of students using the drugs was so small, this section will only highlight where differences were seen when compared with cannabis. The first time that the students tried amphetamines, 48.1% of the students were under the influence of alcohol and another 9.6% were under the influence of another drug, likely cannabis. Only 37 students had used amphetamines in the last year, 85% had taken it by pill and 58.9% had sniffed (snorted) it. Only 10 students had used these drugs more than once month over the last year. It was more common for people to buy their own amphetamines (85%) than to be offered some by someone for free (47.1%). These drugs were most commonly used at a friend’s house (57.6%), at bars (45.5%), and at home (42.4%). Another

45


20% used amphetamines outside of Sweden, and only 3% used them at the university. Answers to the questions about control over use and fear of consequences of use of amphetamines followed similar patterns to that of cannabis.

Figure 4.4 Number of Times Amphetamines and Ecstasy Have Been Used - Lifetime

5060708090

100# times used# times used

Percent

100 or more41 - 99 times11 - 40 times5 - 10 times

3040

3- 4 times1

1020

0

Amphetamines Ecstasy

- 2 times

The first time that the students tried ecstasy, 44.8% of the students were under the influence of alcohol and another 6.2% were under the influence of another drug, likely cannabis. Only 39 students had used ecstasy in the last year, all had taken it in pill form. Only 7 students had used these drugs more than once month over the last year. As with amphetamines, it was more common for people to buy their own ecstasy (82.1%) than to be offered some by someone for free (43.6%). These drugs were most commonly used at bars (63.2%), a friend’s house (42.1%), a club or rave (23.7%), and at home (23.7%). Another 23.7% used ecstasy outside of Sweden, and none had reported their use at the university. Answers to the questions about control over use and fear of consequences of use of amphetamines and ecstasy followed similar patterns to that of cannabis.

Prevalence of Use of Other Drugs The prevalence use other drug use is presented in Table 4.4. Painkillers (11.6%) had the highest lifetime prevalence rate, followed by Sedatives (5.2%), Antidepressants (4.3%), magic mushrooms (3.1%) and cocaine (2.7%).

(n=187) (n=146)

46


Table 4.4 Drug Use Prevalence1 (n=4559) Drug Type Lifetime

% Year %

Term %

Prescription Drugs Painkillers Sedatives Anti-depressants Rohypnol

11.6 5.2 4.3 1.4

7.1 2.2 2.0 0.3

5.5 1.4 2.2 0.2

Cocaine Crack

2.7 0.1

0.6 0.04

0.2 0.02

Magic Mushrooms Other Hallucinogens

3.1 1.6

0.3 0.2

0.09 0.04

GHB 0.6 0.02 0.02

Heroin 0.6 0.0 0.0

Doping 0.5 0.3 0.2

Other drugs 1.9 0.5 0.4

1 drug used as least one time during the period indicated 2 To be included these drugs were to have been taken against or without a physician’s prescription. However, given the high rates of reported use it is not clear that participants followed this direction explicitly. There were very few variations, by site, in the rates of lifetime use for the drugs listed in Table 4.3. Students in Lund (3.8%), and to a lesser extent Kalmar (2.2%) were more likely to report using cocaine than students in either Umeå (1.7%) or Växjö (1.8%) (p<0.0018). Magic mushrooms were also not used at the same rates at all universities. Their use was most common in Lund (3.8%), followed by Umeå (2.7%), Växjö (2.7%) and Kalmar (1.9%) (p=0.0182). Cocaine was the only drug that showed variation across the sites, in the 12-month prevalence rates. More students at Lund reported using cocaine (1.00%), than at any other site (Kalmar, 0.6%, Umeå 0.3%, and Växjö, 0%) (p=0.0038). During the course of the fall term, the use of two drugs differed across universities, painkillers and sedatives. Use of painkillers during the fall term was highest at Lund University (6.2%), with Kalmar second highest (5.3%), followed by Umeå (4.7%) and Växjö (3.5%) (p=0.0380). Similarly, Lund recorded the highest prevalence rate for sedative use during the fall term (1.8%), followed by Växjö (0.9%), Umeå (0.9%) and Kalmar (0.8%). Risk Factors for Current Cannabis and Prescription Drug Use Individual Characteristics Twelve-month prevalence rates of cannabis use and prescription drug use were examined in relation to a number of potential risk factors including: sex, age, living status income, health status, and social support (see Table 4.5). The rates of both cannabis use and prescription drug use were related to sex. Men reported more use of cannabis (12.2%) than women (6.9%), and less use of prescription drugs (7.3% versus 10.6%). Younger students were more likely to use cannabis, and older students were more likely to report using prescription drugs.

47


Table 4.5 Individual Characteristics That Increase the Risk For Cannabis and Prescription Drug Use by Students (n=4559)

Characteristic Cannabis Use

12 month Prevalence

%

Prescription Drug Use 12 month

Prevalence %

Sex Male Female

**** 12.2 6.9

**** 7.3 10.6


**** 7.2 10.8 8.4 3.7 0.9

* 12.3 8.7 8.8 10.2 12.6


**** 9.4 14.9 15.4 7.9 2.6 4.1 5.7 8.3

*** 10.1 7.6 12.7 8.9 11.1 7.3 11.6 10.8


**** 10.1 4.4 5.9 6.5 7.5 2.4

* 9.4 10.5 10.3 0.0 8.2 6.1


**** 3.7 9.3 9.8 11.1 7.9 11.8

*** 11.3 8.6 8.9 7.9 10.8 11.3


* 7.9 9.3 10.4 8.9 7.7

**** 6.9 9.5 11.7 14.1 23.1


*** 7.9 8.1 9.5 11.9 17.4

**** 5.6 8.3 12.1 13.3 30.4

Social support At present, how many people do you have that you feel you could comfortably confide in?

0 1-2 3-5 6 or more

14.0 8.3 8.8 9.3

*** 16.0 11.6 9.4 6.4

* p<0.05, ** p<0.01, *** p<0.001, **** p<0.0001

48


Twelve-month cannabis use was most common among students living on their own (14.9%), in student corridors (15.4%), and with roommates (9.4%). There was some overlap with prescription drug use, in that students living with roommates (12.7%) reported the highest rates of use. Use was also high among students living with children—with (11.1%) or without (11.6%) a partner—and it was also increased among those who lived alone (10.1%). Students living primarily off of money obtained through student loan (10.1%) were most likely to use cannabis; whereas those who obtained their income primarily through work (10.5% and 10.3%) were more likely to use prescription drugs. With both types of drugs, individuals with higher disposable incomes were more likely to have taken the drug in the past year. However, the rate of prescription drug use was also raised among those with a disposable income of only 500 SEK or less. Physical and Mental health status was related to both types of drugs, although the association was stronger with prescription drug use. Cannabis use was highest amongst people who described their physical health as okay (10.4%); whereas prescription drug use increased with deteriorating physical health. The trend with mental health was similar with both types of drugs. People with poorer health used significantly more cannabis and prescription drugs than did people who reported their mental health to be better. Social support was poorer for those taking prescription drugs, they felt that they had fewer close friends and family members that they could confide in. Pre-university Factors A number factors that occurred in students lives before they attended university also were related to the use of cannabis and prescription drugs (see Table 4.6). Students moving to their university town from one of Sweden’s three largest cities (11.7%), and those relocating from outside of Sweden were more likely to use cannabis (23.9%); whereas students who had already lived in their current location (10.5%) and those who moved from Stockholm, Göteborg and Malmö (10.5%) used more prescription drugs. Students who had less stability in the home prior to the age of 18 were more likely to use cannabis and prescription drugs. Students who had lived in special circumstances also reported higher rates of prescription drugs (12.9%) compared with those who had not (9.0%). University-related Characteristics Course of study, involvement in activities on-campus, and progress through school were also of interest in relation to students’ use of cannabis and prescription drugs in the 12 months prior to the study (see Table 4.7). Students enrolled in free-standing courses reported higher rates of both types of drugs, than those enrolled in a program of study. Students enrolled in Social Science (13.0%), Humanities (12.8%), Technology (10.8%) and Economics/marketing (10.5%) reported the highest rates of cannabis use. Those enrolled in Law (12.8%), Health (12.4%), Humanities (10.9%) and Social work (10.5%) reported the highest rates of prescription drug use. Students in Police studies reported the lowest rates of both cannabis (1.6%) and prescription drugs (0.0%). Students studying full-time reported more cannabis use, but not more prescription drug use. As students progressed further into their education (increased number of academic points) their use of both types of drugs decreased. Living in a moderate-to-high student-density area was associated with increased cannabis use, but was unrelated to the use of prescription drugs. Involvement in university-based activities was not related to drug use. Studies outside of Sweden were associated with increased use of both types of drugs (cannabis, 13.4%,

49


prescription drugs 11.3%) compared with study that occurred only in Sweden (cannabis 7.8%, prescription drugs 8.7%). Increased course pressure was associated with an increase prescription drug use (10.7%), but not cannabis use. A low level of satisfaction with one’s course of study was also associated with increased prescription drug use (14.3%). Cannabis use was associated with increased course autonomy (9.0%). Table 4.6 Pre-university Factors That Increase the Risk for Cannabis and Prescription

Drug Use by Students (n=4559) Pre-university Factors Cannabis Use

12 month Prevalence

%


Prevalence %


**** 5.7 11.7 9.7 8.3 23.9

* 10.5 10.5 8.8 7.7 9.9


* 8.4 12.7 9.9 9.2 4.8

* 8.7 10.7 12.5 8.2 4.8

Lived in special circumstances prior to age 18 1 Yes No

8.8 10.3

*** 9.0 12.9

1 Special Circumstances include ever having lived in any of the following places prior to the age of 18: relatives other than parents or adoptive parents, foster home, boarding school, treatment or other care institution, jail, or living on one’s own, with or without a roommate. * p<0.05, ** p<0.01, *** p<0.001, **** p<0.0001

50


Table 4.7 University-Related Factors That Increase the Risk for Cannabis and Prescription Drug Use by Students (n=4559)

University-Related Factors Cannabis Use

12 month Prevalence

%


Prevalence %


** 8.3 10.7

** 8.7 10.6


**** 10.5 5.6 9.2 12.8 6.6 3.7 1.6 13.0 6.3 10.8 7.6

**** 8.4 12.4 12.8 10.9 9.5 6.6 0.0 9.9 10.5 6.9 11.3


** 10.5 9.3 8.6 7.6

* 10.2 9.7 8.9 8.4

Study full-time Yes No

**** 9.3 2.4

9.1 10.7


**** 9.1 10.7 6.1

8.4 9.1 9.9

Participate in activities on campus Pubs and parties Athletics and hobbies Extracurricular academics Nations and associations None of the above

6.5 11.7 8.2 11.1 9.3

8.9 9.6 8.3 8.5 9.5

Studied outside of Sweden in gymnasium or university Yes No

**** 13.4 7.8

** 11.3 8.7


9.1 8.6

** 8.3 10.7


** 7.2 9.6

9.8 8.9


9.0 8.9

** 14.3 8.8

* p<0.05, ** p<0.01, *** p<0.001, **** p<0.0001

51


Other Substance Use Frequent and heavy alcohol use, daily (or former daily) use of tobacco and having close contacts who used illicit drugs were also related to use of cannabis and prescription drugs (see Table 4.8). Cannabis use was more prevalent among students who currently or formerly used tobacco daily (16.5%), those who binge drank at least monthly (17.1%), those who drank at least weekly (15.8%), those who had experienced more alcohol problems and students who had at least one close friend or family member who had used illicit drugs (20.5%). Prescription drug use was more prevalent among students who currently or formerly used tobacco daily (12.1%), those who drank at least weekly (10.3%), those who had experienced more alcohol problems and students who had at least one close friend or family member who had used illicit drugs (11.3%). Table 4.8 Substance Use Correlates with the Use of Cannabis and Prescription Drugs

by Students (n=4539) Substance Use Indicators Cannabis Use

12 month Prevalence

%


Prevalence %

Used Tobacco daily or formerly daily (lifetime) Yes No

**** 16.5 5.6

**** 12.1 7.9

Binge drink at least twice monthly (12 months) Yes No

**** 17.1 4.3

9.5 9.0

Drink weekly (12 months) Yes No

**** 15.8 4.3

* 10.3 8.4

Alcohol problems 0 1 2 3 4 5

**** 5.5 10.5 15.8 19.7 24.6 18.4

**** 7.4 8.8 14.2 12.3 23.1 21.1

Close family member or friend uses/has used drugs Yes No

**** 20.5 2.6

** 11.3 8.3

1 Binge drinking is equivalent to drinking a bottle of wine on one occasion. In terms of volume of alcohol consumed, this equates to about 1-75cl bottle of while, or 5-6 (25 cl) shots of spirits, or 4 cans of strong beer, or 6 cans of light beer. * p<0.05, ** p<0.01, *** p<0.001, **** p<0.0001 Clearly, there are different patterns, and predictors of use for prescription drugs and cannabis. We are also perhaps seeing some confusion between those who might have been taking the prescription legitimately compared to those using it illicitly. Some things about the patterns of responses for these drugs indicate this, including: bimodal distributions, poor health status, and the use of these drugs even with a low disposable income. However, other patterns are indicative of a more recreational type of drug use, such as: their association with other

52


substance use indicators, increased use within only certain types of educational programs and among students taking free-standing courses, and their relationship to study outside of Sweden and course pressure and satisfaction. Further research is necessary in this area to confirm or refute these findings. Multivariate Risk Factors for Cannabis Use In order to gain a more thorough understanding of the main predictors of cannabis use among university students a multivariate logistic regression was conducted. Each of the risk factors identified in the bivariate analyses in this chapter was assessed for retention in the model. Ultimately, since many of them were related, some had to be removed because they were too similar to have in the model and others were no longer significant risk factors once all were examined together in one analysis. The resulting model (seen in Table 4.9) identifies the main risk factors predicting cannabis use during the year prior to the students’ participation in this study. Males were more likely than females to have used cannabis. Students aged 20 to 24 used cannabis at a rate of two and a half times that of those aged 35 and older. While there was a trend towards increased cannabis use by students in the other age groups, the trend was not significant at the p=0.05 level in this particular analysis. Students who lived in small towns prior to beginning their university studies were more likely to use cannabis (a 40% increase); however, those who came to the university from outside of Sweden were four times as likely to have used cannabis in the last year. Students who studied as guest students, outside of Sweden, also had a 40% higher likelihood of having used cannabis during the last 12 months. Full-time students were twice as likely as part-time students to have used cannabis. In addition, for every two confidants that students had, the risk of using cannabis increased an additional 16%. Students whose main income came from their work were only 60% as likely, as those who were supported by other means, to use cannabis; and students who were enrolled in a program of study were only 75% as likely as those in free-standing courses to be current users. Other substance use was also strongly related to the use of cannabis. Students who drank weekly had a 68% increased risk, those who binge drank had a two-fold risk, those who had smoked daily had a two and half times greater risk, and students who has a close family member or exhibited a six and half times greater risk of using cannabis than those who did not. Finally, students at Lund University were 42% more likely to have used cannabis in the 12-month period prior to completing the survey.

53


Table 4.9 Multivariate Logistic Regression Identifying Risk Factors for Cannabis Use During the 12 Months Prior to the Study (n=4512)




1.00 1.41

1.10 - 1.80


2.43 2.64 1.81 1.79 1.00

0.84 - 6.96 1.26 - 5.51 0.85 - 3.85 0.71 - 4.43


1.00 1.06 0.55

0.64 - 1.73 0.32 - 0.96

Main form of income Work All other forms [REF]

0.59 1.00

0.39 - 0.91



1.00 1.41 1.40 3.99

0.95 - 2.08 1.01 - 1.92 2.32 - 6.83

Study full-time Yes No [REF]

2.04 1.00

1.24 - 5.02

Course of Study Program Free-standing courses [REF]

0.73 1.00

0.55 - 0.96

Studied outside of Sweden in gymnasium or university Yes No [REF]

1.41 1.00

1.05 - 1.88

Used Tobacco daily or formerly daily (lifetime) Yes No [REF]

2.58 1.00

2.01 - 3.29

Binge drink at least twice monthly (12 months) 1 Yes No [REF]

1.96 1.00

1.46 - 2.62

Drink weekly (12 months) Yes No [REF]

1.68 1.00

1.26 - 2.24

Close family member or friend uses/has used drugs Yes No [REF]

6.35 1.00

4.84 - 8.31

University Lund Other universities

1.42 1.00

1.11 - 1.81

[REF] identifies the reference group where dummy variables have been used. 1 Binge drinking is equivalent to drinking a bottle of wine on one occasion. In terms of volume of alcohol consumed, this equates to about 1-75cl bottle of while, or 5-6 (25 cl) shots of spirits, or 4 cans of strong beer, or 6 cans of light beer.

54


5. Drug and Alcohol Use Problems The Occurrence of Substance Use-related Harms Students who reported drinking alcohol within the 12 months prior to the study (n=4362, or 96% of the study sample) were asked a follow-up set of questions around the negative effects of alcohol. Specifically they were asked whether their alcohol consumption had had a significant negative affect on any of the following areas of their life, within the last 12 months: (a) Family life, marriage or relationship; (b) Friendships or social life; (c) Physical Health; (d) Studies or work life; or (e) financial situation. Students who reported using drugs other than alcohol or tobacco were asked this set of questions again, later in the questionnaire. The second time, the question asked specifically whether their drug use had negatively impacted any of the areas listed above. Table 5.1 shows the results of these two sets of questions. Table 5.1 Harms experienced by Students as a Result of Substance Use Area of Life where harm has experienced due to OTHER DRUGS1 use in the last 12 months

Percent of students who had used drugs1 in the last 12 months

(n=423)

Percent of All students

(n=4559)

Physical Health Financial situation Study or work life Family life/ marriage/relationship Friendships or social life

8.2 6.2 4.7 5.4 4.7

0.8 0.6 0.4 0.5 0.4

Area of Life where harm has experienced due to ALCOHOL use in the last 12 months

Percent of students who had used alcohol in the last 12 months

(n=4362)

Percent of All students

(n=4575)

Physical Health Financial situation Study or work life Family life/ marriage/relationship Friendships or social life

26.3 25.7 9.4 8.0 6.3

25.1 24.5 9.0 7.5 6.0

1 In this table, “other drugs” refers to all drugs other than tobacco, alcohol and prescription drugs. The first column of numbers in the table indicates the proportion of students who actually used alcohol or drugs during the 12 months in question. The second column of numbers shows what percentage of the whole student sample would experience the problem, given that 96% of the students use alcohol, and only 9.8% of the students used drugs during the same time period. For example, negative effects to one’s physical health were reported most frequently in relation to current drug use. Over 8% of those who took drugs (other than alcohol, tobacco and prescription drugs) within the 12 months prior to the survey reported experiencing consequences to their physical health. As a result, this means that only 0.8% of the entire student sample experienced negative physical health consequences due to drug use. Contrast this with the proportion of students who experienced negative physical consequences resulting from drinking alcohol (25.1%). It is clear from this table that alcohol use carries

55


many more negative consequences for student users than do drugs. The small amount of drug harms experienced by students who have used them is likely to be a direct result of the fact that so few students had ever used them on a regular basis, whereas most students used alcohol on a very regular basis. On average, students who drank experienced 0.74 harms per person, pr less than one. Yet 43% of students had experienced harm within at least one of these areas; therefore a number of students experienced negative consequences in more than one area. Table 5.2 shows the number of drinkers/users and how many areas they have received negative consequences in. A much larger number of drug users reported being free of negative consequences often associated with drug use. On average, drug users only experienced 0.29 harms per user, compared to 0.74 per alcohol drinker. Table 5.2 Cumulative number of areas in which students experienced Negative Consequences Number of Areas in Negative Consequences were experienced

Current Drinkers (n=4362)

(%)

Current drug users1

(n=423) %

0 1 2 3 4 5

57.3 21.0 12.9 5.5 1.5 0.9

83.5 9.2 4.0 1.9 0.9 0.5

1 In this table, “drugs” refers to all drugs other than tobacco, alcohol and prescription drugs. Alcohol and Drug Harms by Site The prevalence of drug and alcohol-related harms were compared across the four participating universities (see Table 5.3). Students at Lund University recorded the highest prevalence of drug-related harms (2.0% of students), while those at Kalmar (0.7% of students) recorded the least. However in relative terms, Växjö drug users experienced more harms that those at the other three sites, Växjö merely has a smaller population of drug users, so that there is not a comparatively high percentage of students, overall, experiencing these harms. More drinkers at Umeå University experienced one or more alcohol-related harm in the 12 months prior to the survey, at 45.7%. This ultimately translated into 43.1% of the entire Umeå sample experiencing an alcohol-related harm. Risk Factors for Alcohol and Drug Related Harms The same demographic characteristics that were examined in relation to drinking frequency and pattern, illicit drug use and illicit prescription use were also examined with respect to alcohol and drug-related harms. The tables in this section use the reporting of one or more alcohol-related harm, and the reporting of one or more drug related harm as the dependent variables of the analyses. Since so few students experiences drug-related harm, the percentages seen in the tables are very low (mostly below 1%) and thus there are very few significant predictors. Future analyses will also examine these predictors within the smaller sub-population of students who have used drugs within the last year.

56


Table 5.3 Percentage of Students Who Experienced at least One negative consequence due to

Drinking or Drug Use1 in the 12 months Prior to the Study, by Site

University / Högskola Kalmar Växjö Umeå Lund Total

Number of current drug users2

32 49 100 242 423

Percent of drug users reporting 1 or more negative drug experiences

12.5% 22.4% 14.0% 16.9% 16.5%

Percent of students reporting 1 or more negative drug experiences

0.07% 1.5% 1.0% 2.0% 1.5%

Number of current drinkers2 517 671 1230 1944 4362 Percent of drinkers reporting 1 or more negative alcohol experiences

37.5% 40.1% 45.7% 41.0% 42.7%

Percent of students reporting 1 or more negative alcohol experiences

35.4% 38.3% 43.1% 40.0% 41.0%

1 In this table, “drugs” refers to all drugs other than tobacco, alcohol and prescription drugs. 2 This number refers to the total number of individuals who have answered all relevant questions in this table, a small number of missing cases on the harm questions, the total is less than is used in other current drug user tables. Individual Characteristics A number of characteristics were associated with having experienced one or more type of negative alcohol consequences during the year prior to the study (see Table 5.4). Males, students aged 20 to 24, and living in a student corridor, with a roommate or alone all increased the risk of harm. Having a higher disposable income and having a student loan as one’s main form of income were also related to the experience of harm. Finally, poor psychological health was a strong predictor of alcohol-related harm. Only two of the individual characteristics tested predicted student’s experience of drug-related negative consequences; however, a few others indicated potential trends. Living in a student corridor or with roommates, and having a higher disposable income both were predictive of experiencing drug-related harm.

Pre-university Factors Only one of the factors tested was related to increased alcohol-related harm (see Table 5.5). Students who had lived either Stockholm, Göteborg, Malmö/Lund or outside of Sweden directly before beginning their education at the university were more likely to have experienced an negative consequence related to drinking. Increased drug harm was associated with living with only one parent for at least before the age of 18, and living in special circumstances outside of the traditional family setting.

57


Table 5.4 Individual Characteristics That Increase Students’ Risk of Experiencing Alcohol and Drug-related Problems (n=4559)

Characteristic Percent experiencing

alcohol problems Percent experiencing

drug problems Sex Male Female

**** 48 36

0.21 0.05


**** 41 46 41 24 19

0.72 0.78 0.82 0.36 0.00


**** 47 62 65 30 20 35 16 42

** 0.45 1.62 0.79 0.56 0.48 0.28 0.00 0.83


**** 44 36 33 24 36 26

0.79 0.34 1.69 0.00 0.31 0.00


**** 28 39 43 50 44 56

** 0.00 0.03 0.60 0.71 0.81 2.12


*** 36 43 47 42 35

0.69 0.63 1.00 0.00 0.00


**** 35 43 44 49 51

0.45 0.65 1.17 0.65 0.00

Social support At present, how many people do you have that you feel you could comfortably confide in? 0 1 – 2 3 – 5 6 or more

40 38 42 44

0.00 0.77 0.70 0.60

* p<0.05, ** p<0.01, *** p<0.001, **** p<0.0001

58


Table 5.5 Pre-university Factors That Increase Students’ Risk of Experiencing Alcohol and Drug-related Problems (n=4559)

Pre-university Factors Percent

experiencing alcohol problems

Percent experiencing

drug problems


**** 33 50 44 42 47

0.84 1.18 0.62 0.25 0.29


41 45 38 36 33

* 0.52 1.75 1.16 0.00 0.88

Lived in special circumstances prior to age 18 1 No Yes

41 42

**** 0.58 3.58

1 Special Circumstances include ever having lived in any of the following places prior to the age of 18: relatives other than parents or adoptive parents, foster home, boarding school, treatment or other care institution, jail, or living on one’s own, with or without a roommate. * p<0.05, ** p<0.01, *** p<0.001, **** p<0.0001 University-related Characteristics A number of factors related to the university setting and experience were also associated with increased alcohol-related harm (see Table 5.6). Students enrolled in full-time studies, those living in medium and high-student density housing, students early in the course of their studies, and those participating in all types of activities on campus experienced elevated levels of harm. Students who reported high levels of course autonomy and satisfaction were more likely to have experienced a negative consequence related to drug use during the year prior to the interview. Other Substance Use All of the other substance use measures examined in this section were strongly related to both alcohol and drug related harms (see Table 5.7). Students who either currently or formerly used tobacco daily, and those who had a close friend or a family member who had used drugs were at increased risk of harm. Also, students who drank at least weekly and those who binge-drank at least bi-weekly were at increased risk of both alcohol and drug-related harm.

59


Table 5.6 University-Related Factors That Increase Students’ Risk of Experiencing Alcohol and Drug-related Problems (n=4559)

University-Related Factors Percent experiencing


drug problems Course of study Program Free-standing courses

39 42

0.70 0.63


** 48 38 53 40 36 38 33 42 35 47 49

0.64 0.60 1.32 1.29 0.91 0.00 0.00 0.53 0.90 0.72 0.91


** 46 44 41 37

* 1.03 0.62 0.44 0.65

Study full-time No Yes

* 33 42

0.00 0.72


**** 49 46 32

0.32 0.91 0.68

Participate in activities on campus Pubs and parties Athletics and hobbies Extracurricular academics Nations and associations None of the above

**** 50 49 47 52 41

0.75 0.66 0.73 0.89 0.72

Studied outside of Sweden in gymnasium or university No Yes

41 44

0.66 0.73


41 44

* 0.53 0.95


* 39 45

0.69 0.58


** 38 51

* 1.23 0.64

* p<0.05, ** p<0.01, *** p<0.001, **** p<0.0001

60


Table 5.7 Substance Use Correlates of Experiencing Alcohol and Drug-related Problems (n=4559)

Substance Use Indicators Factors Percent experiencing


drug problems Used Tobacco daily or formerly daily (lifetime) No Yes

**** 37 51

* 0.48 1.15

Binge drink at least twice monthly (12 months) 1 No Yes

**** 27 66

**** 0.26 1.48

Drink weekly (12 months) No Yes

**** 30 68

**** 0.18 1.43

Close family member or friend uses/has used drugs No Yes

**** 34 52

**** 0.03 1.88

1 Binge drinking is equivalent to drinking a bottle of wine on one occasion. In terms of volume of alcohol consumed, this equates to about 1-75cl bottle of while, or 5-6 (25 cl) shots of spirits, or 4 cans of strong beer, or 6 cans of light beer. * p<0.05, ** p<0.01, *** p<0.001, **** p<0.0001 The Alcohol Use Disorders Identification Test (AUDIT) The AUDIT was developed by the World Health Organisation, as a 10-item screening instrument to identify people at risk of developing alcohol problems. Individuals item scores range from zero to four and a score of eight or more is used as an indicator of problem drinking (Allen, 1997). The percentage of students drinking harmfully according to the AUDIT 8-point cut-off for is men 35.7% and the AUDIT 6-point cut-of for women is 56.6%. These figures were quite similar across sites. This figure was highest for men in Lund (59.0%), followed by Växjö (57.9%), Umeå (56.7%) and Kalmar (54.6%). Although once standardized by age and sex, Umeå drops to the lowest position (p<0.01). This figure was highest for women in Lund (58.2%), followed by Växjö (56.5%), Umeå (57.5%) and Kalmar (49.5%), with Kalmar significantly lower in score for the women (p<0.001). Driving Under the Influence Sweden has put considerable effort forth in attempting to reduce the incidence of drink-driving. In this study we asked a limited number of questions regarding the practice of drink-driving. These questions were in the final section of the questionnaire where the Universities could put forth questions that they felt were of particular interest to themselves, but that might not be relevant to everyone. Three sites chose to include the questions about driving, under the influence of alcohol and drugs, and being a passenger while the driver was under the influence. Students from Lund University did not complete this section of questions. This set of questions only dealt with one of the study’s three time frames: the Fall 2003 school term. As a result, the participants’ answers cannot be compared to data from any other source, as the time frame is variable depending upon when the student completed the questionnaire. It is estimated that, on average this period would be roughly 9 weeks, based upon when the completed questionnaires were received at the study office.

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Students were asked initially if they had access to a car during the school term. 35% indicated that they “never” had access to a car, and thus they were not asked questions about driving under the influence, only riding. Of the 1639 participants who indicated that they had access to a car, 1.57% indicated that they had driven while under the influence of alcohol (1.10% had driven once, 0.37% had driven between two and four times, and 0.10% indicated that they were unsure how many times they had driven). It was most common to drive after drinking strong beer; however, a small number of participants also drove after drinking spirits and wine. When asked how many drinks they had had prior to driving the answers ranged from less than one full drink to more than ten drinks, with the mean of three (SD 2.4). Eleven of the 33 students who had driven while under the influence had consumed more than five drinks before driving. Students with access to a car were also asked about driving under the influence of drugs other than alcohol during the Fall 2003 term. Ten individuals, 0.61% of students, with an available car, reported having driven under the influence of drugs. Riding in a Car When the Driver Had Been Drinking Once again, these questions were asked regarding behaviour during the Fall 2003 school term only. All students at Växjö, Umeå and Kalmar were to answer these questions, not merely those with a car available for them to drive. Less than 5% (4.26%) reported riding in a car when the driver had been drinking, a further 5.2% indicated that they did not know if they had been in this situation. Another 2.13% of the students indicated that they had ridden in a car when the driver was under the influence of drugs other than alcohol. In most cases the drug used was cannabis. A further 2.4% reported that they had ridden in a car when they were unsure whether the driver was under the influence of drugs or not.

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6. Reasons Why Students Choose NOT to Try Drugs The majority of the study sample (2917) had neither experimented with drugs nor used them regularly. These students were asked a series of questions regarding their interest in trying drugs, and their reasons for not using them to date. Desire to Try Drugs Sixteen and a half percent of the students who had never used a drug for “recreational“ purposes expressed a desire to try them. Students who indicated that they had at least one close friend or family member who had used drugs, expressed significantly lower desire to try drugs (13.3%) when compared with students who had no close contacts with drug-use experience (26.0%). By site, the desire to try a drug was highest at Kalmar (86.8%), followed by Växjö (85.3%), Umeå (84.5%) and Lund (80.8%). Reasons Given by Participants for Not Using Drugs The top ten reasons endorsed by non-drug users for continuing not to use them are listed, in order of popularity, in Figure 6.1. The reason that was endorsed by the largest number of students was that “Drugs aren’t good for your health.” The law (drugs are illegal) was not considered to be a particularly important reason not to use drugs, it placed 7th in the list according to how many people indicated that it was an important reason for them. Health reasons, and the influence of drugs on behaviour were far more important reasons for these students. Table 6.1 shows the percentages of students who agreed and strongly agreed with each of the top 10 reasons, by site. There was remarkable consistency across the universities in how the participants answered these questions. There were significant differences between the sites on only four of the items, and the rank ordering was highly consistent across sites. Students at Lund did tend to endorse most statements with a lower level of agreement. Table 6.1 Reasons Not to Use Drugs, by Site (n=2894)

University / Högskola Reason Kalmar n=547 % Agree

Växjö n=702 % Agree

Umeå n=1304 % Agree

Lund n=2022 % Agree

Total n=4575 % Agree

Drugs aren’t good for your health 96,3 94.9 94.6 93.6 94.5 One can become addicted 94.3 94.1 93.8 93.0 93.6 I just don’t want to use them * 95.5 92.6 92.9 90.9 92.4 One could die * 93.8 94.1 90.8 89.7 91.3 I don’t like how they would influence my behaviour ***

86.7 86.9 80.7 79.7 82.2

Family members think that I shouldn’t 76.9 76.4 74.4 73.4 74.7 My friends don’t use drugs 66.7 69.4 65.7 62.8 65.3 They are illegal ** 57.6 58.3 57.1 50.8 54.8 Medical Reasons 26.9 26.7 23.8 28.1 9.3 Religious Reasons 10.5 8.3 9.6 9.0 7.1 * p<0.05, ** p<0.01, *** p<0.001, **** p<0.0001

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Figure 6.1 Top 10 Reasons Given for Not Using Drugs (n=2894 non.drug users)

0% 20% 40% 60% 80% 100%

Religious Reasons

Medical Reasons

They are illegal

My friends don't use drugs

Family members think I shoudn't

I don't like how they influence my behaviour

One could die

I just don't want to

One can become addicted

Drugs aren't good for your health

Strongly agree Somewhat agree Somewhat disagree Strongly disagree

Two additional reasons were counted only for students who reported that they had at least one close friend or family member who had used illicit drugs. A total of 730 (25%) non-drug using students had a close acquaintance that had at least tried drugs other than tobacco and alcohol. Of these students, 45.4% indicated that one of their reasons for not using drugs was that a “family member or friend became sick or injured due to their use of drugs.” An additional 37.6% reported that “a family member or friend injured someone else due to their use of drugs.”

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7. Sources of Information, Help and Treatment Previous Sources of Information and Advice All students were to answer questions regarding where they had received information about drugs in the past. However, almost all of the 10.2% of the participants who left this section blank were individuals who had never tried drugs (433/466 people). It is likely that they suspected that this section did not apply to them, although there were no directions to this effect specifically stated. However, some students may have felt that the questionnaire was too long and decided to pass over this particular page. Students were first asked about the their past sources of information. They were not asked about whether they liked those sources, or believed or trusted the information that they received, bur merely how often in the past they had received information from each of the 15 sources listed. The results can be seen in Table 7.1. Table 7.1 Past Sources of Drug-related Information and Advice (n=4109)

Frequency of Receipt of Information or Advice Have you ever received information, or advice concerning drugs from… Never Rarely Sometimes Often Your friends 31.5 41.1 23.1 4.3

Your parents 32.4 40.5 20.5 7.1

Your siblings or other relatives 55.5 29.1 12.8 2.7

The university administration 87.4 9.5 2.6 0.5

The student Union 86.0 10.9 3.8 0.3

Student Health 83.0 15.4 4.3 0.4

A doctor, nurse or other health professional outside of the university

64.9 25.6 7.8 1.5

A social worker 85.6 9.2 2.5 0.9

A free-time leader 72.3 20.3 6.1 1.4

A specialist in the drug area 48.6 37.7 10.5 3.1

The Police 43.2 45.5 9.3 2.3

A telephone help line 98.7 1.1 0.2 0.1

A web site run by an authority in the drug area (e.g., CAN, public health)

86.3 10.8 2.4 0.5

A web site run by some non-official organization

75.8 17.6 5.4 1.3

An association that works with drug abuse (e.g., self-help groups)

52.7 36.7 8.9 2.4

The most frequently reported sources of information or advice were parents, friends, siblings and other relatives, a specialist in the drug area and the police. These were top five sources of prior information for each of the university sites. These sources are clearly more informal than via formal authoritative sources.

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Few people indicated that they had received information from the university-affiliated sites including the university administration, student Union and Student Health. Students from Växjö and Kalmar reported receiving slightly more information from University Administration and their Student Union than the other sites. Significantly more students at Växjö (8.5%) than from the other sites (kalmar 4.1%, Lund 4.8%, Umeå 3.7%) indicated that they had received drug-related information from Student Health. People who had reported using drugs within their lives (compared with non-drug users) were more likely to have received information/advice from friends and non-offical web sites. They also reported receiving less information/advice from a specialist in the drug area, the police and associations that work with drug abuse. Preferred Future Sources of Information and Advice Students were then asked where they would prefer to go in the future for information and advice (see table 7.2). Students clearly were not interested in receiving any information, or advice from their university administrations and student unions. They were however more open to the Student Health Services as a future source. Students who had tried drugs were as open to health services as a source of information and support as were those who had not tried drugs. Students at Växjö (40.1%) were the most willing to accept Student Health Services as a future source, followed by Umeå 35.3%, Lund 30.7%, and kalmar 26.5% (p<0.0001). Students who had and had not tried drugs in the past identified the same six sites as being most preferred. They were not in the same order, and those that had tried drugs were slightly less approving than those who had not tried drugs. The top five preferred sources, as cited by students who had tried drugs were: 1. a web site run by some non-official organization 2. a specialist in the drug area 3. friends 4. a heath professional outside the university 5. an association that works with drug abuse (e.g., self-help groups) 6. a web site that is run by an authority in the drug area (e.g., CAN, public health) The top five preferred sources, as cited by students who had not tried drugs were: 1. a specialist in the drug area 2, a web site run by some non-official organization 3. an association that works with drug abuse (e.g., self-help groups) 4. a heath professional outside the university 5. a web site that is run by an authority in the drug area (e.g., CAN, public health) 6. friends Although this information provides some information regarding where people feel safe to go, and where they feel that they will receive the sort of information or help they would want, it leaves out a very important point. People may prefer to get particular types of information, help, advice or support from some agencies or people that they would not like to receive from others. Further research needs to be done prior to making any shifts in educational policy.

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Table 7.2 Preferred Future Sources of Drug-related Information and Advice Have you ever received information, or advice concerning drugs from…

All Respondents (n=4109)

%

Respondents who had tried drugs in

their lives (n=1633)

%

Respondents who had NOT tried

drugs in their lives (n=2476)

% Your friends 54.7 62.5 50.0

Your parents 19.6 16.2 21.7

Your siblings or other relatives 22.9 21.4 23.7

The university administration 3.2

2.5 3.6

The student union 5.5 4.6 6.2

Student health 33.0 32.0 34.2

A doctor, nurse or other health professional outside of the university

55.0 54.4 56.2

A social worker 19.9 18.4 21.0

A free-time leader 9.6 8.7 10.4

A specialist in the drug area 67.2 63.1 70.0

The Police 28.8 20.8 33.3

A telephone help line 31.5 30.3 32.6

A web site run by an authority in the drug area (e.g., CAN, public health)

52.9 50.2 54.7

A web site run by some non-official organization

66.3 66.1 65.9

An association that works with drug abuse (e.g., self-help groups)

58.9 52.8 63.2

Treatment for Alcohol and Drug Problems Very few individuals indicated that they had ever received any form of treatment (including behavioural therapy, counselling, and self-help groups) with respect to their alcohol or drug problems. As mentioned at the beginning of this chapter, our estimates may be underestimates, as a number of people who had not used drugs did not answer the questions in this section. If they had preciously received treatment for alcohol, this could affect the estimates of treatment substantially as they number of people who reported receiving any form of treatment was so small. Twenty people had previously received treatment for alcohol problems (0.48% of the 4153 students responding to the question). Twelve people (0.29%) had received drug treatment, and a further nine people had received both alcohol and drug treatment. The large majority of them received counselling as their treatment mode.

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Students who had never received any form of treatment, were then asked if they had ever been told by someone else that they should seek help for an alcohol or drug problem. Only 59 people (1.3% of 4130 who answered the question) were told that they should seek help for alcohol problems, 7 (0.17%) for drug problems and an additional 12 (0.29%) for both alcohol and drug problems. Friends, followed by family members, most often suggested this form of action.

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8. Attitudes Towards Drug and Alcohol Use A large number of attitudinal questions were asked in this survey. The attitudinal questions are being reported in this chapter with three main purposes, to show what attitudes are held amongst the group, and how they differ across the participating universities and between students who have tried drugs and those who have not. These attitudes are also most likely related to student demographic variables, notably sex and age among other things. This report however will not present these results by age and sex at this time, more in-depth analyses of students’ attitudes will be conducted later in a separate manuscript. How Easy is it to Obtain Drugs? Students were asked their perceptions about the ease of obtaining drugs. Cannabis was perceived to be quite easy to buy, with 67.1% of the students indicating that it would be ‘very easy’ or ‘rather easy’ to obtain (see Table 8.1). The next easiest drug to procure was judged to be far less available to the average person. Thirty-four percent indicated that it would be very or rather easy to obtain ecstasy, 32.4% amphetamines, 21.5% cocaine, and 17.8% felt it would be relatively easy to obtain heroin. Table 8.1 Perceived Ease of Obtaining Drugs (n=4515)

Perceived Ease How difficult do you think it would be for you to obtain the following drugs, if you wanted them?

Very Easy Rather Easy

Rather Difficult

Very Difficult

Almost Impossible

Marijuana or hash 23.1 43.9 16.8 11.7 4.4

Amphetamines 7.5 24.9 30.6 26.4 10.7

Ecstasy 7.2 27.2 28.3 26.4 10.8

Cocaine 4.4 17.1 31.7 32.1 14.6

Heroin 3.6 14.2 29.1 35.5 17.6

Since more students in Lund reported using drugs, it would be logical that they might find it easier to buy drugs there. But this was not the case. There was no difference in the perception of ease in obtaining cannabis, amphetamines, or heroin by university. Students in Umeå perceived it to be more difficult to purchase both ecstasy (29.9%) and cocaine (17.2%) than students at the three other sites (p<0.0018 and 0071 respectively). Students who had used drugs perceived that it was easier to purchase cannabis, amphetamine, ecstasy and heroin than those who had not used drugs. Eighty-two percent of students who had previously tried drugs perceived it to be relatively easy (very or rather easy) to obtain cannabis compared with 61% of those who had never tried a drug (p<0.0001). Similarly, 37% of students who had previously tried drugs perceived it to be relatively easy to obtain amphetamines compared with 30.5% of those who had never tried them (p=0.0491). Finally, 15.0% of students who had previously tried drugs perceived it to be relatively easy to obtain amphetamines compared with 18.8% of those who had never tried them (p=0.0027).

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The Relative Importance of Student Alcohol and Drug Use in Context of Campus Life Students were asked to provide their opinion on the severity of a number of social problems that could potentially be present on their university campus. This was done in order to determine how important the students see the issues of alcohol and drugs relative to other issues that they may come into contact with on campus. In order to do this, students were asked how large of a problem each of eight social problems was on their campus, and they were to provide an answer by rating the problem on a scale from 1 to 4, where 1 = not a problem at all, and 4 = a very large problem. Students’ alcohol use ranked first in importance among the problems listed (see Table 8.2). The mean rating it received was 2.6 indicating that it was believed to be a rather significant campus issue. Vandalism and theft of property ranked second, and rated quite a bit lower on the scale. Student drug use ranked third, at virtually the same level as sexual discrimination and sexual harassment and rape. Table 8.2 Students’ Rating of the Severity of Various Social Problems on their University

Campus (n=4556)

Rank Problem Mean Rating 1

(SD)

1 Student’s alcohol use 2.60 (0.82) 2 Vandalism and theft of property 2.15 (0.76) 3 Students drug use 2.01 (0.69) 4 Sexual discrimination 2.00 (0.79) 5 Sexual harassment and rape 1.93 (0.71) 6 Racism 1.93 (0.73) 7 Physical violence 1.78 (0.66) 8 Personal safety on campus 1.59 (0.64)

1 Students were asked to rate how large the problem was on their campus on a scale between 1 and 4 where 1 = not a problem at all, and 4 = a very large problem. There were differences between the university sites both in the order of the ranking, and in the magnitude of the problem estimates. Table 8.3 shows how the universities varied in their ranking of problems. Kalmar and Växjö ranked drug use as the third largest problem. The others each ranked it fourth. Students from Kalmar tended to rank all of the problems at a significantly lower level of magnitude than students from the other locations, this is likely a reflection on of the University of Kalmar being a small university in a small city, and with less drug use occurring in the university, and possibly fewer other social problems as well. In addition, Umeå generally rated each of the problems are more severe than the other schools, with the exception of alcohol and drug use, where Kalmar was the cite to rate them differently than the others. Students who had used drugs ranked drug use much lower (6) than students who did not use drugs (3). However, the large difference in rankings was not reflected in a difference in the magnitude of the rating that students assigned to drug use. The two groups did not rate drug use significantly differently in terms of its importance as a problem (means ratings of 2.02 and 2.00, p=0.2220). Instead, students who had tried drugs rated the sexual discrimination, sexual harassment and racism items significantly higher than the student who had not tried drugs p<0.0001).

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Table 8.3 Relative Ranking of Social Problems by site

University Drug Use Status Problem

Kalmar

Rank

Växjö

Rank

Umeå

Rank

Lund

Rank

Has tried Drugs

Rank

Has Not tried

Drugs Rank

Student’s alcohol use 1 1 1 1 1 1 Vandalism and theft of property 2 2 2 2 2 2 Students drug use 3 3 4 4 6 3 Sexual discrimination 5 5 3 3 3 4 Sexual harassment and rape 7 6 5 5 4 6 Racism 4 4 6 6 5 5 Physical violence 6 7 7 7 7 7 Personal safety on campus 8 8 8 8 8 8 At What Age is it Acceptable to for a Person to Start Smoking, Drinking and Using Drugs? In many cultures, adults accept that youth and young adults will behave badly from time to time, including such behaviour as getting drunk, trying drugs, and generally taking more risks. At the same time, society likes to set minimum ages for many of these risky behaviours in attempt to keep the experimentation and risk-taking to a minimum. In attempt to find the balance in these two competing forces, we asked students at what age they thought people should be allowed to try out these contested behaviours, irrespective of what the law currently says. This was an attempt to determine whether there would be variation in the age limit between the behaviours depending upon their degree of social acceptability. The question asked of the students can be seen in Table 8.4, along with the results. If students answered that the behaviour was never acceptable (the first column of numbers in the table), they did so instead of providing an age, thus the mean ages and modal ages presented in the table are only for those who felt that it was acceptable to conduct the behaviour. Drinking alcohol, both beer and spirits, was the least contested behaviour, with only 2.7% and 2.5% indicating that these behaviours were never acceptable. This was followed by tying a cigarette and smoking regularly, which 12.1% and 37.2% judged as never being acceptable to do. Then we can see that as the strength and reputation of the drug increases, the acceptance of the behaviour decreases. Interestingly enough, the modal (most commonly reported) age stays the same for all activities. However, the mean age of acceptance of the behaviour does alter, increasing as the level of danger is perceived to increase. Never though, does the mean age differ too far from the legal age, where a legal age exists. Students from Lund were more accepting when it came to trying cannabis, amphetamines and ecstasy; they more likely to say that these behaviours are acceptable at a given age (p<0.0001). Students from Växjö were more accepting to smoking cigarettes regularly (p<0.001). Kalmar was more restrictive when it came to trying cannabis and amphetamines, indicating that they should never be allowed (p<0.0001). Among students finding the behaviours acceptable, there were only two instances when students from one university recommended a lower or higher mean age. Students from Lund University indicated that people should be able to try a cigarette at a younger age (mean 16.5 years as opposed to 17.05) (p<0.0001). Students at Lund also felt that people should be able to drink strong beer at an earlier age (17.0 years) than students from the other schools (16.6 years) (p<0.0001).

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Table 8.4 The Social Clock, and When Students Judge that it is Acceptable to

Participate in Contested Behaviours Irrespective of what the law says, at what age do you think that it is ok for a person to do the following things

Percent indicating

“never OK”

Mean (SD) Age

Modal Age

Try a cigarette 13.1 16.9 (1.96) 18

Smoke regularly 37.2 18.3 (1.78) 18

Drink a strong beer 2.7 17.2 (1.64) 18

Drink a 4 cl glass of spirits 2.8 17.6 (1.60) 18

Try marijuana or hash 59.5 16,0 (2.18) 18

Try ecstasy 82.0 19.4 (2.47) 18

Try amphetamines 85.7 19.6 (2.66) 18

Try heroin 91.5 19.6 (2.90) 18

Students who had tried drugs were more accepting with respect to trying cigarettes, cannabis, ecstasy, amphetamines and even heroin (but not by as large a margin as with the other behaviours) compared with other students (p<0.001). They also recommended lower age limits or trying smoking, smoking regularly, trying cannabis and drinking beer and spirits (p<0.002). General Attitudes Towards Drugs and Alcohol A number of statements were posed, and students were required to indicate how strongly they agreed or disagreed with them. The statements related to the role of alcohol and drugs in university life, how large a problem Sweden has with drugs, how alcohol and drug use are related, and what actions need to be taken in dealing with drug use ad users in society. The results are presented in Table 8.5. Students felt strongly that alcohol was a normal part of university life; however, the believed that if one did not want to drink, it would still be possible to fit in. While alcohol was believed to be a bigger social problem than drug use, there was moderate support for the idea that alcohol use could lead to drug use, and drugs were not considered to be a normal part of university life. Students strongly believed that early use of drugs was a sign of a much more serious problem. They felt that prescription drugs were just as dangerous as illicit drugs and were concerned that if it were to become permissible to use drugs, there would be a large increase in their use. Even so, students were neither for nor against increased actions by University Administrators to exercise more control over student drug use. There was modest support for more treatment and control facilities in Sweden and also modest support for the idea of compulsory treatment. Harm reduction in the form of increased access to needle exchange facilities was not widely supported.

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Table 8.5 Students’ Agreement and Disagreement with Statements about Alcohol

and Drug Use, Abuse and Care in Sweden Statement Agree1

%

Neither /Nor %

Disagree1

%

Drinking alcohol is a normal part of student behaviour at university 75.6 14.0 10.4

One can’t have many friends in this university if one doesn’t drink alcohol 9.1 13.1 77.8

Alcohol is a bigger problem for Sweden than drugs 66.4 17.4 16.2 People who drink alcohol experiment more with drugs than those who do not drink alcohol 57.5 22.4 20.1

If a teenager tries drugs it is a sign of a much more serious problem 68.9 14.7 16.4

Trying drugs is a normal part of growing up when you are a student at university 7.2 14.4 78.5

If it becomes permissible to use drugs, there will be a large increase I their use 69.9 18.2 11.9

Misuse of prescription drugs can be as dangerous as misuse of narcotics 90.0 6.6 3.4

The university’s administration should exercise more control over students’ drug use 27.5 35.6 36.9

More treatment and care facilities are needed for drug abusers in Sweden 58.2 31.8 10.0

One should require that all drug abusers seek care 54.9 27.0 18.1 There should be needle exchange programs available throughout Sweden 47.5 31.3 21.2

1 There were 5 answer categories in the questionnaire. Here, the ‘Agree* category represents the sum of the two categories strongly agree and somewhat agree, and the ‘Disagree’ category is a combination of strongly disagree and somewhat disagree. There was a great deal of consistency across sites with respect to these attitude statements (see Table 8.6. A few notable exceptions are of interest though. Students at Lund were more likely to agree with the statement that drinking is a normal part of student behaviour, and along with students from Växjö the felt more strongly that it might be difficult to find friends and fit in, if one was not a drinker. Students from Lund also sowed slightly stronger agreement to the statement that drugs are a normal part of university life. This was only a mild endorsement, seems to reflect the increased prevalence of drug use at that school. Finally, students from Lund were far more likely to see value in broadening needle exchange program to make exchanges available throughout Sweden. This is logical, since needle exchanges in Sweden began in Lund and Malmö. It is possible that Lund students are more aware of what they are and how they work, than other students.

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Table 8.6 Students’ Agreement Statements about Alcohol and Drug Use, Abuse and Care

in Sweden, by site (n=4543)

Statement Kalmar Växjö Umeå Lund

Agree1

% Agree1

% Agree1

% Agree1

% Drinking alcohol is a normal part of student behaviour at university 71.0 76.0 73.4 78.2

One can’t have many friends in this university if one doesn’t drink alcohol 6.8 13.3 7.1 10.2

Alcohol is a bigger problem for Sweden than drugs 62.0 65.4 71.8 64.5

People who drink alcohol experiment more with drugs than those who do not drink alcohol

56.2 52.4 61.0 57.3

If a teenager tries drugs it is a sign of a much more serious problem 76.3 71.3 71.3 64.5

Trying drugs is a normal part of growing up when you are a student at university

4.0 5.0 4.6 10.4

If it becomes permissible to use drugs, there will be a large increase I their use 72.6 64.7 74.6 68.2

Misuse of prescription drugs can be as dangerous as misuse of narcotics 89.7 88.4 91.8 89.5

The university’s administration should exercise more control over students’ drug use

28.2 31.2 28.9 25.1

More treatment and care facilities are needed for drug abusers in Sweden 56.8 57.9 61.1 56.8

One should require that all drug abusers seek care 61.4 54.4 55.7 52.8

There should be needle exchange programs available throughout Sweden 36.8 40.0 41.1 57.0

1 There were 5 answer categories in the questionnaire. Here, the ‘Agree* category represents the sum of the two categories strongly agree and somewhat agree.

The use of drugs other than alcohol, and the use of prescription drugs were also examined in relation to the attitude questions (see Table 8.7). The responses of students who used prescription drugs were very similar to those who did not. However, the responses differed greatly between student who did and did not use drugs other than alcohol and prescriptions. Students who had used drugs, felt more strongly that both alcohol and drugs are a normal part of being a university student, but they also felt more strongly that alcohol was a bigger problem in Sweden that drugs. While drug users felt that people who drink alcohol are more likely to experiment with drugs, they clearly did not support the statement that teenage drug use was a sign of a much larger problem. A view directly opposed to those of students who had not tried drugs. Those who had tried drugs were generally less supportive of intervention by authorities to try to control drug use, and saw more value to needle exchange programs.

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in Sweden, by Use of Drugs (n=4543) Statement Used Drugs 1

last 12 months No Yes

Used Prescription Drugs last 12 months

No Yes Agree2

% Agree2

% Agree2

% Agree2





56.5 65.9 57.3 58.1



5.3 24.0 6.8 11.2


Misuse of prescription drugs can be as dangerous as misuse of narcotics 89.7 93.0 90.2 87.2


29.1 11.7 27.3 27.9


One should require that all drug abusers seek care 57.0 35.1 55.3 51.2

There should be needle exchange programs available throughout Sweden 45.9 61.7 46.9 53.4 1 Drug use includes use of any illicit drugs, except prescription drugs. Tobacco and alcohol are not included. 2 There were 5 answer categories in the questionnaire. Here, the ‘Agree* category represents the sum of the two categories strongly agree and somewhat agree. Students who binge drank and those who drank more frequently responded to the statements in the same general pattern (see Table 8.8). While there is a great deal of overlap between the habits (i.e., the people who are binge drinking are also drinking frequently) not all binge drinkers are regular drinkers. This said, heavy drinkers—of both types—were more likely to think drinking is a normal part of university life, and were less likely to see a teen who tries drugs as a troubled teen, harbouring a more serious problem. As with drug users, they were less supportive of intrusive actions by authorities in attempt to control drug use.

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in Sweden, by Drinking Style and Frequency (n=4543) Statement Binge Drink 1

twice a month No Yes

Drink weekly

No Yes Agree2

% Agree2

% Agree2

% Agree2





56.9 58.4 58.5 55.9



5.8 9.6 5.5 9.8


Misuse of prescription drugs can be as dangerous as misuse of narcotics 90.9 88.6

50.8

90.7 89.1


30.5 22.3 30.4 23.1


One should require that all drug abusers seek care 57.3 50.9 57.8

There should be needle exchange programs available throughout Sweden 47.0 48.4 44.2 52.6

1 Binge drinking is equivalent to drinking a bottle of wine on one occasion. In terms of volume of alcohol consumed, this equates to about 1-75cl bottle of while, or 5-6 (25 cl) shots of spirits, or 4 cans of strong beer, or 6 cans of light beer. 2 There were 5 answer categories in the questionnaire. Here, the ‘Agree* category represents the sum of the two categories strongly agree and somewhat agree.

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9. Alcohol and Drug Policy and Action Does the University Have a Drug or Alcohol Policy?

This survey only contained a few questions that were policy related. Before we began, there was a dearth of information regarding the drug use habits of university students, and a number of myths in circulation, and the main purpose of the study was to provide descriptive information to help fill that dearth. Therefore, the questionnaire, limited in space as it was, could not address a wide range of policy issues. To begin, we asked students two questions: Do you know if there is an alcohol policy at your university? Do you know if there is a drug policy at your university? Only 10.6% of students were aware of an alcohol policy, 1.3% indicated there was no alcohol policy and the remaining 88% responded that they did not know whether there was one or not. Even fewer students knew if their university had a drug policy. Only 8.4% indicated that there was a policy, 0.6% said there was not, and 91.0% said that they did not know. The response patterns were similar across all universities.

Are the Narcotics Sentences too Severe in Sweden? Few students felt that the sentences for being caught using or selling narcotics in Sweden were too severe (6.8% and 2.3% respectively). The majority felt that sentences were not severe enough for being caught selling (52.6%), 14.6% thought they were just about right and the remaining 30.6% did not have an opinion. With respect to the penalties for being caught using narcotics, 38.1% felt that they were not severe enough, another 17.4% found them just about right, and 37.7% did not hold an opinion. Students who had used drugs during their lives held different opinions than those who had never tried drugs (see Figure 9.1). More of them thought that the Swedish sentences for both drug selling and using were too harsh, compared with students who had never tried drugs.

How Should the University Administration Handle Drug Use Offences on Campus? Students were asked to indicate what they felt should happen if a student were caught using various different drugs and on campus, and also asked about selling drugs on campus. The answer they gave differed depending upon the type of drug involved, whether it was the first offence or not, and depending upon whether the action was using or selling (see Figure 9.2).

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Figure 9.1 Respondent’s Opinions on the Laws Regarding the Selling of Drugs and the Use of Drugs in Sweden

0

10

20

30

40

50

60

70

80

Drug Users Non-Users Drug Users Non Users

Not severeenoughJust right

Too severe

Percent

Penalties for selling Drugs

Penalties for Using Drugs

Opinions of

Figure 9.2 Students’ Views Regarding How The University Should Handle Students Who are Caught With Drugs

0102030405060708090

Cannabis - 1st time Cannabis - 2nd time Amphetamine Cocaine Selling Cannabis

nothing counselling suspend from school expell from school report to police

Percent

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If a student were caught using cannabis for the first time, a large majority of the students felt that the individual should receive counselling, yet 31% also believed the individual should be reported to the police. A second offence using cannabis on campus, also resulted in counselling (62.8%), but also a merited a temporary suspension from school (32.2%), and being reported to the police (48.8%). For a first time offence of using amphetamines on campus, counselling was still the most highly reported punishment (66.0%), however 58.8% indicated that the event should be reported to the police, and 31.0% indicated that the student should be temporarily suspended from school. Caught selling cocaine, the likelihood of being reported to the police increases further (62.8%). Students caught selling cannabis on campus for the first time were not treated as leniently as those caught using cannabis on campus for the first time—84.8% of the participants felt that university authorities should report the seller to the police, only 32.1% thought that the person warranted counselling, 25.0% indicated temporary suspension, whereas 34.8% of students felt that the seller should be expelled from school. In brief, student who used drugs were less likely than those who had not tried drugs to treat the user caught for the first time as severely. They were more likely to suggest doing nothing or recommending counselling. For an individual caught a second time, students who had used drugs were less likely to report them to the police, and for a person caught selling on campus, there were no discernible differences between students who had and had not tried drugs with respect to the recommended punishments. What would I do? This next section is not actually about a question of policy; however, it could have policy implications. Informal social control is very important in the area of alcohol and drugs. Often people act in a manner that is deemed socially acceptable because they wish to avoid the repercussions that might arise if they were to act in a less socially accepted manner. Wives often help to control their partners drinking patterns, and keep them from drinking too much, friends stop other friends from drinking and driving, or trying drugs, and there are many more examples of this. In the absence of social controls, formal mechanisms of control would have to be much more effective, and they could easily become overburdened. It was with this idea of informal social control in mind that students were asked what they would do if placed in a number of situations: for example, what would they do if someone they knew were about to try marijuana for the first time, or was actually selling drugs. The full question, as well as the students’ responses can be seen in Table 9.1. As with the previous set of questions, the actions that the student would take were related to both whether it was the first time the individual were doing the illegal action, how hard the drug was, and whether the offence was using or selling. The responses that received the strongest endorsement, when the friend was about to try marijuana for the first time was to try to talk the person out of it (68.3%)or do nothing (16.7%): however, a few people indicated that they would either join them or try to see that they received good quality drugs (less than 8% each). If the student that had just found out that their friend was using marijuana daily, they were most likely to try to talk the person into seeking help (73.9% versus 11.5%), and or inform the friend’s family or other close friends about the situation. Debut into harder drugs warranted more severe responses. There was an increase to 85.4% of students indicating that they would try to persuade the person not to take the drug, and 75.2% would now inform

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family members and other friends about the situation. When it came to a friend found to be selling drugs, a third of the study participants indicated that they would report their friend to the police, and far fewer (27.5%) would involve other friends and family members in the situation.

Table 9.1 Student’s Response to finding out that someone they know is involved with Drugs

Question: What would you do if you found out that someone you know is…

Respondents reply:

about to try marijuana for the first time

using marijuana daily

about to try amphetamines for the first time

selling small amounts of marijuana to other adults

ask if i could join in 5.9 0.4 1.0 0.5

try to assure that the drug is of good quality 7.6 1.6 3.8 1.1

try to persuade them not to do it 68.3 65.6 85.4 68.1

try to persuade them to seek help 11.5 73.9 28.7 24.9

report them to the police 0.9 6.3 2.9 33.3

tell the person’s family or close friends 9.6 42.3 75.2 27.5

Nothing 16.7 2.1 4.0 7.4

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10. Summary and Conclusions Swedish Universities are a place where alcohol is consumed on a regular basis, and by a very large proportion of the student body. Students also tend to drink heavily when they drink, as seen in the measures of binge drinking. Their scores on the AUDIT indicate a much higher risk of future alcohol problems than is seen in the non-student population. And indeed these students are already experiencing a great many harms related to their drinking. These harms could potentially cause some students to withdraw from school, their education incomplete. Swedish Students see drinking as a part of the university experience, while the majority do not make that connection with respect to drug use. They do not use illicit drugs to anywhere near the level that they use alcohol, and it is also clear that as a result students do not experience drug-related harm at a rate at all comparable to alcohol. Having said that, the findings of this study show one of the highest rates reported for lifetime and 12-month cannabis use (Guttormsson, 2004). Our rates are higher that that reported for in the Undomars Drogvanor 1994-2003 report even with the high proportion of females in the sample and the age make-up of students older then the CAN sample (and rates of use decline with age). One of the most interesting pieces of information to emerge from this study is that although a quarter the students had used cannabis during their lives, the large majority had only used it a few times. One hypothesis is that students who use it more often would eventually drop out of school, thus exiting the sample, so we see a skewed view when only looking at this functional group. An opposing possibility is that this is how it has always been, young adults experiment, find out what is and is not for them, and discard behaviours they find unappealing. More research is needed to address this. Another finding of particular interest is that a number of structural elements that may act to increase the frequency and quantity of students drinking. In particular, the findings that students who live in student corridors and with roommates, where there is high-student density, exhibited the highest rates of problem drinking and drug use. Also, students participate in events on campus drink more. It is well known that university students experience high levels of stress. Particular program areas are strongly linked to heavy, drinking and the use of drugs. There is also a connection between course pressure, autonomy and satisfaction and drinking; as well as the connection between poor mental health status and both cannabis and prescription drug use. This suggests a number of alternatives, drug use maybe a coping mechanism engaged by students, and/or the camaraderie in some programs (perhaps related to increased social support) may result in increased festive drinking. These types of findings suggest that there may be some underlying structural facilitators to students’ drinking that may be best addressed though unique approaches that bypass the standard educational campaigns, and individually targeted approaches that have been used in past attempts to reduce risky behaviour. Creativity and further research is needed to move forward in this area. While this work is being done, teaching students how to become better students may be useful to help them gain the most out of their study time. An important issue for further investigation is the increased risk of all alcohol and drug use and harm for students during their first 40 credits. This finding remained significantly related

81


to binge drinking even in the multivariate analyses when age and relocation (where lived before starting school) were being controlled for. More work needs to be done to gain an understanding of why these first year students are so vulnerable and what might be done to improve their situation. Prescription drug use and abuse by the students is another area where further research is necessary. A more specialized study directed towards finding out what drugs people are taking when and why is necessary before any policy issues can be addressed. Are students self-medicating and thus do not think of their medication use as drug use? Are they trying to obtain a high? to escape, to relax? Little is known about this area, and more needs to be known, given the large number of people who indicated that they were using prescription drugs. Students indicated that they are not supportive of additional controls being put in place by the university administration in attempt to control drinking and drug use behaviour. However, at the same time many of them indicated that the university authorities should act to suspend, expel or provide counselling for students who are caught using or selling drugs. Therefore it seems that there is leeway for new policy development if the students see the benefit in it and buy into it. However, getting the students to that state will be a challenge to achieve since less than ten percent of the students were even aware if the university had a drug or alcohol policy in place. Finally, students indicated that they would be receptive to information and help from specialists in the drug area. It seems that Mob and its drug coordinators are well placed at this juncture to assist students.

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References Allen, J.P., Litten, R.Z., Fertig, J.B. & Barbor,T. (1997). A review of the research on the Alcohol Use Disorders Test (AUDIT). Alcoholism: Clinical and Experimental Research, 42(4):613-619. Edwards. P., Roberts, I., Clarke, M., DiGuiseppi, C., Pratap, S & Wentz, R. (2002). Increasing Response rates to postal questionnaires: Systematic Review. British Medical Journal, 324(7347): 1183-1191.

SCB (2004b). Befolkningens studiedeltagande höstterminen 2002. http:/www.scb.se/templates/print___27808.asp. Stockholm: Statistiska centralbyrån.

Guttormsson, U., Andersson, B. & Hibell (2004). Undomars drogvanor 1994—2003: Intervjuer med 16—24-åringar. [Young Adult’s drug use 1994—2003: Interviews with 16—24 year olds] Rapport nr 75. Stockholm: Centralförbundet för alkohol- och narkotikauppylsning. Mangione, T.W. (1995). Mail Surveys: Improving the Quality. London: Sage Publications. SCB (2001). Befolkningens utbildning och sysselsättning. Statistiska centralbyrån. Stockholm SCB (2003). Befolkningens utbildning. Stockholm: Statistiska centralbyrån. SCB (2004a). Befolkningens studiedeltagande höstterminen 2002. http:/www.scb.se/templates/print___27814.asp. Stockholm: Statistiska centralbyrån.

Trinkoff, A.M. & Storr, C.L. (1997). Collecting substance use data with an anonymous mailed survey. Drug and Alcohol Dependence, 48:1-8.

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Appendix A – Study Materials Sample Reminder Card (mailings 2 & 4):

Hej! Det här är en påminnelse ifall du inte har skickat in ditt frågeformulär. Vi skulle uppskatta om du har möjlighet att göra det så snart som möjligt. Om du redan har skickat in det – tack så mycket!

84


Sample Response Card (front):

Jag har returnerat frågeformuläret separat i det bifogade svarskuvertet. Nu behöver jag inte få några fler påminnelser. Jag är samtidigt med i utlottningen av: 1. En cykel 2. En biobiljett

Från

Akademiska Föreningen Kuratorskollegiet Lunds Universitets studentkårer Sandgatan 2 223 50 LUND

Till: Lunds universitet 809543

SVARSPOST kundnummer 22 332349 00 228 20 LUND

Frankeras ej Mottagaren betalar portot.

(back)

Sätt etiketten här

85

SoRAD:s rapportserie ISSN 1650-5441 Leifman H. & Trolldal B. (2001) Alkoholkonsumtionen i Sverige under andra halvåret 2000. Stockholms Universitet:

SoRAD – Forskningsrapport nr. 1 Leifman H. & Trolldal B. (2001) Alkoholkonsumtionen i Sverige 2000/2001. Stockholms universitet:

SoRAD – Forskningsrapport nr. 2 Leifman H. & Trolldal B. (2002) Svenskens alkoholkonsumtion i början av 2000-talet med betoning

på 2001. Stockholms universitet: SoRAD – Forskningsrapport nr. 3 Westfelt L. (2002) Internationella kasinon i Sundsvall och Malmö – Inställning, attityder och

förväntade effekter. Rapport från SoRADs forskningsprojekt “The community impacts of casinos”. Stockholms universitet: SoRAD – Forskningsrapport nr. 4

Eriksson M. & Olsson B. (2002) Alkohol- och drogförebyggande arbete på mindre arbetsplatser. En

telefonintervjuundersökning med personalchefer på 445 företag i Sverige med mellan 20-99 anställda. Stockholms universitet: SoRAD – Forskningsrapport nr. 5

Abrahamsson M. (2002) Ungas definitioner av alkoholist, storkonsument och fyllo. Stockholms

universitet: SoRAD – Forskningsrapport nr. 6 Palm J. (2003) Kvinnor och män i svensk missbruksbehandling: en beskrivning av personalen inom

socialtjästens missbrukarvård i Stockholms län och deras syn på missbrukarvården år 2002. Stockholms universitet – Forskningsrapport nr. 7

Storbjörk J. (2003) Kvinnor och män i svensk missbruksbehandling: en beskrivning av personalen i

Stockholms läns landsting beroendevård och deras syn på missbrukarvården år 2001. Stockholms universitet: SoRAD – Forskningsrapport nr. 8

Palm J. & Storbjörk J. (2003) Kvinnor och män i svensk missbruksbehandling: en beskrivning av

patientgruppen i Stockholms läns landstings beroendevård 2002-2001. Stockholms universitet: SoRAD – Forskningsrapport nr. 9

Westfelt L. (2003) Spelproblem i tre svenska orter: resultat från 6000 intervjuer i Sundsvall, Malmö

och Karlstad. Stockholms universitet: SoRAD – Forskningsrapport nr. 10 Leifman H. & Gustasson N-K. (2003) En skål för det nya millenniet. En studie av svenska folkets

alkoholkonsumtion i början av 2000-talet. Stockholms universitet: SoRAD – Forskningsrapport nr. 11

Fondén C., Skrinjar M., Leiknes M. & Olsson B. (2003) På vems villkor? Om möten mellan

myndigheter och narkotikabrukare. Stockholms universitet: SoRAD – Forskningsrapport nr. 12 Lalander P. & Andreasson J. (2003) Det statliga kasinot: Mellan myt och verklighet. Stockholms

universitet: SoRAD – Forskningsrapport nr. 13 Romelsjö A. (2003). Missbrukare med psykisk sjuklighet i Stockholms län. Stockholms universitet:

SoRAD – Forskningsrapport nr. 14

Eriksson A., Palm J. & Storbjörk J. (2003) Kvinnor och män i svensk missbruksbehandling: en beskrivning av klientgruppen inom socialtjänstens missbrukarvård i Stockholms län 2001-2002. Stockholms universitet: SoRAD – Forskningsrapport nr. 15

Westfelt L. (2004) Kasinoetablering, spelvanor och spelproblem. Situationen före och efter

etableringen av statliga kasinon i Sundsvall och Malmö. Stockholms universitet: SoRAD – Forskningsrapport nr. 16

Sandberg B. (2004) I väntan på sämre tider? En explorativ studie av statsmaktens och centrala

aktörers intentioner, roller och förväntningar på alkoholprevention i arbetslivet. Stockholms universitet: SoRAD – Forskningsrapport nr. 17

Abrahamson M. (2004) Alkohol och unga i 20-årsåldern – rus, lust, problem och prevention.

Stockholms universitet: SoRAD – Forskningsrapport nr. 18 Eriksson A. & Olsson B. (2004) Alkoholvanor bland studerande: Konsumtion, konsekvenser och

attityder bland högskolestuderande och övriga i åldrarna 19-29 år. (Ännu ej publicerad) Stockholms universitet: SoRAD – Forskningsrapport nr. 19

Hradilova Selin K. (red.), Eriksson M., Leifman H., Olsson, B., Ramstedt, M. Room, R., Steen, P

(2994): Svenska dryckesvanor och deras konsekvenser i början av det nya millenniet. Stockholms universitet: SoRAD – Forskningsrapport nr. 20

Bullock, S. (2004) Alcohol, Drugs and Student Lifestyle: A Study of the Attitudes, Beliefs and Use of

Alcohol and Drugs among Swedish University Students. Stockholms universitet: SoRAD – Forskningsrapport nr. 21

Alcohol, Drugs and Student Lifestyle A Study of the Attitudes, Beliefs and Use of Alcohol and Drugs

among Swedish University Students

Sandra Bullock

Centrum för socialvetenskaplig alkohol- och drogforskning Stockholms universitet, Sveaplan, 106 91 Stockholm www.sorad.su.se Telefon: 08-16 20 00 SoRAD – Forskningsrapport nr 21 – 2004 SoRADs rapportserie ISSN 1650-5441 ISBN 91-975134-7

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