Associations between Gender, Alcohol Use and Negative Consequences among Korean College Students: A National Study

Round 1

Reviewer 1 Report

Associations Between Gender, Alcohol Use and Negative Consequences Among Korean College

Students: A National Study

This study examines Korean college students’ rates and severity of various negative consequences related to the frequency and quantity of alcohol consumption. The study assesses how the gender, age and other associated socio-demographic characteristics mediate the relationship between alcohol use and 21 negative consequences.

The purpose of this study is to determine the effect of alcohol consumption levels on negative 90 consequences for Korean college students and compare the results to prior research evidence

The introduction provides sufficient background and includes all relevant references. The research design is appropriate and the methods are adequately described

Concerns

1.- Line 72-73 The authors said that “….another important outcome of this comparative study indicates that reporting on certain negative consequences such as ‘guilt,’ are culturally specific” and in Line 237 the authors said ..  “Numerous previous studies have shown that women tend to report drinking less than men [8, 15, 45]…”

Did the authors measure guilt perception? It can be different depending on gender.

2.-Line 75 – Is the first time the authors use the abbreviation of Harvard School of Public Health College Alcohol Study (CAS)-

Replace the abbreviation: (HCAS) instead of CAS and check the text from there on (i.e- Line 123 Harvard College Alcohol Study (HCAS))

3.- In this way I suggest introducing an abbreviation table (i.e. GPA- Grade Point Average)

4.- I suggest checking typographical errors (i.e. Line 205…. 0, 1-2, 2-4 and 5)

Discussion

I have ethical concerns about the conclusions

                In my humble opinion, being methodologically correct, the article introduces into the discussion an opinion far from the standards of gender equality typical of a magazine like IJERPH Q1 38/164 in the area of Public, Environmental and Occupational Health-SSCI

In Line 321-325 the authors said

“….the findings of this study indicate that interventions aimed at addressing heavy drinking on Korean college campuses would benefit from targeting females and males differently. Prevention programs should recognize the higher severity of certain negative consequences for females like unplanned sex, sexual harassment and sexual assault and educate females about protective and harm-reduction tactics while drinking”

It seems delicate to me to make these kind of suggestions without also including training for men about respecting women even if they have drunk alcohol. A number of programs work specifically with male peer groups, addressing values and attitudes associated with violence against women, redefining concepts of masculinity and engaging men in violence prevention.

Reference

Violence prevention. The evidence. Promoting gender equality to prevent violence against women. WHO Library Cataloguing-in-Publication Data. 2009. ISBN 978 92 4 159788 3

Overall recommendation:

Accept after revision 

Author Response

Thank you for your time and feedback. In responding to all the reviewers’, we have made major edits to the introduction and discussion sections of the article. We have also added a new conclusion section and edited the abstract. Minor changes were made to the methods and results sections. Regarding your specific suggestions:

• Expanded on in the topic of “guilt” in the discussion section.
• Made the HCAS abbreviation consistent throughout document.
• Added a new abbreviation table.
• Checked for errors and made corrections.
• Made edits to the new conclusion section to address your ethical concern and recognize that males are included in the suggested prevention strategies.

Reviewer 2 Report

This paper is mostly well written and the data set reported from seems to be a large and representative one.  

I do have, however, some objections and comments:

Abstract:

The abstract needs more background and international context. Why is this study of interest to an international audience in an international journal? Possible policy implications may also be hinted at.

Introduction:

The authors assess previous studies in a satisfactory manner, but they should be clearer about how they aim to contribute to current knowledge and what this study adds to international alcohol studies.

The research problem may be more clearly articulated in the introduction by incorporating the various “objectives” of the study referred to in the results section.

P2, line 89. In general, I would be hesitant to use the term “effect” in a cross-sectional study.  

Methods:

The description of the sampling process was not entirely evident to me. The response rate was 68.7 %, but of what? In addition, what does “cross-validate this study’s sample based the probability of proportional distributions of mutually exclusive college area characteristics” mean?

It is unusual to designate health indicators such as smoking and depressive thoughts as socio-demographics. Also, the sentence “Most respondents (4,568, 95.1 percent) reported drinking alcohol at least one time in the last 12 months” should be moved to the section on “Alcohol consumption variables”.

P4, line 192-195: This sentence is largely superfluous, as this classification has already been introduced to the reader.

Results:

The results section is a bit confusing to read, as the sequencing of figures and the comments on figures does not flow well. I would urge the authors to re-write this section, and introduce and comment on one table at a time. In addition, the table headlines should include information on type of analyses utilized to generate the table.

Discussion and conclusion:

The study lacks a conclusion. What are the policy implications of the study (if any)?

Author Response

Thank you for your time and feedback. In responding to all the reviewers’, we have made major edits to the introduction and discussion sections of the article. Regarding your specific suggestions:

• The abstract was edited to reflect a more international perspective and foretell the implications of the study.
• The introduction section was rewritten to clarify objectives and better emphasize significance of the study.
• We use the term “effect” through the article as a noun to mean influence or a statistical relationship and are considering whether this is appropriate or not given the nature of the study. We may replace it with a different term like ‘association’ but we are still thinking about it.
• The study’s methods were clarified.
• The term “sociodemographic” was replaced with the broader phrase “respondent characteristics”.
• The sentence “Most respondents (4,568, 95.1 percent) reported drinking alcohol at least one time in the last 12 months” was moved to the results section.
• The results section was reviewed, and edits were made to make it flow better.
• Information on type of analyses was added to the table headlines.
• A new conclusions section was added to focus on the implications of the study.

Reviewer 3 Report

The authors of the study concentrate on very important topic - rates and severity of various negative  consequences related to the frequency and quantity of alcohol consumption among Korean students. The topic of the study is very important – according to WHO  harmful use of alcohol is accountable for 7.1% and 2.2% of the global burden of disease for males and females and is the leading risk factor for premature mortality and disability among those aged 15 to 49 years. The subject of the study is important on international level: heavy drinking among college students has been recognized as a major public health concern in many countruies  as well as no more „national” level, as authors state that : „In Korea, there is a lack of evidence on the prevalence of student drinking and related negative consequences”.

The results are importnat on the social and clinical level and I think that authors do not discuss them enough. As the study reveals  most Korean young adults will be exposed to frequent and heavy drinking behaviors and although females report drinking less often on average than males, they also report higher incidents of negative consequences , the reader may wonder  what kind of help or preventive programms may receive college students in Korea.

Unfortunately authors do not write more about it in conclusions section. In my opinion international readers could benefit from some data desribing mental health services (preventive programms or models of intervention/suport/treatment which are available for college students) in Korea. Additionally, there are some factors commonly implicated in problematic alcohol use, such as drinking to cope with negative affect or depressive symptoms. Some studies (e.g. Weitzman et al., 2004) suggest that female students with previuos mental health problems are more likely to report drinking-related harms and alcohol abuse than students without suh problems. Discussion of the results in the wider context of mental health problems or coping strategies and the descrpitnion of mental health services and programms available in Korea could interest the readers and extend the value of the discussion.

Author Response

Thank you for your time and feedback. In responding to all the reviewers’ comments, we have made major edits to the introduction and discussion sections of the article. We have also added a new conclusion section and edited the abstract. Minor changes were made to the methods and results sections. Regarding your specific suggestions; we have expanded on our discussion of the implications of the research on prevention strategies in Korea and tried to better explain some of the underlying factors related to gender differences.

Round 2

Reviewer 2 Report

The authors have responded to my objections in a satisfactory manner.