PREVALENCE OF AT-RISK PREVALENCE OF AT-RISK DRINKING AMONG A DRINKING AMONG A

NATIONAL SAMPLE OF NATIONAL SAMPLE OF MEDICAL STUDENTSMEDICAL STUDENTS

Primary Investigator/Presenter: Ameet Shah, Primary Investigator/Presenter: Ameet Shah, MDMD

Department of Family Medicine, Kaiser Department of Family Medicine, Kaiser PermanentePermanente

Co-Authors: Shahrzad Bazargan-Hejazi, PhDCo-Authors: Shahrzad Bazargan-Hejazi, PhDKenneth Wolf, PhDKenneth Wolf, PhD

Richard Lindstrom, MARichard Lindstrom, MA

BackgroundBackground Motor vehicle accidentsMotor vehicle accidents FallsFalls DrowningDrowning HomicidesHomicides SuicidesSuicides Child AbuseChild Abuse Domestic violenceDomestic violence

HypertensionHypertension Heart attacksHeart attacks PancreatitisPancreatitis Liver CirrhosisLiver Cirrhosis UlcersUlcers Neurological SxNeurological Sx CHFCHF

They have all been associated with . . .They have all been associated with . . .

Alcohol MisuseAlcohol Misuse

BackgroundBackground

24% of physicians drink alcohol daily24% of physicians drink alcohol daily

16% misuse alcohol16% misuse alcohol

Specific AimsSpecific Aims

1)1) To assess the prevalence of harmful To assess the prevalence of harmful drinking among medical students drinking among medical students and and

2)2) To assess the correlates of at-risk To assess the correlates of at-risk drinkingdrinking

Study HypothesisStudy Hypothesis

1)1) 11stst and 2 and 2ndnd year medical students will year medical students will report a significantly higher level of at-risk report a significantly higher level of at-risk drinking as compared to 3drinking as compared to 3rdrd and 4 and 4thth year year medical students.medical students.

2)2) Medical students who report lower levels Medical students who report lower levels of social support will be more likely to of social support will be more likely to report at-risk drinking.report at-risk drinking.

3)3) Medical students who report higher levels Medical students who report higher levels of stress will be more likely to at-risk.of stress will be more likely to at-risk.

MethodsMethods

Cross-sectional structured, web-based survey Cross-sectional structured, web-based survey study of 1st -4th year medical studentsstudy of 1st -4th year medical students

The study was approved by the Charles Drew The study was approved by the Charles Drew university IRBuniversity IRB

Permission requested from all 126 accredited Permission requested from all 126 accredited U.S. M.D.-granting medical schools to contact U.S. M.D.-granting medical schools to contact their respective studentstheir respective students

MethodsMethods

States Sampled

36 medical schools agreed to take part in the survey.36 medical schools agreed to take part in the survey.

• 2710 responses obtained2710 responses obtained

Alcohol Use Disorders Identification Test (AUDIT)Alcohol Use Disorders Identification Test (AUDIT)

MethodsMethodsMeasures used in the study include:Measures used in the study include:

Sociodemographics BMI Exercise Have Regular Physician Stressful life event Social Support Center for Epidemiologic Studies Depression Scale (CES-D) South Oaks Gambling Screen (SOGS) Impulsivity Risk Perception Risky Sexual Behavior Current Tobacco Product Use Illicit Drug Use Alcohol Use Disorders Identification Test (AUDIT)

AUDITAUDIT

Alcohol Use Disorders Identification Alcohol Use Disorders Identification TestTest

Detects at-risk, hazardous, and Detects at-risk, hazardous, and alcohol dependencealcohol dependence

Cut-off score of 8 or more considered Cut-off score of 8 or more considered at-risk drinkingat-risk drinking

92% sensitivity and 94% specificity92% sensitivity and 94% specificity

DemographicsDemographics GenderGender

Male (40%)Male (40%) Female (60%)Female (60%)

AgeAge 20 to 48 years 20 to 48 years (mean age 25.6; SD (mean age 25.6; SD 3.2)3.2)

Marital statusMarital statusUnmarriedUnmarried N=195N=19588

72.8%72.8%

MarriedMarried N=730N=730 27.2%27.2%

Medical School YearMedical School Year 11stst Year (32.5%) Year (32.5%) 22ndnd Year (25.2%) Year (25.2%) 33rdrd Year (23.3%) Year (23.3%) 44thth Year (19.0%) Year (19.0%)

DemographicsDemographics

1st Year33%

4th Year19%

3rd Year23%

2nd Year25%

AlcoholAlcohol

85.6% of Medical Students Drink 85.6% of Medical Students Drink Alcohol on a Regular BasisAlcohol on a Regular Basis

AUDITAUDIT Sensitivity of 92%Sensitivity of 92% Specificity of 94%Specificity of 94%

15.4% of Medical Students At-Risk Drink

85.6% of Medical Students Drink 85.6% of Medical Students Drink Alcohol on a Regular BasisAlcohol on a Regular Basis

Alcohol ConsumptionAlcohol ConsumptionQuantity of DrinkingQuantity of DrinkingFrequency of Binge Frequency of Binge

DrinkingDrinking22.9%

36.5%

20.0%

6.1%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Per

cen

t of

Dri

nk

ing

Sam

ple

monthly

2 - 4/m

onth

2- 4/week

4+/week

Frequency of Alcohol Consumption

Frequency of DrinkingFrequency of Drinking

1 to 2 drinks 64.9%

3 to 4 drinks 23.1%

5 to 9 drinks 11.2%

>=10 drinks0.8%

>=10, 0.8%

1 to 2, 64.9%

5 to 9, 11.2%

3 to 4, 23.1%

34.6%

17.2%

7.2%

0%

5%

10%

15%

20%

25%

30%

35%

Per

cen

t o

f D

rin

kin

g

Sam

ple

< Monthly Monthly Weekly

Frequency

Frequency of Binge Drinking

Frequency of Drinking Quantity of Drinking

Alcohol-Related Harm

0%

5%

10%

15%

20%

25%

30%

35%

% o

f S

amp

le

1st/2nd Year 3rd/4th Year

Year of School

30.4%24.2%

Medical School Year vs. Drinking Medical School Year vs. Drinking BehaviorBehavior

0%

5%

10%

15%

20%

25%

% o

f S

am

ple

1st/2nd Year 3rd/4th Year

Year of School

At-Risk Drinking

17.1%13.3%

0%

10%

20%

30%

40%

50%

60%

70%

% o

f S

am

ple

1st/2nd Year 3rd/4th Year

Year of School

Hazardous Drinking62.7% 58.5%

0%

5%

10%

15%

20%

25%

% o

f S

amp

le1st/2nd Year 3rd/4th Year

Year of School

Alcohol Dependency21.7%

15.4%

p<0.001 p<0.05

p<0.001 p<0.001

Correlates of At-Drinking with ΧCorrelates of At-Drinking with Χ22 testtest

CharacteristicsCharacteristics nn %% p-valuep-value

Age (mean; SD)

Male

Unmarried

1st/2nd Year

Smoker

Illicit Drug Use

Risky Sexual Behavior

Pathological Gambler

Depressed

Moderate to Major Stressors

Impulsive Behavior

Low Risk Perception

26

244

369

265

172

238

116

34

224

258

308

265

3.2

22.7

18.8

17.1

10.8

26.4

27.6

41.5

20.5

18.3

52.2

22.4

0.000

0.000

0.007

0.000

0.000

0.000

0.000

0.000

0.000

0.000

0.000

0.000

Younger Age

CharacteristicsCharacteristics OROR 95% CI95% CI p-valuep-value

3.04

2.71

2.04

2.04

1.79

1.78

1.72

1.71

1.71

1.49

1.05

(2.32-3.97)

(1.89-3.88)

(1.60-2.60)

(1.20-3.47)

(1.39-2.29)

(1.37-2.31)

(1.34-2.21)

(1.33-2.20)

(1.28-2.29)

(1.16-1.91)

(1.01-1.10)

p<0.001

p<0.001

p<0.001

p<0.01

p<0.001

p<0.001

p<0.001

p<0.001

p<0.001

p<0.01

p<0.05

Predictors of At-Risk Predictors of At-Risk DrinkingDrinking

DiscussionDiscussion 11stst Hypothesis: Hypothesis: more 1more 1stst and 2 and 2ndnd year year

medical students than 3medical students than 3rdrd and 4 and 4thth year medical year medical students at-risk drinkstudents at-risk drink

No difference in at-risk drinking among the No difference in at-risk drinking among the years.years.

The medical school curriculum plays no The medical school curriculum plays no significant role in reducing at-risk drinking significant role in reducing at-risk drinking rates among students.rates among students.

Partially approved!Partially approved!

0

5

10

15

20

25

30

1st/2nd

Year3rd/4th

Year

Leve

l of

At-

Ris

k D

rinki

ng

DiscussionDiscussion

2nd Hypothesis:2nd Hypothesis: medical students with medical students with lower levels of social support are more likely to lower levels of social support are more likely to engage in at-risk drinking.engage in at-risk drinking.

We found no difference in the level of social We found no difference in the level of social support and drinking behavior.support and drinking behavior.

Previous studies have suggested social support Previous studies have suggested social support plays a protective role for at-risk drinking.plays a protective role for at-risk drinking.

REJECTED!REJECTED!

DiscussionDiscussion 33rdrd Hypothesis: Hypothesis: medical students with medical students with

higher levels of stress are more likely to at-risk higher levels of stress are more likely to at-risk drinkdrink

At-risk drinking positively correlated with stress.At-risk drinking positively correlated with stress.(Lower stress at 12% vs. Higher stress at 18%)(Lower stress at 12% vs. Higher stress at 18%)

Stressed students 1.5 times more likely to at-risk Stressed students 1.5 times more likely to at-risk

drink.drink. Level of at-risk drinking possibly influenced by Level of at-risk drinking possibly influenced by

unique pattern of exposure to stressors.unique pattern of exposure to stressors. At-risk drinking could be a manifestation of a At-risk drinking could be a manifestation of a

coping system medical students implement.coping system medical students implement.

ACCEPTED!

ACCEPTED!

LimitationsLimitations

1)1) Online SurveyOnline Survey

2)2) Survey under-reportingSurvey under-reporting

3)3) Cross-sectional studyCross-sectional study

ConclusionConclusion

With at-risk alcohol consumption being With at-risk alcohol consumption being a possible marker for future alcohol a possible marker for future alcohol abuse and its potential health, social, abuse and its potential health, social, and economic impacts, the results of and economic impacts, the results of this study stress the need for effective this study stress the need for effective interventions among medical students. interventions among medical students.

AcknowledgementAcknowledgement

My mentors:My mentors:

Family and FriendsFamily and Friends

KennethWolf, PhD

Richard Lindstrom, MA

Shahrzad Bazargan-Hejazi,

PhD

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