articipation in athletics can promote health, fitness, and personal development. However, an accumulating body of evidence indicates that athletes in college are more likely to engage in some forms of risky behavior, particularly binge drinking, that is detrimental to health compared with their nonathlete peers (4,6,7,8,10). This discrepancy between the health-promoting and health-compromising aspects of sport deserves further attention from professionals in sports medicine and sports science.
In a previous analysis of the Harvard School of Public Health College Alcohol Study data set, the correlates of binge drinking were examined to determine whether any unique factors existed that were associated with binge drinking for those involved in athletics (10). Several social factors, such as a high level of importance placed on parties and sports, having five or more close friends, spending a great deal of time socializing, and parents alcohol use habits, had significant, independent value for predicting binge drinking among the population of college students. However, the factors associated with binge drinking did not differ for those who were involved in athletics and those who were not.
One study of college athletes (4) demonstrated that they experience more harms as a result of drinking alcohol than nonathletes. However, the personal characteristics of athletes differ from those of nonathletes, and athletes possess those characteristics associated with an increased risk of binge drinking. The analysis of alcohol-related harms did not control for these factors that may have accounted for the higher rate of experienced harms.
College athletes have been targeted for education programs that address alcohol use. The National Collegiate Athletic Association (NCAA) has developed and sponsored drug and alcohol educational programs and a speakers’ program targeted specifically for athletes in their member schools. In addition, college athletic departments often provide support services beyond those offered to the general student population. The use of an educational approach argues that athletes have insufficient knowledge or awareness of alcohol problems. We examine the extent to which athletes are targeted with information about alcohol use. Further, athletic teams are by nature highly social organizations, and team members are often dependent on their teammates for athletic success. Athletes may be more likely to possess some of the social characteristics that predict binge drinking. We examine the extent to which athletes possess these risk factors for binge drinking.
Much of the previous research on this topic has relied on convenience-sampling techniques and may not be based on representative samples of college students or athletes. The current study examines alcohol use among randomly sampled students at 4-yr colleges in the United States, some of whom self-identified as athletes. The present study reports on the drinking behavior and the related harms among athletes compared with their age-matched nonathlete peers. Because alcohol use differs significantly by age, gender, and race, we controlled for these factors in the analyses.
The study participants were respondents to the 1997 Harvard School of Public Health College Alcohol Study (CAS), a survey of students attending 130 4-yr colleges and universities. These schools are a representative sample of 4-yr postsecondary academic institutions in the United States. Subjects were selected at random based on lists of full-time students provided by the registrar at each school. The sampling methods and design of the CAS are described in greater detail elsewhere (11,13). Participation in the survey was voluntary and the identity of the respondent was kept anonymous. The overall response rate was 60%. For the purposes of the present analysis we limited the sample to students of typical college age by excluding those over the age of 24 yr. Older students were excluded because they fell disproportionately into the nonathlete group and did not provide a meaningful comparison group. In addition, the sample was limited to undergraduate students. The final sample included 12,777 college students, including 2,172 classified as athletes.
A 20-page self-report questionnaire was mailed directly to students and asked them to report on personal characteristics, student activities, and behaviors and attitudes related to alcohol use. The questionnaire was distributed and completed during the spring of 1997. Athletes were identified according to students’ responses to the question “In the past 30 days, how many hours per day on average have you spent on each of the following activities? Average number of hours per day: 0, 1, 2, 3, 4, 5+.” Playing or practicing intercollegiate athletics was one of eight activities listed. One question in the list of eight activities asked respondents about their time spent in other physical activities (e.g., intramural athletics, jogging, biking), and this question helped distinguish members of intercollegiate athletic teams from regular exercisers. Athletes were defined as those students who participated in athletics an average of one or more hours per day. A “drink” was defined as 12 ounces of beer (one can), a 4 ounces of wine (glass), a 12 ounces of wine cooler, or 1 shot of liquor. Binge drinking was defined as consuming five or more drinks in a row for men (four for women) on one or more occasions during the past 2 wk. This measure has been demonstrated to be a strong predictor of adverse social consequences and is a standard measure of risky alcohol use among college students (9,12).
Differences between athletes and nonathletes were computed using the chi-square statistic. Odds ratios (OR) were computed using logistic regression to determine the degree of difference between the groups of interest. The analyses were adjusted for demographic factors associated with both the outcome measure and athlete status, such as age (under 21 yr; 21 yr and over), gender (male; female), and race (white; nonwhite).
Demographic characteristics of the sample.
In the entire sample of undergraduate college students, 12.9% of female and 23.4% of male subjects were classified as athletes. Athletes were more likely to be male (54.1%) than nonathletes in the sample (36.3%) (OR = 2.09 95% CI 1.91–2.29).
Athletes were more likely to be under the age of 21 (OR = 1.36 95% CI 1.24–1.50), to be members of a fraternity or sorority (OR = 1.21 95% CI 1.07–1.37), and to live either in single sex (OR = 1.38 95% CI 1.22–1.56) or co-ed on-campus dormitories (OR = 1.39 95% CI 1.26–1.53) or fraternity or sorority houses (OR = 1.32 95% CI 1.05–1.67). Male athletes were less likely to report average grades of B+ or better (OR = 0.79 95% CI 0.70–0.90) and less likely to be white (OR = 0.79 95% CI 0.68–0.91) compared with male nonathletes.
Table 1 reports the patterns of alcohol use by athletic participation and gender. Athletes reported binge drinking of alcohol at higher rates than their nonathlete peers. Among male subjects, 57.0% of athletes reported at least one binge drinking episode in the previous 2 wk compared with 48.8% of nonathletes (chi-square = 24.53, df = 1, P < 0.001). Among female subjects, athletes also reported a higher rate of recent binge drinking (48.0%) than nonathletes (40.2%) (chi-square = 21.62, df = 1, P < 0.001). Male athletes were less likely to abstain from alcohol than male nonathletes (chi-square = 14.27, df = 1, P < 0.001). No similar difference was found in female subjects. In logistic regression analyses controlling for age, sex, and race, athletes were more likely to binge drink compared with nonathletes (OR = 1.42 95% CI 1.29–1.56).
Beyond their higher rates of binge drinking, athletes also reported a more extreme style of alcohol consumption than nonathletes. Among those respondents who reported drinking alcohol in the past year, athletes were more likely to say they usually binged when they drank (OR = 1.50 95% CI 1.34–1.68), more likely to be drunk three or more times in the past 30 d (OR = 1.17 95% CI 1.04–1.32), and more likely to say that drinking to get drunk was an important reason for drinking (OR = 1.30 95% CI 1.17–1.45) than nonathletes. Although female athletes did not report more frequent drinking, male athletes were more likely to drink on 10 or more occasions in the past month than male nonathletes (OR = 1.23 95% CI 1.04–1.45).
More athletes reported experiencing alcohol-related harms than nonathletes. Athletes were more likely to experience a wide range of alcohol-related harms, such as academic problems and more antisocial behaviors (damaging property, getting in trouble with the police) than their nonathlete peers. Athletes are also more likely to experience five or more different problems related to alcohol use than other college students. Table 2 presents the results with adjusted odds ratios.
Social influences among athletes.
Athletes were found to be more likely than their nonathlete peers to exhibit several social factors which have been found to increase risk for binge drinking. Table 3 summarizes the social influences related to alcohol use reported by athletes and nonathletes. Athletes were more likely to report they had five or more close friends than nonathletes. Compared with nonathletes, athletes were also more likely to consider parties as important to them and to spend an average of 2 or more hours per day socializing. In terms of potential peer pressure, athletes were more likely to say that most of their friends (70% or more) were binge drinkers.
Athletes were as likely as nonathletes to report that at least one parent drank alcohol while they were growing up. However, athletes were more likely to say that their family did not approve of drinking.
Reasons for limiting alcohol consumption or abstaining from alcohol.
Athletes were far more likely than nonathletes to report that participating in athletics is an important reason for either abstaining from alcohol or limiting their drinking. A summary of the reasons athletes who drank limited their drinking is listed in Table 4. Table 5 provides information on the reasons provided by athletes for abstaining from alcohol.
Athletes reported a greater exposure to college alcohol education efforts than nonathletes. This increased exposure was observed across a range of methods and topic areas. Table 6 provides a summary of athletes’ exposure to these educational efforts compared with nonathletes. The students who reported being exposed to each of the various educational approaches were more likely to binge drink, controlling for athlete status, age, race, and gender. The magnitude of the difference ranged from 16% (course) to 63% (poster) and all were significant (i.e., exposure was associated with binge drinking).
Students who reported that their school provided them information on the college alcohol rules, various consequences of alcohol use, recognizing problems, and getting help were also as likely or more likely to binge drink as students who did not receive that information, even when athlete status, age, race, and gender were controlled.
Athletes are more likely than other college students to engage in binge drinking. This finding is consistent with the results of other studies using different samples and sampling techniques (3,4,6,7). Previous work demonstrated that the factors associated with binge drinking did not differ between athletes and nonathletes (10). However, the present study found that athletes were more likely than nonathletes to be surrounded by the type of social environment that is associated with binge drinking. Athletes are more likely to have a large number of friends, particularly those who binge drink and attend parties, and this may account for their increased risk of binge drinking. Binge drinking poses a threat to the health and well-being of students who participate in college athletics because athletes are also more likely to experience alcohol-related harms than nonathletes. College administrators, athletic departments, coaches, and sports medicine professionals should increase their efforts to address this persistent health risk to college athletes.
Education about the risks posed by alcohol consumption is a frequently employed tactic to reduce binge drinking among athletes. In the current study, athletes reported a significantly higher level of exposure to educational efforts about alcohol than nonathletes. This higher rate of exposure may reflect the educational efforts of the NCAA and of individual athletic departments to decrease the alcohol-related problems experienced by their athletes. Because the data on both binge drinking and exposure to educational efforts was collected at a single point in time, it is not possible to determine the effectiveness of educational programming. However, the findings demonstrate that athletes are “educated” about both the acute and chronic risks of alcohol. Those who received education were not less likely to binge drink than those who did not receive education. Given the high rate of binge drinking among athletes, it appears that educational efforts highlighting the risks of alcohol are not a sufficient strategy to reduce the rate of binge drinking. Although we do not wish to discourage education in the college environment about any topic, other measures can complement the educational efforts currently employed.
The results of the present study identify several leverage points that can be used to discourage risky drinking. One potential method is to reinforce the motives athletes already express when they choose not to drink or limit their drinking. An example of a motivating factor that is unique to athletes is their athletic performance. When athletes do limit their drinking or decide not to drink, athletic performance is an important reason for doing so. A previous study using the CAS data found that athletes are less likely to smoke cigarettes than nonathletes (10), and this may be attributable to the widely recognized negative effects of smoking on athletic performance. It is possible that some athletes do not view their alcohol use as having a detrimental effect on their athletic performance. The athlete’s understanding of the relationship between alcohol use and athletic performance deserves further investigation.
A second potential area of leverage with athletes is their social environment. The present study found that athletes are more socially connected than their nonathlete peers, and the same sociability factors promote binge drinking among college students (12). College students are susceptible to peer influence and the team atmosphere supports those social bonds. Interventions to reduce alcohol consumption that can tap into the athlete’s culture and reverse the social pull toward alcohol have the potential to be effective. Research should examine the social environment of athletes to investigate whether these social connections can play a role in binge drinking prevention. Additionally, forces within the school and the community can contribute to the athletes greater propensity to misuse alcohol. The amount of importance placed on athletics, the money, and the pressure of collegiate athletics may all play a role in promoting binge drinking among athletes and are important topics for further work.
Participating in college athletics has many benefits for young adults, and it also has some unique risks. Student-athletes are a valuable resource at colleges and serious efforts must be employed to reduce the potential harms of alcohol.
The present report should be considered in light of potential limitations to the data. The data are based on self-report questionnaires. However, self-report surveys are commonly used in examining alcohol use and are generally considered to be valid (1,2,5). Bias may have been introduced through nonresponse. It is not possible to know whether the response rate for athletes and nonathletes differed, because athlete status of the randomly selected survey sample was not known. However, no significant differences existed between early and late responders to the survey on measures of binge drinking, and response rate at individual schools was not associated with binge drinking or other covariates in multiple logistic regression analyses on 1997 CAS samples (13,14). Another potential source of error may be from the misclassification of respondents as athletes or nonathletes through the use of the measure of time spent on the activity. However, in an anonymous population survey of college students, we are dependent upon the self-classification of a respondent.
This study was supported by a grant from the Robert Wood Johnson Foundation.
Address for correspondence: Toben F. Nelson, 1633 Tremont Street, Boston, MA 02120; E-mail: [email protected]
1. Cooper, A. M., M. B. Sobell, L. C. Sobell, and S. A. Maisto. Validity of alcoholics’ self-reports: duration data. Int. J. Addict. 16: 401–406, 1981.
2. Frier, M. C., R. M. Bell, and P. L. Ellickson. Do Teens Tell the Truth? The Validity of Self-Report Tobacco Use by Adolescents
. Santa Monica, CA: RAND, 1991. RAND publication N-3291-CHF.
3. Kokotailo, P. K., B. C. Henry, R. E. Koscik, M. F. Fleming, and G. L. Landry. Substance use and other health risk behaviors in collegiate athletes. Clin. J. Sport Med. 6: 183–189, 1996.
4. Leichliter, J. S., P. W. Meilman, C. A. Presley, and J. R. Cashin. Alcohol use and related consequences among students with varying levels of involvement in college athletics. J. Am. Coll. Health 46: 257–262, 1998.
5. Midanik L. Validity of self report alcohol use: a literature review and assessment. Br. J. Addict. 83: 1019–1030, 1988.
6. Nattiv, A., J. C. Puffer, and G. A. Green. Lifestyles and health risks of collegiate athletes: a multi-center study. Clin. J. Sport Med. 7: 262–272, 1997.
7. Nattiv, A., J. C. Puffer. Lifestyles and health risks of collegiate athletes. J. Fam. Pract. 33: 585–590, 1991.
8. Selby, R., H. M. Weinstein, and T. S. Bird. The health of university athletes: attitudes, behaviors, and stressors. J. Am. Coll. Health 39: 11–18, 1990.
9. Wechsler, H., S. B. Austin. Binge drinking: the five/four measure. J. Stud. Alcohol. 59: 122–123, 1998.
10. Wechsler, H., A. Davenport, G. Dowdall, S. Grossman, and S. Zanakos. Binge drinking, tobacco, and illicit drug use and involvement in college athletics. J. Am. Coll. Health 45: 195–200, 1997.
11. Wechsler, H., A. Davenport, G. Dowdall, B. Moeykens, and S. Castillo. Health and behavioral consequences of binge drinking in college: a national survey of students and 140 campuses. JAMA 272: 1672–1677, 1994.
12. Wechsler, H., G. W. Dowdall, A. Davenport, and E. B. Rimm. A gender-specific measure of binge drinking among college students. Am. J. Public Health 85: 982–985, 1995.
13. Wechsler, H., G. W. Dowdall, G. Maenner, J. Gledhill-Hoyt, and H. Lee. Changes in binge drinking and related problems among American college students between 1993 and 1997: results of the Harvard School of Public Health College Alcohol Study. J. Am. Coll. Health 47 (9): 57–68, 1998.
14. Wechsler, H., M. Kuo, H. Lee, and G. W. Dowdall. Envi-ronmental correlates of underage alcohol use and related problems of college students. Am. J. Prev. Med. 19: 24–29, 2000.