Substance Use & Misuse, 50:106–113, 2015 C 2015 Informa Healthcare USA, Inc. Copyright ISSN: 1082-6084 print / 1532-2491 online DOI: 10.3109/10826084.2014.960591
ORIGINAL ARTICLE
Changes in Alcohol Use Among First Year University Students in Mexico Lee Strunin1 , Alejandro D´ıaz-Mart´ınez2 , L. Rosa D´ıaz-Mart´ınez2 , Seth Kuranz1 , 4 3 ´ ´ ´ ´ Carlos HernandezAvila and Hector Fernandez-Varela 1
Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA; Department of Psychiatry and Mental Health, National Autonomous University of Mexico, Mexico City, Mexico; 3 General Medical services, National Autonomous University of Mexico, Mexico City, Mexico; 4 Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut, USA 2
(Hallett et al., 2012; Karam, Kypri, & Salamoun, 2007; Wicki, Kuntsche, & Gmel, 2010). Reviews of drinking among university students found high prevalence of alcohol consumption among students in 21 European countries (Wicki et al., 2010) and similar high rates of drinking in Australasia, Europe, Brazil, and Ecuador as in North America (Karam et al., 2007). Understanding risk factors for alcohol use among young people in different countries with different drinking norms can illuminate protective factors and help understand drinking patterns of immigrants. Young people in all cultural settings tend to follow social timetables for engaging in normative behaviors by observing others of similar background or by taking cues from gatekeepers or institutions within their immediate environments (Arnett, 2001; Fussell & Furstenberg, 2005). Their drinking may echo parental or peer sentiment, reflect culturally normative behavior, or their own norms or preferences (Arnett, 2001; Baer, 1993; Baer & Bray, 1999; Brody, Ge, Katz, & Arias, 2000). Late adolescence and early adulthood, the age period 18–24, is a time of culturally sanctioned transitions to young adulthood including the transition from drinking experimentation to more regular or heavy consumption patterns and may set the stage for lifelong difficulties. During this time of major life transitions that are culturally distinctive, alcohol may be regarded as an acceptable method for coping with new feelings especially if drinking is regarded as normative (Arnett, 2001; Baer, 1993; Fussell & Furstenberg, 2005; Jessor, 1991; Johnston, O’Malley, Bachman, & Schulenberg, 2013). Alcohol also interacts with demographic, economic, and political factors. Patterns of drinking vary according to phases of the lifetime including changes in context of drinking, frequency, and quantity consumed in relation to role changes and life events (Neve, Lemmens, & Drop, 2000; Perreira & Sloan, 2001).
Background: Alcohol use and misuse is widespread among university students in many countries. Specific cultural factors may impact alcohol use after entering university. Objective: This paper considers changes in alcohol use among first year university students in Mexico. Methods: A qualitative study using ethnographic interviews with 57 female and 60 male student drinkers in Mexico City from March to June 2011. Each interview was evaluated by a set of thematic codes developed inductively from the interviews. Findings from excessive, heavy, regular, occasional drinkers, abstainers, and non-drinkers were analyzed to explore whether or not linkages existed between and/or among particular themes. Results: Students reported factors associated with changes in role and status, friendships, and increased autonomy as reasons for increasing or decreasing their alcohol use after entering university. Conclusions/Importance: Understanding the influence of Mexican cultural norms on alcohol use among Mexican and Mexican Americans can be helpful in informing studies and preventive efforts among both Mexican and Mexican American young people. Keywords alcohol, Mexico, first year university students, changes in drinking, qualitative methods
INTRODUCTION
Rates of alcohol use are high among college students in the United States and also among university students in other countries. Drinking and misuse of alcohol among college students has long been of concern in the United States and recently researchers have called for better surveillance and greater attention to the misuse of alcohol use among university populations in other countries
Address correspondence to Professor Lee Strunin, Boston University School of Public Health, 801 Massachusetts Ave., Boston, MA 02118, United States; E-mail: [email protected]
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In Mexico, alcohol is the most commonly used substance (Degenhardt et al., 2008) and there is concern about increased use among all young people. Cross-sectional surveys of entering first year university students in Mexico City found 75% of males and 66% of females drank in the past year in 2005 (D´ıaz-Mart´ınez et al., 2008), 26.9% of students reported drinking 4+ drinks on a single occasion in 2007 (Sol´ıs-Torres, Gorab-Ram´ırez, & Fern´andezVarela, 2012) and in 2008 86.3% of students ages 17–19 reported being ever drinkers with 35.2% of males and 23.7% of females drinking 2+ times per month (Strunin et al., 2013). These rates reflect the most recent National Survey of Addiction (NSA), a national household survey, showing past year alcohol use among 12–17 year olds significantly increased from 25.7% in 2002 to 30.0% in 2011 and in 2011 14.5% of 12–17 year olds and 42.4% of 18–34 year olds drank 5+ (4+ for females) drinks in the past year (Instituto Nacional de Psiquiatr´ıa Ram´on de la Fuente Mu˜niz; Instituto Nacional de Salud P´ublica; Secretar´ıa de Salud, 2012). Little is known about reasons for drinking among university students in Mexico and what factors may influence increased or decreased use after entering university. Although enhancement, social, and coping motives may be reasons for drinking among all young people (Kuntsche, Knibbe, Gmel, & Engels, 2005), social context and social influences are considered the most important predictors among college students (Read, Wood, Kahler, Maddock, & Palfai, 2003). This paper explores reasons for changes in drinking frequency, quantity, and related behaviors among first year students at a large public university in Mexico City where previous studies of entering first year students show most students report drinking (D´ıazMart´ınez et al., 2008; Sol´ıs-Torres et al., 2012; Strunin et al., 2013). The study of Mexican young people is from phase one of a project investigating patterns of alcohol use, including alcohol-related risk behavior and protective factors, cultural attributes that may modify or prevent the likelihood of risk taking, and will indicate whether specific cultural factors affect beliefs and behaviors about alcohol use. In Phase 1 of the project, qualitative interviews explored patterns of alcohol use and context of drinking; circumstances that result in heavier drinking; and cultural attributes that may modify or prevent the likelihood of risk taking. Investigating the drinking behaviors of Mexican young people can be helpful in informing studies and prevention efforts for university students and non-students in Mexico and potentially for Mexican American students and non-students in the United States. METHODS
We conducted a qualitative study using ethnographic open-ended interviews with 117 first year students at a large free public university in Mexico City. The ethnographic interview was designed to elicit young peoples’ alcohol beliefs and patterns of use and encouraged explicit explanations. The interviews explored drinking behaviors and identified alcohol-related risk and protective
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factors. The interviews constitute phase one of a twophase study about alcohol-related risk and protective factors among Mexican students. Phase 1 of the study will indicate whether specific cultural factors affect beliefs and behaviors about alcohol use. The term “ethnographic interviewing” is based on the anthropological method of describing the local point of view and social organization, the culture of a people, and results in studying systems of meaning and rules (Hahn, 1995). Ethnographic interviewing permits the researcher to understand the world as seen by the respondent within the context of the respondent’s everyday life. Sample Selection
A random sample of students was identified from frequency and quantity of alcohol use questions in a mandated general health survey conducted by the university Medical Services during orientation in which students were asked how often they drank alcohol and the number of drinks they consumed each time they drank. Students received an email from Medical Services with a request to participate in an interview and were informed of a follow-up telephone call from research staff if they did not respond. The study project coordinator contacted students who did not respond by telephone 2 days after the email. Students were excluded from the study if they were under 18 years old (legal drinking and purchase age and age of adulthood). The sample was a stratified, purposeful sample of 117 18–24 year old students (60 male and 57 female drinkers) in four consumption groups: 15 male and 12 female heavy drinkers, 15 male and 15 female each of regular, occasional, and non-drinkers. The sample is large enough for both detailed complexity and depth and to make meaningful comparisons. The goal of purposeful sampling strategies is to understand a phenomenon, not to represent a population (Patton, 2002). Heavy drinkers drank 3+ days a week and 4–5 or 6+ drinks per drinking occasion, regular drinkers drank 2–4 times a month, occasional drinkers drank monthly or less, non-drinkers never drank. However, although the sample was identified from the survey, the ethnographic interviews revealed six drinking groups: excessive drinkers drank 10+ drinks 1–2+ times a week (21 students; 13 males, 8 females); heavy drinkers drank 5–8 drinks 2–3 times a week (27 students; 15 males, 12 females); regular drinkers drank 1–4 drinks 2–8 times a month (23 students; 8 males, 15 females); occasional drinkers drank 1–4 drinks once a month or less (28 students; 14 males, 14 females); abstainers did not drink in the past 6 months (10 students; 4 males, 6 females); non-drinkers did not drink (8 students; 6 males, 2 females). Question Development
To help assure collection of comparable qualitative data, an interview guide listed specific questions and topics to be covered in a particular order in the interview. Questions were drawn from previous research about alcohol use among Italian young people and from a national cross-sectional survey about early age of onset among
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young people in the United States. The procedures used to obtain self-reported drinking data included using a quantity-frequency index, a specific settings approach, and beverage-specific questions. Questions about past week, month, and 6 month alcohol use were asked using a chart with pictures of a drink for different types of alcoholic beverages, for example, a 330 ml bottle and can of beer. Students were asked to tell their story about their alcohol use and the interview guide included probe questions about the student’s relationship with alcohol and alcohol use before and after entering university. Probe questions included, “Usually when do you drink?” “Who do you usually drink with?” “Has your alcohol consumption changed since you entered university?” “How is it different? More or less?” “Has anyone in your family ever talked to you about your drinking? What have they told you?” The interviews were conducted by eight interviewers trained in qualitative interviewing techniques by the PI. Language appropriateness and understandability was an important aspect of the training. All interviewers participated in a pre-test of the final questions.
existed between and/or among particular themes using HyperRESEARCH software (HyperRESEARCH, 2009), a text retrieval program geared toward in-depth exploration of data. All names are pseudonyms. RESULTS
At the time of the interview, 6–9 months after entering university, a majority of students reported a change in their drinking behavior. Among the 75 students who changed their alcohol use, 39 (52%) increased and 36 (48%) decreased use. Male and female excessive drinkers reported most decreased use; male heavy drinkers and female regular drinkers reported most increased use. In the following analysis, we use the experiences of the students to describe the changes in alcohol use after attending university and to describe the personal and social impact of these changes. Concepts and themes identified in the findings about responsibilities and priorities, socializing and autonomy illustrate how becoming a university student affects beliefs and behaviors about alcohol use among young people in Mexico.
Interview Procedure
Interviews were conducted in a private space on campus and lasted between 45 and 90 minutes. The interviews were audio recorded and checked by the study coordinator in Mexico City to ensure fidelity with the interview script. The interviews were translated into English by a subcontractor and back-translated by the study coordinator. The participant’s written consent was obtained before the interview. The study was approved by the university IRB for the PI in the United States and the IRB in Mexico City. Analytic Procedures
Data analysis was guided by an interpretive paradigm. The interviews were analyzed to inform and develop concepts and theories related to beliefs, behaviors, traditions, and alcohol-related risk and protective factors of young people before and after entering university. The coding process utilized content analysis to inductively develop a set of thematic codes from the interviews. Coding organizes the text and involves identifying issues and themes of relevance in the text. Codes represent a category or theme found in the data and the codes were attached to corresponding segments of text. To develop the codes and improve inter-rater reliability, two qualitative analysts and the PI each coded four interviews, reviewed the codes, and when it was clear that all understood the coding scheme, four coders used a final code list to organize all interview transcripts with 53 discrete codes of which 43 had subcodes. In order to ensure that each interview was coded correctly, each of the four coders recoded eight interviews of another coder and the project coordinator checked the coding for consistency. Coders reached a level of agreement of 95% or more. Throughout the coding process, the PI and coders discussed any coding differences and resolved any problem cases. The findings from excessive, heavy, regular, occasional drinkers, abstainers, and nondrinkers were analyzed to explore whether or not linkages
Responsibilities and Priorities
For all young people the transition from high school to university incorporates a role change including new expectations and responsibilities (Brown et al., 2008; Schulenberg & Maggs, 2002). The students described the responsibilities and priorities in terms of societal and familial obligations and use of time. New Obligations. Many students reduced their drinking behaviors after entering university because of the need to be more “responsible” and behave in a manner reflective of their new status. Excessive and heavy drinkers were most affected by their new role and described very different drinking patterns than before entering university. Ignacio and Ivan, two excessive drinkers, illustrated these differences: Yes I reduced my consumption a lot because, for example, in the 6th semester of high school we often went drinking after school, very often, I mean two or three times a week between classes and always on weekends, sometimes at nights. But since I got here, no, I mean, I don’t drink on weekdays because of school . . . I mean I couldn’t do it because of all the things I have to do. I feel like the change hit me very hard but I see it as good because I say I’m 19 years old already and I’m about to turn 20 and I have to be more responsible. Besides it’s also school more than anything because I have to work hard, because after this I’ll have to work so I can’t have that immature attitude. (Ignacio) Interviewer: For example, now that you are in university do you think you drink more or less? Ivan: No, less . . . because of school and to study medicine you need to be responsible and you can’t behave like before.
Time Management. For these first year students, time, specifically lack of time, underscored the new priorities of university life and role
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change from a high school to university student. Time issues mostly affected the pre-university socializing and drinking patterns of heavy and excessive drinkers as explained by Nicol´as, a male excessive drinker, and Abril, a female heavy drinker: Right now, [I drink] during the week but I don’t have much time because of school, but before, I started on Friday and then I went out the whole Saturday until early the next Sunday morning. (Nicol´as)
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non-drinker when he began university, and Julieta, an occasional drinker, illustrate how new friendships resulted in drinking onset or increase: Miguel: I didn’t even drink in high school. Interviewer: Do you think there was a change when you started university? Miguel: Yes, because of the friendships I made.
It was a very drastic change at school getting used to everything and all, so I didn’t have time for anything. I had to do my homework and I couldn’t go out. For example, on Fridays, we used to go out on Fridays, but I couldn’t go out because I had my monthly tests on Saturdays. It was the same on Saturday, I was super tired and the last thing I wanted to do was go out. (Abril)
During high school I hardly drank. I drank only when I went out to parties with my sister and my dad picked us up. After I started university I got to meet different people and there was a month when we just went out and drank twice a week which was the time when I felt like an alcoholic. (Julieta)
Socializing
For many students their new status as university student and the transition from high school to university encompassed expanded independence including increased independence from parents, living away from home, and attaining legal age of drinking. Autonomy for many meant more opportunities to drink.
Another factor impacting students’ drinking behaviors was friendships, both new university friendships and existing pre-university friendships. Young people described spending time with new friends from university as well as with old friends and how these friendships influenced their decreasing or increasing alcohol use. New Friends, Old Friends. Both difficulties with socializing and making new friends at university who drank as well as reduced socializing and drinking with high school or other pre-university friends affected use. As with role changes, excessive and heavy drinkers talked most about friendship changes as reasons for reducing alcohol use. Ernesto and Lucas, two heavy drinkers, describe the influence of tangential relationships with other students at university on their drinking: Interviewer: Do you think that your alcohol consumption changed since you started university? Ernesto: Mmm, yes. Well it maybe decreased because I don’t hang out with so many people as in high school, or the people who I hang out with haven’t got that close to me or I haven’t felt that close like the people in my high school. Lucas: When I started university it [drinking] became distant. I’ve barely drunk alcohol, but during the 6th year [at high school] it was at every party and some days during the week also. Interviewer: What about your friends from university? Lucas: Well, it’s a little bit strange. It’s more difficult to drink. I’ve joined them once or twice but hardly. Well, the problem here is that it’s more difficult to make friends because we all attend classes in different groups . . . I have different groups for every subject so the people are changing all the time so it’s very difficult to interact . . . I don’t know, it’s strange, but the relationship is less, and I think the people are more responsible so, it’s very rare if they agree to go [for a drink] . . . . I practically don’t drink anymore at university, and I used to drink a lot in high school . . . . and I’ve found my friends less available since they are at school also.
However, some students in all drinking groups initiated or increased drinking after entering university because of new friends at university. Occasional drinkers and female regular drinkers reported most increase in alcohol use because of new friends who drank. Miguel, a
Autonomy
Increased Freedom. Students in all groups described fewer parental restrictions on their activities after they began university and described drinking more because of the increase in freedom: My parents gave me more freedom precisely because of my age, and then I untied a little bit more with drinking. (Tom´as, occasional drinker) When I started university there was more fooling around. I feel that when I started I began very well in my classes so I said; “Now I have more freedom to go here and there.” Interviewer: So would you say you drink more or less? More. (Paula, heavy drinker)
However although they may have reached age 18 the legal age of alcohol use after entering university, the legality did not necessarily result in increased alcohol use. As illustrated by Ana, a heavy drinker, and Olivia, an abstainer, some students reduced drinking because the illicit attraction of underage drinking was lost: Interviewer: Do you think that you drink differently since you started university? Ana: Yes, I drink less . . . in high school it was . . . the excitement of being minors. Interviewer: But did you keep drinking more, or less? Or the same? Olivia: Ah! No, I mean, nothing. Maybe at the next get-together, or maybe if I go out again, but, no, nowadays, since it’s not that forbidden anymore for my friends or kids my age.
Away From Home. Although the university is a commuter campus and most students live at home with family, those living away from
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home described initiating or increasing drinking after beginning university because of the absence of parental or familial restrictions. Marco, a male heavy drinker living alone, and Emma, a female regular drinker living alone, explained: Interviewer: Do you drink more or less compared to when you were living in [at home]? Marco: I drink more. Well I drank, but less, and almost only on weekends . . . it was very rare during the week . . . only on Friday, Saturday, sometimes on Sunday, and here it is more often. For example, as I said, being here sometimes I buy some beers and I keep them in the fridge and when I crave one I drink it, and back there, my mom doesn’t like me to drink, she knows that I drink sometimes . . . and my father invites me to have one or two beers if I’m with him, but, yes I drink much more here than being there. Interviewer: Didn’t you drink before? Emma: It was after I got here and started to live alone.
DISCUSSION
For many young people the role or status change from high school to university student coincides with other developmental and social changes across different domains including family, work, and/or friends (Brown et al., 2008; Schulenberg & Maggs, 2002). Among students in our study, the transition from high school to university marked a new status with concomitant responsibilities and demands, new friendships, and increased autonomy all of which contributed to decreased or increased alcohol use. Our study indicates that the responsibilities associated with the new status of university student and the social aspect of drinking may be protective for moderate drinking. Students reported decreased alcohol use because of responsibilities related to change in status from high school to university student. While academic motives have been shown to be a reason first year college students do not drink (Vaughan, Corbin, & Fromme, 2009), to our knowledge, no other studies report decreased alcohol use because of perceived responsibilities. The social aspect of drinking also had a major influence on alcohol use. Students reported reducing drinking because of difficulties making new friends or new friends who drank and because of less socializing with pre-university friends who drank. Heavy and excessive drinkers in this study appear to be most influenced by both responsibilities and scarcer social drinking and reduced their drinking. Some students, mainly occasional and female regular drinkers, did initiate or increase drinking because of socializing with new friends at university who drank but they drank moderately. Most students in our study lived at home and commuted to university and the few students in our study not living at home or with relatives initiated or increased drinking after beginning university. Research in the United States shows students living with parents during the first year of college drank less than students living in campus housing or off campus (Fromme, Corbin, & Kruse, 2008) and White students living away from parents had increased odds of en-
gaging in heavy drinking, an association not found among Hispanic students or other racial/ethnic groups (Paschall, Bersamin, & Flewelling, 2005). Although students in our study described increased freedom and fewer parental restrictions after entering university, the increase in drinking may be due to their new university status, reaching the legal age of drinking, or because parental restrictions do not play as important a role in Mexican university students’ drinking patterns. The findings also suggest that students in all drinking groups regulated their alcohol use according to their class schedules and day of the week. They moderated their end of week drinking if classes were scheduled the next day, no longer drinking on Fridays if they attended Saturday classes. Other studies also show that college students drink according to class schedules. In the United States, drinking among college students increased through the week from Sunday to Saturday (Tremblay et al., 2010) with heavy alcohol use occurring on the weekends (Beets et al., 2009). Many first year college students increased consumption when class was not in session and Thursday medium drinkers were less engaged in school and spent less time on homework than other drinking groups including the non-Thursday high drinking group (Hoeppner et al., 2012). Students not enrolled in Friday morning classes were more likely to binge drink (Wood, Sher, & Rutledge, 2007). In New Zealand, heavier drinking students were less likely to schedule Friday morning classes (Paschall, Kypri, & Saltz, 2006). Although the difficulties of scheduling Friday morning classes are addressed in the literature (Ward, Cleveland, & Messman-Moore, 2013) it seems that Friday classes and Saturday morning classes in Mexico reduce weekend drinking and may be an effective intervention among university students (National Institute on Alcohol Abuse and Alcoholism, 2002). An event-specific approach addressing responsibilities and socializing during orientation is another strategy that could be adapted by Mexican university campuses during orientation and at other appropriate times and events. In the United States, college drinking increases during holidays and vacations (Del Boca, Darkes, Greenbaum, & Goldman, 2004), at the end of the school year (Dierker et al., 2008) and heavy episodic drinkers engage in consistent weekend drinking (Beets et al., 2009; Tremblay et al., 2010). Interventions showing some success in reducing alcohol use adopted by U.S. college campuses are event-specific strategies associated with these and other specific times and events (Neighbors et al., 2007; Saltz, Welker, Paschall, Feeney, & Fabiano, 2009). Our findings may also be helpful in informing studies and preventive efforts among Mexican American college students. In 2010, Hispanics comprised 14.1% of college undergraduates in the United States and from 1976 to 2010 the percentage of Hispanic college students increased more than any other racial/ethnic group (U.S. Department of Education, 2012). Over 16 million people residing in the United States were born in Mexico or are children of Mexican immigrants many of whom move back and forth between the United States to Mexico
CHANGES IN ALCOHOL USE AMONG MEXICAN STUDENTS
(Strunin, Edwards, Godette, & Heeren, 2007), maintain ongoing relationships in Mexico and are influenced by changes in Mexican cultural practices. A study examining how young people from different ethnic minority groups in the United States view the transition from adolescence to adulthood found African American, Asian and Latino American young people more likely than Whites to view the criteria reflecting obligation to others as necessary for adult status. Fewer Latino than other ethnic minorities or Whites agreed that deciding on personal beliefs and values independently of parents or other influences was a criterion to be achieved for transition to adulthood. Although the study does not identify ethnic subgroups comprising the Latino sample, the findings suggest the import of the Hispanic/Latino cultural collectivistic norm among Latino American young people (Arnett, 2003). The few studies about the alcohol use of male and female Mexican American college students suggest associations between drinking and identifying with Mexican ethnicity but results are inconsistent. Although stronger identification with Mexican ethnicity was associated with increased frequency of heavy alcohol use among males but not females at a Midwestern university (Zamboanga, Raffaelli, & Horton, 2006) and higher acculturation predicted drinking in more public settings and increased alcohol use among female college students but decreased use among male college students at three universities in Texas (Raffaelli et al., 2007), no association was found between acculturation and drinking among college students in the Southwestern United States (Schweizer, Doran, Roesch, & Myers, 2011). Differences in measures of ethnic identity, acculturation, study samples, and location make comparisons of findings between studies difficult. Further, the observed drinking patterns in the United States may reflect drinking practices among young people both in the United States and Mexico because Mexican migration is often neither linear nor unidirectional, which makes it difficult to associate alcohol use with migration to the United States within this population (Strunin et al., 2007). There are limitations to this study. Questions used to define students’ drinking for inclusion into the study underestimated the quantity and frequency of alcohol use. However, the ethnographic interviews with students were conducted within 6 months of the first year of university and all students were of the legal drinking age. Quantity and frequency of alcohol use were queried using anchors for past 6 and past month alcohol use to help students recall their drinking accurately. For these reasons it is likely students provided reliable information about changes in their drinking before and after starting university. Further, surveys of Mexican youths of similar ages to students in our study found similar rates of drinking (D´ıaz-Mart´ınez, ´ D´ıaz-Mart´ınez, & Hern´andez-Avila, 2012; Latimer et al., 2004; Medina-Mora, Borges, & Villatoro, 2000; Sol´ısTorres et al., 2012). More research among Mexican and MexicanAmerican students focusing on whether moderating use reflects roles and responsibilities and investigating concerns about responsibilities may reveal a potential
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area for intervention. Investigating specific cultural norms and values can inform prevention and intervention for university students and other young people in Mexico as well as Mexican American young people and potentially different ethnic groups of Hispanic/Latino youths in the United States. Declaration of Interest
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article. THE AUTHORS Lee Strunin, PhD, is a medical anthropologist and Professor in the Department of Community Health Sciences at Boston University School of Public Health (BUSPH). Her research focuses on identifying and comparing alcohol-related risk and protective factors and behaviors among young people from different racial and/or ethnic backgrounds. She has conducted studies of alcohol use among Black, White, and Hispanic young people in the United States, young people in Italy and in Mexico.
Alejandro D´ıaz Mart´ınez, MD, is a Professor of Psychiatry at the National Autonomous University of Mexico Medical School (UNAM). He has conducted studies on the pharmacotherapy of depression and schizophrenia as well as examining prevalence rates and correlates of drinking problems among UNAM students in Mexico City.
L. Rosa D´ıaz Mart´ınez, MD, is an Assistant Professor of Psychiatry at UNAM Medical School and a clinical researcher at the Mexico National Institute of Psychiatry in Mexico City. She has conducted studies on the psychosocial rehabilitation of schizophrenic patients, on the extent of alcohol and mental health problems in rural communities in central Mexico and was co-investigator on a
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study examining drinking problems and the effectiveness of brief interventions among UNAM students in Mexico City.
Seth Kuranz, MPH, is a doctoral student in the Department of Epidemiology, BUSPH, and a project coordinator in the Department of Community Health Sciences, BUSPH. His research interests include neighborhood context and alcohol and drug use among adolescents.
´ Carlos A. Hern´andez-Avila, MD, PhD, is a psychiatrist with a specialty in addiction psychiatry. He is an Assistant Clinical Professor of Psychiatry, and is affiliated with the Alcohol Research Center at the University of Connecticut School of Medicine.
H´ector Fern´andez Varela, MD, is a pediatrician and the Director General of Medical Services at the National Autonomous University of Mexico (UNAM). He oversees all medical and dental services to UNAM students and is responsible for an annual health survey administered to all entering first year students across the 10 UNAM campuses in Mexico City, which focuses on early detection of health problems.
GLOSSARY
Ethnographic interviewing: anthropological method of describing the local point of view and social organization, the culture of a people, and results in studying systems of meaning and rules (Hahn, 1995). Interpretive paradigm: in this study, interviews were analyzed to inform and develop concepts and theories related to beliefs, behaviors, traditions, and alcoholrelated risk and protective factors of young people. Stratified, purposeful sample: the goal of purposeful sampling strategies is to understand a phenomenon, not to represent a population (Patton, 2002). The social aspect of drinking: drinking in a social setting and/or using alcohol to foster socialization with peers.
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Read, J. P., Wood, M. D., Kahler, C. W., Maddock, J. E., & Palfai, T. P. (2003). Examining the role of drinking motives in college student alcohol use and problems. Psychology of Addictive Behaviors, 17, 13–23. ResearchWare, Inc. (2009). HyperRESEARCH. Retrieved September 10, 2012, from http://www.researchware.com Saltz, R. F., Welker, L. R., Paschall, M. J., Feeney, M. A., & Fabiano, P. M. (2009). Evaluating a comprehensive campuscommunity prevention intervention to reduce alcohol-related problems in a college population. Journal of Studies on Alcohol and Drugs. (Supplement), 16, 21–27. Schulenberg, J. E., & Maggs, J. L. (2002). A developmental perspective on alcohol use and heavy drinking during adolescence and the transition to young adulthood. Journal of Studies on Alcohol and Drugs, 14, 54–70. Schweizer, C., Doran, N., Roesch, S., & Myers, M. (2011). Progression to problem drinking among Mexican American and White European first-year college students: A multiple group analysis. Journal of Studies on Alcohol and Drugs, 72, 975–980. Sol´ıs-Torres, C., Gorab-Ram´ırez, A., & Fern´andez-Varela, H. (2012). Consumo de alcohol, marihuana y coca´ına en estudiantes de la zona metropolitana de la ciudad de M´exico que ingresaron a licenciatura en el a˜no 2007. In L. Mar´ıa-Reydl (Ed.), Desarrollo de nuevos modelos para la prevenci´on y el tratamiento de conductas adictivas (pp. 215–235). M´exico: Universidad Nacional Aut´onomas de M´exico y Miguel Angerl Porr´ua. Strunin, L., D´ıaz-Mart´ınez, A., D´ıaz-Mart´ınez, L. R., Heeren, T., Kuranz, S., Winter, M., . . . Sol´ıs-Torres, C. (2013). Parental monitoring and alcohol use among Mexican students. Addictive Behaviors, 38, 2601–2606. Strunin, L., Edwards, E. M., Godette, D. C., & Heeren, T. (2007). Country of origin, age of drinking onset, and drinking patterns among Mexican American young adults. Drug and Alcohol Dependence, 91, 134–140. Tremblay, P. F., Graham, K., Wells, S., Harris, R., Pulford, R., & Roberts, S. E. (2010). When do first-year college students drink most during the academic year? An internet-based study of daily and weekly drinking. Journal of American College Health, 58, 401–411. U.S. Department of Education. (2012). Digest of Education Statistics, 2011 (No. 2012001). NCES. Retrieved October 22, 2013, from http://nces.ed.gov/pubsearch/pubsinfo.asp? pubid=2012001. Vaughan, E. L., Corbin, W. R., & Fromme, K. (2009). Academic and social motives and drinking behavior. Psychology of Addictive Behaviors, 23, 564–576. Ward, R. M., Cleveland, M. J., & Messman-Moore, T. L. (2013). Latent class analysis of college women’s Thursday drinking. Addictive Behaviors, 38, 1407–1413. Wicki, M., Kuntsche, E., & Gmel, G. (2010). Drinking at European universities? A review of students’ alcohol use. Addictive Behaviors, 35, 913–924. Wood, P. K., Sher, K. J., & Rutledge, P. C. (2007). College student alcohol consumption, day of the week, and class schedule. Alcoholism: Clinical and Experimental Research, 31, 1195–1207. Zamboanga, B. L., Raffaelli, M., & Horton, N. J. (2006). Acculturation status and heavy alcohol use among Mexican American college students: Investigating the moderating role of gender. Addictive Behaviors, 31, 2188–2198.
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ORIGINAL ARTICLE
Changes in Alcohol Use Among First Year University Students in Mexico Lee Strunin1 , Alejandro D´ıaz-Mart´ınez2 , L. Rosa D´ıaz-Mart´ınez2 , Seth Kuranz1 , 4 3 ´ ´ ´ ´ Carlos HernandezAvila and Hector Fernandez-Varela 1
Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA; Department of Psychiatry and Mental Health, National Autonomous University of Mexico, Mexico City, Mexico; 3 General Medical services, National Autonomous University of Mexico, Mexico City, Mexico; 4 Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut, USA 2
(Hallett et al., 2012; Karam, Kypri, & Salamoun, 2007; Wicki, Kuntsche, & Gmel, 2010). Reviews of drinking among university students found high prevalence of alcohol consumption among students in 21 European countries (Wicki et al., 2010) and similar high rates of drinking in Australasia, Europe, Brazil, and Ecuador as in North America (Karam et al., 2007). Understanding risk factors for alcohol use among young people in different countries with different drinking norms can illuminate protective factors and help understand drinking patterns of immigrants. Young people in all cultural settings tend to follow social timetables for engaging in normative behaviors by observing others of similar background or by taking cues from gatekeepers or institutions within their immediate environments (Arnett, 2001; Fussell & Furstenberg, 2005). Their drinking may echo parental or peer sentiment, reflect culturally normative behavior, or their own norms or preferences (Arnett, 2001; Baer, 1993; Baer & Bray, 1999; Brody, Ge, Katz, & Arias, 2000). Late adolescence and early adulthood, the age period 18–24, is a time of culturally sanctioned transitions to young adulthood including the transition from drinking experimentation to more regular or heavy consumption patterns and may set the stage for lifelong difficulties. During this time of major life transitions that are culturally distinctive, alcohol may be regarded as an acceptable method for coping with new feelings especially if drinking is regarded as normative (Arnett, 2001; Baer, 1993; Fussell & Furstenberg, 2005; Jessor, 1991; Johnston, O’Malley, Bachman, & Schulenberg, 2013). Alcohol also interacts with demographic, economic, and political factors. Patterns of drinking vary according to phases of the lifetime including changes in context of drinking, frequency, and quantity consumed in relation to role changes and life events (Neve, Lemmens, & Drop, 2000; Perreira & Sloan, 2001).
Background: Alcohol use and misuse is widespread among university students in many countries. Specific cultural factors may impact alcohol use after entering university. Objective: This paper considers changes in alcohol use among first year university students in Mexico. Methods: A qualitative study using ethnographic interviews with 57 female and 60 male student drinkers in Mexico City from March to June 2011. Each interview was evaluated by a set of thematic codes developed inductively from the interviews. Findings from excessive, heavy, regular, occasional drinkers, abstainers, and non-drinkers were analyzed to explore whether or not linkages existed between and/or among particular themes. Results: Students reported factors associated with changes in role and status, friendships, and increased autonomy as reasons for increasing or decreasing their alcohol use after entering university. Conclusions/Importance: Understanding the influence of Mexican cultural norms on alcohol use among Mexican and Mexican Americans can be helpful in informing studies and preventive efforts among both Mexican and Mexican American young people. Keywords alcohol, Mexico, first year university students, changes in drinking, qualitative methods
INTRODUCTION
Rates of alcohol use are high among college students in the United States and also among university students in other countries. Drinking and misuse of alcohol among college students has long been of concern in the United States and recently researchers have called for better surveillance and greater attention to the misuse of alcohol use among university populations in other countries
Address correspondence to Professor Lee Strunin, Boston University School of Public Health, 801 Massachusetts Ave., Boston, MA 02118, United States; E-mail: [email protected]
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In Mexico, alcohol is the most commonly used substance (Degenhardt et al., 2008) and there is concern about increased use among all young people. Cross-sectional surveys of entering first year university students in Mexico City found 75% of males and 66% of females drank in the past year in 2005 (D´ıaz-Mart´ınez et al., 2008), 26.9% of students reported drinking 4+ drinks on a single occasion in 2007 (Sol´ıs-Torres, Gorab-Ram´ırez, & Fern´andezVarela, 2012) and in 2008 86.3% of students ages 17–19 reported being ever drinkers with 35.2% of males and 23.7% of females drinking 2+ times per month (Strunin et al., 2013). These rates reflect the most recent National Survey of Addiction (NSA), a national household survey, showing past year alcohol use among 12–17 year olds significantly increased from 25.7% in 2002 to 30.0% in 2011 and in 2011 14.5% of 12–17 year olds and 42.4% of 18–34 year olds drank 5+ (4+ for females) drinks in the past year (Instituto Nacional de Psiquiatr´ıa Ram´on de la Fuente Mu˜niz; Instituto Nacional de Salud P´ublica; Secretar´ıa de Salud, 2012). Little is known about reasons for drinking among university students in Mexico and what factors may influence increased or decreased use after entering university. Although enhancement, social, and coping motives may be reasons for drinking among all young people (Kuntsche, Knibbe, Gmel, & Engels, 2005), social context and social influences are considered the most important predictors among college students (Read, Wood, Kahler, Maddock, & Palfai, 2003). This paper explores reasons for changes in drinking frequency, quantity, and related behaviors among first year students at a large public university in Mexico City where previous studies of entering first year students show most students report drinking (D´ıazMart´ınez et al., 2008; Sol´ıs-Torres et al., 2012; Strunin et al., 2013). The study of Mexican young people is from phase one of a project investigating patterns of alcohol use, including alcohol-related risk behavior and protective factors, cultural attributes that may modify or prevent the likelihood of risk taking, and will indicate whether specific cultural factors affect beliefs and behaviors about alcohol use. In Phase 1 of the project, qualitative interviews explored patterns of alcohol use and context of drinking; circumstances that result in heavier drinking; and cultural attributes that may modify or prevent the likelihood of risk taking. Investigating the drinking behaviors of Mexican young people can be helpful in informing studies and prevention efforts for university students and non-students in Mexico and potentially for Mexican American students and non-students in the United States. METHODS
We conducted a qualitative study using ethnographic open-ended interviews with 117 first year students at a large free public university in Mexico City. The ethnographic interview was designed to elicit young peoples’ alcohol beliefs and patterns of use and encouraged explicit explanations. The interviews explored drinking behaviors and identified alcohol-related risk and protective
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factors. The interviews constitute phase one of a twophase study about alcohol-related risk and protective factors among Mexican students. Phase 1 of the study will indicate whether specific cultural factors affect beliefs and behaviors about alcohol use. The term “ethnographic interviewing” is based on the anthropological method of describing the local point of view and social organization, the culture of a people, and results in studying systems of meaning and rules (Hahn, 1995). Ethnographic interviewing permits the researcher to understand the world as seen by the respondent within the context of the respondent’s everyday life. Sample Selection
A random sample of students was identified from frequency and quantity of alcohol use questions in a mandated general health survey conducted by the university Medical Services during orientation in which students were asked how often they drank alcohol and the number of drinks they consumed each time they drank. Students received an email from Medical Services with a request to participate in an interview and were informed of a follow-up telephone call from research staff if they did not respond. The study project coordinator contacted students who did not respond by telephone 2 days after the email. Students were excluded from the study if they were under 18 years old (legal drinking and purchase age and age of adulthood). The sample was a stratified, purposeful sample of 117 18–24 year old students (60 male and 57 female drinkers) in four consumption groups: 15 male and 12 female heavy drinkers, 15 male and 15 female each of regular, occasional, and non-drinkers. The sample is large enough for both detailed complexity and depth and to make meaningful comparisons. The goal of purposeful sampling strategies is to understand a phenomenon, not to represent a population (Patton, 2002). Heavy drinkers drank 3+ days a week and 4–5 or 6+ drinks per drinking occasion, regular drinkers drank 2–4 times a month, occasional drinkers drank monthly or less, non-drinkers never drank. However, although the sample was identified from the survey, the ethnographic interviews revealed six drinking groups: excessive drinkers drank 10+ drinks 1–2+ times a week (21 students; 13 males, 8 females); heavy drinkers drank 5–8 drinks 2–3 times a week (27 students; 15 males, 12 females); regular drinkers drank 1–4 drinks 2–8 times a month (23 students; 8 males, 15 females); occasional drinkers drank 1–4 drinks once a month or less (28 students; 14 males, 14 females); abstainers did not drink in the past 6 months (10 students; 4 males, 6 females); non-drinkers did not drink (8 students; 6 males, 2 females). Question Development
To help assure collection of comparable qualitative data, an interview guide listed specific questions and topics to be covered in a particular order in the interview. Questions were drawn from previous research about alcohol use among Italian young people and from a national cross-sectional survey about early age of onset among
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young people in the United States. The procedures used to obtain self-reported drinking data included using a quantity-frequency index, a specific settings approach, and beverage-specific questions. Questions about past week, month, and 6 month alcohol use were asked using a chart with pictures of a drink for different types of alcoholic beverages, for example, a 330 ml bottle and can of beer. Students were asked to tell their story about their alcohol use and the interview guide included probe questions about the student’s relationship with alcohol and alcohol use before and after entering university. Probe questions included, “Usually when do you drink?” “Who do you usually drink with?” “Has your alcohol consumption changed since you entered university?” “How is it different? More or less?” “Has anyone in your family ever talked to you about your drinking? What have they told you?” The interviews were conducted by eight interviewers trained in qualitative interviewing techniques by the PI. Language appropriateness and understandability was an important aspect of the training. All interviewers participated in a pre-test of the final questions.
existed between and/or among particular themes using HyperRESEARCH software (HyperRESEARCH, 2009), a text retrieval program geared toward in-depth exploration of data. All names are pseudonyms. RESULTS
At the time of the interview, 6–9 months after entering university, a majority of students reported a change in their drinking behavior. Among the 75 students who changed their alcohol use, 39 (52%) increased and 36 (48%) decreased use. Male and female excessive drinkers reported most decreased use; male heavy drinkers and female regular drinkers reported most increased use. In the following analysis, we use the experiences of the students to describe the changes in alcohol use after attending university and to describe the personal and social impact of these changes. Concepts and themes identified in the findings about responsibilities and priorities, socializing and autonomy illustrate how becoming a university student affects beliefs and behaviors about alcohol use among young people in Mexico.
Interview Procedure
Interviews were conducted in a private space on campus and lasted between 45 and 90 minutes. The interviews were audio recorded and checked by the study coordinator in Mexico City to ensure fidelity with the interview script. The interviews were translated into English by a subcontractor and back-translated by the study coordinator. The participant’s written consent was obtained before the interview. The study was approved by the university IRB for the PI in the United States and the IRB in Mexico City. Analytic Procedures
Data analysis was guided by an interpretive paradigm. The interviews were analyzed to inform and develop concepts and theories related to beliefs, behaviors, traditions, and alcohol-related risk and protective factors of young people before and after entering university. The coding process utilized content analysis to inductively develop a set of thematic codes from the interviews. Coding organizes the text and involves identifying issues and themes of relevance in the text. Codes represent a category or theme found in the data and the codes were attached to corresponding segments of text. To develop the codes and improve inter-rater reliability, two qualitative analysts and the PI each coded four interviews, reviewed the codes, and when it was clear that all understood the coding scheme, four coders used a final code list to organize all interview transcripts with 53 discrete codes of which 43 had subcodes. In order to ensure that each interview was coded correctly, each of the four coders recoded eight interviews of another coder and the project coordinator checked the coding for consistency. Coders reached a level of agreement of 95% or more. Throughout the coding process, the PI and coders discussed any coding differences and resolved any problem cases. The findings from excessive, heavy, regular, occasional drinkers, abstainers, and nondrinkers were analyzed to explore whether or not linkages
Responsibilities and Priorities
For all young people the transition from high school to university incorporates a role change including new expectations and responsibilities (Brown et al., 2008; Schulenberg & Maggs, 2002). The students described the responsibilities and priorities in terms of societal and familial obligations and use of time. New Obligations. Many students reduced their drinking behaviors after entering university because of the need to be more “responsible” and behave in a manner reflective of their new status. Excessive and heavy drinkers were most affected by their new role and described very different drinking patterns than before entering university. Ignacio and Ivan, two excessive drinkers, illustrated these differences: Yes I reduced my consumption a lot because, for example, in the 6th semester of high school we often went drinking after school, very often, I mean two or three times a week between classes and always on weekends, sometimes at nights. But since I got here, no, I mean, I don’t drink on weekdays because of school . . . I mean I couldn’t do it because of all the things I have to do. I feel like the change hit me very hard but I see it as good because I say I’m 19 years old already and I’m about to turn 20 and I have to be more responsible. Besides it’s also school more than anything because I have to work hard, because after this I’ll have to work so I can’t have that immature attitude. (Ignacio) Interviewer: For example, now that you are in university do you think you drink more or less? Ivan: No, less . . . because of school and to study medicine you need to be responsible and you can’t behave like before.
Time Management. For these first year students, time, specifically lack of time, underscored the new priorities of university life and role
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change from a high school to university student. Time issues mostly affected the pre-university socializing and drinking patterns of heavy and excessive drinkers as explained by Nicol´as, a male excessive drinker, and Abril, a female heavy drinker: Right now, [I drink] during the week but I don’t have much time because of school, but before, I started on Friday and then I went out the whole Saturday until early the next Sunday morning. (Nicol´as)
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non-drinker when he began university, and Julieta, an occasional drinker, illustrate how new friendships resulted in drinking onset or increase: Miguel: I didn’t even drink in high school. Interviewer: Do you think there was a change when you started university? Miguel: Yes, because of the friendships I made.
It was a very drastic change at school getting used to everything and all, so I didn’t have time for anything. I had to do my homework and I couldn’t go out. For example, on Fridays, we used to go out on Fridays, but I couldn’t go out because I had my monthly tests on Saturdays. It was the same on Saturday, I was super tired and the last thing I wanted to do was go out. (Abril)
During high school I hardly drank. I drank only when I went out to parties with my sister and my dad picked us up. After I started university I got to meet different people and there was a month when we just went out and drank twice a week which was the time when I felt like an alcoholic. (Julieta)
Socializing
For many students their new status as university student and the transition from high school to university encompassed expanded independence including increased independence from parents, living away from home, and attaining legal age of drinking. Autonomy for many meant more opportunities to drink.
Another factor impacting students’ drinking behaviors was friendships, both new university friendships and existing pre-university friendships. Young people described spending time with new friends from university as well as with old friends and how these friendships influenced their decreasing or increasing alcohol use. New Friends, Old Friends. Both difficulties with socializing and making new friends at university who drank as well as reduced socializing and drinking with high school or other pre-university friends affected use. As with role changes, excessive and heavy drinkers talked most about friendship changes as reasons for reducing alcohol use. Ernesto and Lucas, two heavy drinkers, describe the influence of tangential relationships with other students at university on their drinking: Interviewer: Do you think that your alcohol consumption changed since you started university? Ernesto: Mmm, yes. Well it maybe decreased because I don’t hang out with so many people as in high school, or the people who I hang out with haven’t got that close to me or I haven’t felt that close like the people in my high school. Lucas: When I started university it [drinking] became distant. I’ve barely drunk alcohol, but during the 6th year [at high school] it was at every party and some days during the week also. Interviewer: What about your friends from university? Lucas: Well, it’s a little bit strange. It’s more difficult to drink. I’ve joined them once or twice but hardly. Well, the problem here is that it’s more difficult to make friends because we all attend classes in different groups . . . I have different groups for every subject so the people are changing all the time so it’s very difficult to interact . . . I don’t know, it’s strange, but the relationship is less, and I think the people are more responsible so, it’s very rare if they agree to go [for a drink] . . . . I practically don’t drink anymore at university, and I used to drink a lot in high school . . . . and I’ve found my friends less available since they are at school also.
However, some students in all drinking groups initiated or increased drinking after entering university because of new friends at university. Occasional drinkers and female regular drinkers reported most increase in alcohol use because of new friends who drank. Miguel, a
Autonomy
Increased Freedom. Students in all groups described fewer parental restrictions on their activities after they began university and described drinking more because of the increase in freedom: My parents gave me more freedom precisely because of my age, and then I untied a little bit more with drinking. (Tom´as, occasional drinker) When I started university there was more fooling around. I feel that when I started I began very well in my classes so I said; “Now I have more freedom to go here and there.” Interviewer: So would you say you drink more or less? More. (Paula, heavy drinker)
However although they may have reached age 18 the legal age of alcohol use after entering university, the legality did not necessarily result in increased alcohol use. As illustrated by Ana, a heavy drinker, and Olivia, an abstainer, some students reduced drinking because the illicit attraction of underage drinking was lost: Interviewer: Do you think that you drink differently since you started university? Ana: Yes, I drink less . . . in high school it was . . . the excitement of being minors. Interviewer: But did you keep drinking more, or less? Or the same? Olivia: Ah! No, I mean, nothing. Maybe at the next get-together, or maybe if I go out again, but, no, nowadays, since it’s not that forbidden anymore for my friends or kids my age.
Away From Home. Although the university is a commuter campus and most students live at home with family, those living away from
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home described initiating or increasing drinking after beginning university because of the absence of parental or familial restrictions. Marco, a male heavy drinker living alone, and Emma, a female regular drinker living alone, explained: Interviewer: Do you drink more or less compared to when you were living in [at home]? Marco: I drink more. Well I drank, but less, and almost only on weekends . . . it was very rare during the week . . . only on Friday, Saturday, sometimes on Sunday, and here it is more often. For example, as I said, being here sometimes I buy some beers and I keep them in the fridge and when I crave one I drink it, and back there, my mom doesn’t like me to drink, she knows that I drink sometimes . . . and my father invites me to have one or two beers if I’m with him, but, yes I drink much more here than being there. Interviewer: Didn’t you drink before? Emma: It was after I got here and started to live alone.
DISCUSSION
For many young people the role or status change from high school to university student coincides with other developmental and social changes across different domains including family, work, and/or friends (Brown et al., 2008; Schulenberg & Maggs, 2002). Among students in our study, the transition from high school to university marked a new status with concomitant responsibilities and demands, new friendships, and increased autonomy all of which contributed to decreased or increased alcohol use. Our study indicates that the responsibilities associated with the new status of university student and the social aspect of drinking may be protective for moderate drinking. Students reported decreased alcohol use because of responsibilities related to change in status from high school to university student. While academic motives have been shown to be a reason first year college students do not drink (Vaughan, Corbin, & Fromme, 2009), to our knowledge, no other studies report decreased alcohol use because of perceived responsibilities. The social aspect of drinking also had a major influence on alcohol use. Students reported reducing drinking because of difficulties making new friends or new friends who drank and because of less socializing with pre-university friends who drank. Heavy and excessive drinkers in this study appear to be most influenced by both responsibilities and scarcer social drinking and reduced their drinking. Some students, mainly occasional and female regular drinkers, did initiate or increase drinking because of socializing with new friends at university who drank but they drank moderately. Most students in our study lived at home and commuted to university and the few students in our study not living at home or with relatives initiated or increased drinking after beginning university. Research in the United States shows students living with parents during the first year of college drank less than students living in campus housing or off campus (Fromme, Corbin, & Kruse, 2008) and White students living away from parents had increased odds of en-
gaging in heavy drinking, an association not found among Hispanic students or other racial/ethnic groups (Paschall, Bersamin, & Flewelling, 2005). Although students in our study described increased freedom and fewer parental restrictions after entering university, the increase in drinking may be due to their new university status, reaching the legal age of drinking, or because parental restrictions do not play as important a role in Mexican university students’ drinking patterns. The findings also suggest that students in all drinking groups regulated their alcohol use according to their class schedules and day of the week. They moderated their end of week drinking if classes were scheduled the next day, no longer drinking on Fridays if they attended Saturday classes. Other studies also show that college students drink according to class schedules. In the United States, drinking among college students increased through the week from Sunday to Saturday (Tremblay et al., 2010) with heavy alcohol use occurring on the weekends (Beets et al., 2009). Many first year college students increased consumption when class was not in session and Thursday medium drinkers were less engaged in school and spent less time on homework than other drinking groups including the non-Thursday high drinking group (Hoeppner et al., 2012). Students not enrolled in Friday morning classes were more likely to binge drink (Wood, Sher, & Rutledge, 2007). In New Zealand, heavier drinking students were less likely to schedule Friday morning classes (Paschall, Kypri, & Saltz, 2006). Although the difficulties of scheduling Friday morning classes are addressed in the literature (Ward, Cleveland, & Messman-Moore, 2013) it seems that Friday classes and Saturday morning classes in Mexico reduce weekend drinking and may be an effective intervention among university students (National Institute on Alcohol Abuse and Alcoholism, 2002). An event-specific approach addressing responsibilities and socializing during orientation is another strategy that could be adapted by Mexican university campuses during orientation and at other appropriate times and events. In the United States, college drinking increases during holidays and vacations (Del Boca, Darkes, Greenbaum, & Goldman, 2004), at the end of the school year (Dierker et al., 2008) and heavy episodic drinkers engage in consistent weekend drinking (Beets et al., 2009; Tremblay et al., 2010). Interventions showing some success in reducing alcohol use adopted by U.S. college campuses are event-specific strategies associated with these and other specific times and events (Neighbors et al., 2007; Saltz, Welker, Paschall, Feeney, & Fabiano, 2009). Our findings may also be helpful in informing studies and preventive efforts among Mexican American college students. In 2010, Hispanics comprised 14.1% of college undergraduates in the United States and from 1976 to 2010 the percentage of Hispanic college students increased more than any other racial/ethnic group (U.S. Department of Education, 2012). Over 16 million people residing in the United States were born in Mexico or are children of Mexican immigrants many of whom move back and forth between the United States to Mexico
CHANGES IN ALCOHOL USE AMONG MEXICAN STUDENTS
(Strunin, Edwards, Godette, & Heeren, 2007), maintain ongoing relationships in Mexico and are influenced by changes in Mexican cultural practices. A study examining how young people from different ethnic minority groups in the United States view the transition from adolescence to adulthood found African American, Asian and Latino American young people more likely than Whites to view the criteria reflecting obligation to others as necessary for adult status. Fewer Latino than other ethnic minorities or Whites agreed that deciding on personal beliefs and values independently of parents or other influences was a criterion to be achieved for transition to adulthood. Although the study does not identify ethnic subgroups comprising the Latino sample, the findings suggest the import of the Hispanic/Latino cultural collectivistic norm among Latino American young people (Arnett, 2003). The few studies about the alcohol use of male and female Mexican American college students suggest associations between drinking and identifying with Mexican ethnicity but results are inconsistent. Although stronger identification with Mexican ethnicity was associated with increased frequency of heavy alcohol use among males but not females at a Midwestern university (Zamboanga, Raffaelli, & Horton, 2006) and higher acculturation predicted drinking in more public settings and increased alcohol use among female college students but decreased use among male college students at three universities in Texas (Raffaelli et al., 2007), no association was found between acculturation and drinking among college students in the Southwestern United States (Schweizer, Doran, Roesch, & Myers, 2011). Differences in measures of ethnic identity, acculturation, study samples, and location make comparisons of findings between studies difficult. Further, the observed drinking patterns in the United States may reflect drinking practices among young people both in the United States and Mexico because Mexican migration is often neither linear nor unidirectional, which makes it difficult to associate alcohol use with migration to the United States within this population (Strunin et al., 2007). There are limitations to this study. Questions used to define students’ drinking for inclusion into the study underestimated the quantity and frequency of alcohol use. However, the ethnographic interviews with students were conducted within 6 months of the first year of university and all students were of the legal drinking age. Quantity and frequency of alcohol use were queried using anchors for past 6 and past month alcohol use to help students recall their drinking accurately. For these reasons it is likely students provided reliable information about changes in their drinking before and after starting university. Further, surveys of Mexican youths of similar ages to students in our study found similar rates of drinking (D´ıaz-Mart´ınez, ´ D´ıaz-Mart´ınez, & Hern´andez-Avila, 2012; Latimer et al., 2004; Medina-Mora, Borges, & Villatoro, 2000; Sol´ısTorres et al., 2012). More research among Mexican and MexicanAmerican students focusing on whether moderating use reflects roles and responsibilities and investigating concerns about responsibilities may reveal a potential
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area for intervention. Investigating specific cultural norms and values can inform prevention and intervention for university students and other young people in Mexico as well as Mexican American young people and potentially different ethnic groups of Hispanic/Latino youths in the United States. Declaration of Interest
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article. THE AUTHORS Lee Strunin, PhD, is a medical anthropologist and Professor in the Department of Community Health Sciences at Boston University School of Public Health (BUSPH). Her research focuses on identifying and comparing alcohol-related risk and protective factors and behaviors among young people from different racial and/or ethnic backgrounds. She has conducted studies of alcohol use among Black, White, and Hispanic young people in the United States, young people in Italy and in Mexico.
Alejandro D´ıaz Mart´ınez, MD, is a Professor of Psychiatry at the National Autonomous University of Mexico Medical School (UNAM). He has conducted studies on the pharmacotherapy of depression and schizophrenia as well as examining prevalence rates and correlates of drinking problems among UNAM students in Mexico City.
L. Rosa D´ıaz Mart´ınez, MD, is an Assistant Professor of Psychiatry at UNAM Medical School and a clinical researcher at the Mexico National Institute of Psychiatry in Mexico City. She has conducted studies on the psychosocial rehabilitation of schizophrenic patients, on the extent of alcohol and mental health problems in rural communities in central Mexico and was co-investigator on a
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study examining drinking problems and the effectiveness of brief interventions among UNAM students in Mexico City.
Seth Kuranz, MPH, is a doctoral student in the Department of Epidemiology, BUSPH, and a project coordinator in the Department of Community Health Sciences, BUSPH. His research interests include neighborhood context and alcohol and drug use among adolescents.
´ Carlos A. Hern´andez-Avila, MD, PhD, is a psychiatrist with a specialty in addiction psychiatry. He is an Assistant Clinical Professor of Psychiatry, and is affiliated with the Alcohol Research Center at the University of Connecticut School of Medicine.
H´ector Fern´andez Varela, MD, is a pediatrician and the Director General of Medical Services at the National Autonomous University of Mexico (UNAM). He oversees all medical and dental services to UNAM students and is responsible for an annual health survey administered to all entering first year students across the 10 UNAM campuses in Mexico City, which focuses on early detection of health problems.
GLOSSARY
Ethnographic interviewing: anthropological method of describing the local point of view and social organization, the culture of a people, and results in studying systems of meaning and rules (Hahn, 1995). Interpretive paradigm: in this study, interviews were analyzed to inform and develop concepts and theories related to beliefs, behaviors, traditions, and alcoholrelated risk and protective factors of young people. Stratified, purposeful sample: the goal of purposeful sampling strategies is to understand a phenomenon, not to represent a population (Patton, 2002). The social aspect of drinking: drinking in a social setting and/or using alcohol to foster socialization with peers.
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