Young adulthood (18–25 years) is a period of exploration, excitation, exposure to peer challenge and adaptation of lifestyle behaviours that cement during later adulthood [1
]. University is a unique environment where young adult males and females of different ethnic cultural backgrounds gather together. Here they are unbound by familial constraints with the freedom to make lifestyle choices to suit personal needs. This university experience involves a variety of small-scale environments, termed micro-environments, including both physical and social settings which contribute to the establishment of behavioural patterns [2
]. Social norms in micro-environments encouraging alcohol intake, such as bars/clubs, student halls and campus events increase the risk of unsafe alcohol consumption greatly at university [3
]. This manifests predominately by integrating into binge drinking (≥5 drinks on one occasion) as part of university cultures [5
]. Although the UK government recommended alcohol limit is <14 units/week (≈6 pints/week) for both male and female adults [6
], exceeding the limit has been identified as a problematic behaviour among university students [3
Tiered above all other illicit narcotics [7
], harmful alcohol intake is defined as a level of drinking that leads to physical or cognitive harm to oneself or others namely, families and society [8
]. The self-inflicted damage arising from excessive alcohol consumption is a prevalent cause of premature mortality due to liver failure and a risk factor for many other diseases [9
]. It is also recognised that neurotoxic effects mediated by an excessive level of alcohol exposure at young ages increases the risk for brain injury [10
] and reductions of brain volume in the subcortical and temporal regions, which lead to poorer academic performance, depression and antisocial behaviours [11
]. Albeit there is evidence to suggest that low levels of alcohol consumption have protective effects against cardiovascular diseases [13
], periodic binge drinking at young ages can precipitate various forms of morbidity and/or alcohol dependence in later adulthood [1
]. Therefore, identifying the factors that influence the level of alcohol consumption at university is important for developing improved strategies to protect this young generation.
Previous studies had highlighted that demographic, psychological and behavioural factors had an important role in the levels of alcohol consumption by university students [14
]. However, there were discrepancies in the literature. For example, some studies reported the male gender as a determinant of greater alcohol intake [15
], whereas others describe similar levels of alcohol consumed across genders [16
]. Increases in alcohol consumption among young adult females [17
] are worrying and imperative to explore as females incur enhanced susceptibility to the harmful effects of alcohol than males upon drinking equal amounts [18
]. Caucasians are reported to consume greater levels of drinking compared to minority ethnic groups [19
]. Reports also highlight an increase in heavy episodic drinking in Asian students to match Caucasians [20
]. Physical activity (PA) had been described to reduce the association between alcohol consumption and risk of death [21
] whereas others had found an association between higher PA and high levels of alcohol consumption [22
]. Another significant lifestyle factor was the amount of recreational sedentary screen-based activities, i.e., internet use and watching television, which was found to be associated with alcohol use [23
]. The relation between high levels of alcohol consumption and recreational sedentary screen-time behaviour remains controversial with reports failing to observe any association between screen-based activities and alcohol [24
], while others have documented a positive association [25
Almost half of young adults in the UK consume alcohol with many engaging in hazardous drinking behaviours [26
]. Interventions to control this misuse require attention as alcohol use disorders are placing enhanced burden upon the National Health Service and causing increased alcohol-specific deaths in England relative to figures from the past decade [27
]. As certain groups are more susceptible to alcohol marketing and developing alcohol dependence than others, the targeting of vulnerable groups to reduce risk has been advocated [28
]. In consideration of the controversial evidence for drinking behaviours in groups of young adults, the identification of certain groups and behaviours that influence alcohol consumption may pose challenge in the attempts to reduce alcohol-related harm in university students. Given that alcohol dependence is postulated to initialise from drinking behaviours during young adulthood [1
], shedding light on which groups are most vulnerable may better inform public health policy to tailor alcohol-related interventions toward high risk groups.
Herein, we hypothesise that alcohol consumption is prevalent among UK university students and that certain sub-groups of individuals exhibiting specific health-related behaviours are at greater risk of higher quantities of alcohol intake. The aims were to elucidate the occurrence of alcohol consumption quantities across genders and the association between this intake and certain demographics and health-related lifestyle factors. By gathering and analysing data from 1440 students crossing three different universities in the UK (Reading, Surrey and Farnborough) this study endeavoured to disentangle the controversies of factors that influence the levels of alcohol consumption in young adults at university. Given the fact that alcohol intake is a modifiable factor, ascertaining the determinants of alcohol consumption is valuable for developing contemporary alcohol-awareness initiatives to protect those who are at risk of developing alcohol-related diseases across the myriad of young adults in the UK.
Hazardous alcohol consumption is ranked above illicit drug use causing harm to our society, economics and health [9
]. Excessive alcohol intake is frequently associated with unhealthy and risk-taking behaviours including poor dietary behaviours, false self-perceptions and psychological and anti-social disorders [39
]. This study sheds light on gender, ethnicity, smoking, levels of PA or recreational sedentary screen-time as influential factors in the levels of alcohol consumption examined from information gathered from 1440 university students over nine years and covering three UK universities. A bimodal fashion of drinking was apparent, with the highest levels of alcohol intake (≥12 units/week) encompassing the most prevalent group among students, particularly males, closely followed by those who were abstinent. Compared to a study in 2016 where 90% of students reported to consuming some form of alcohol, herein a smaller, yet noteworthy, percentage (68.9%) reported to drink alcohol. It is documented that 25% of university students participate in intentional binge drinking once a week or more [42
]. Young adults at university are particularly vulnerable to risk-taking behaviours as they seek social reward by mirroring substance-using peers while in the absence of parental control [43
], posing substance-related harm to health. Herein, factors which encourage such risk of alcohol-related harm are addressed to clarify discrepancies in this field and may support the development of contemporary, gender-specific risk-reducing university programmes.
We found that male students were more engaged in excessive alcohol intake (≥12 units/week) in comparison to their female peers. This is supported by a previous UK study reporting that the male gender is positively associated with alcohol consumption and they more easily engage in hazardous alcohol consumption at university social engagements [15
]. Having a Caucasian background was reported to enhance risk for harmful alcohol consumption compared to other ethnicities [19
]. Similarly, we found that on average, Caucasian students consumed a greater level of alcohol than those from other ethnic backgrounds. Although the pattern of drinking varies between ethnic groups, culture, background and societal influences were thought to play an important role [44
]. As part of the drinking culture in Western countries, drinking behaviour is accepted as a group conduct and a social norm among Caucasians [44
], which is mirrored at university wherein young adults are gathered and free to express their personal autonomy to drink alcohol. The synergistic and additive consequences of smoking and drinking pose strong risk for cardiovascular disease (CVDs), cancers and premature mortality [45
]. Although there were a relatively small number (150) of student smokers in our study, we found that smoking correlated positively with the levels of alcohol consumption. Our discovery parallels the reciprocal association between alcohol and tobacco use reported by international colleagues [46
], and in the UK, where there is increased likelihood of students reporting smoking if they also reported high levels of alcohol intake [3
]. The risk-taking culture of university young adults and the long-term health damage due to combined alcohol and smoking provides indication for the need to regulate these activities at universities.
One important finding from our study is that the levels of PA positively influenced the levels of alcohol consumption such that students who spent more time in PA consumed more alcohol, particularly in males. Previously, heavy drinking behaviours were found in those students who participated in sports (social and team-based) [47
], whereas a more recent meta-analysis reports that abiding by the PA recommendations reduces the association between alcohol consumption and risk of death [21
]. The incongruence with the observation herein may be ascribed to the attraction toward heavy drinking cultures in university-based sports, teams and various clubs during their celebratory or social time. Worryingly, an alcoholic beverage often contains more calories than other forms of social drink, as alcohol contains 7 calories per gram whereas carbohydrates contain only 4 calories per gram. Exercise helps to reduce calories and avoid weight gain after excessive drinking. A longitudinal study shows that higher intensities of PA offers protection from the risk of fatty liver [48
]. However, we had reported previously that starting university life did not lead to the adoption of a healthy lifestyle [4
]. As there is no system in place to limit or record the sale of alcohol (per occasion) provided to students in university bars, once a binge drink starts it may to be difficult for students to refuse more alcohol among the peer and social influence thus alcohol and PA awareness campaigns for these at-risk groups may be worthwhile.
Another novel discovery from our study is that the levels of recreational sedentary screen-time in males is negatively and significantly associated with levels of alcohol consumption. We found that students who spent more time on recreational screen activities drank less alcohol, which contrasts with others describing a positive association [23
]. A potential explanation may in part follow the displacement hypothesis wherein more attention is given to recreational screen-based activities and less interest (or less time) for social binge drinking. Although a sedentary lifestyle increases the risk of cardiovascular and metabolic diseases, a balance between recreational screen-time, PA duration and levels of alcohol consumption is important for the wellbeing of university students.
Being overweight/obese is a prevailing public health concern in young people and strongly associated with risk for CVDs. Research describes the energy derived from alcohol intake as a risk factor for obesity [49
]. In our study, there were only 264 students (18.3%) classified as overweight/obese, and BMI was not correlated with alcohol consumption which may be due to students: (1) not drinking over the limit and (2) becoming new alcohol consumers, the weight gain effects of which are observed in later years. In line with this, studies show that only excessive consumption of alcohol was associated with weight gain in young adults [49
] yet low levels of drinking failed to reflect correlation with any gain in adiposity [50
]. A previous study had found a synergistic link in young adults between sleep quality, alcohol consumption and academic performance [51
]. Conversely, we did not find any association between self-reported sleep duration and the levels of alcohol consumption. The patterns of sleep is also an important measure for optimal health and well-being. Further study is required to clarify the association between sleep and alcohol consumption.
The Medical Research Council describes formative research as central in targeting appropriate groups for effective strategies for behaviour change [52
]. In their research, Epton et al. had developed an intervention to convey health messages to university student groups found to be at higher risk of binge drinking by targeting factors which were found to be predictors of binge drinking [53
]. The preliminary outcomes of the intervention proved effective in modifying intention for binge drinking in the desired direction. In light of the success of targeted strategies, the findings from this study may be used to implement interventions such as web-based smartphone applications to reduce problematic alcohol use in the indicated high risk groups. This avenue provides greater reach in university student groups and is therefore particularly effective to reduce the risk for high levels of alcohol consumption [54
Limitations should be considered when interpreting the data because the parameters used in this study were solely survey-based or self-reported, which may give rise to misestimated information, i.e., PA/alcohol intake, to affect the outcomes of this study. However, previous studies have demonstrated the reliability and validity of self-reported surveys when conducting similar population studies [55
]. Although our data were collected from three universities across several years, we did not find any significant change related to social or economic trends during these years that may influence alcohol behaviours in these universities. The generalisability of the current sample to the UK population, as documented by Universities UK [29
], was reflected by similarity in gender, domicile and ethnicity percentages [30
]. BMI percentages found in our study also aligned with percentages recognised across UK universities [56
]. The response rate (94.1%) achieved was above the standard for avoiding nonresponse bias [57
] however, the cross-sectional design prevents the derivation of any causal relationships. The reporting of screen-time sedentary behaviours may not reflect entire sedentary engagement. Alcohol intake behaviours may differ in various settings; the geographic distribution of the selected universities herein represents only the UK population or countries with similar alcohol cultures. Nevertheless, given the uncertainties in this field of research, this study attempts to disentangle the discrepancies of the factors which influence alcohol consumption in young adults using a large, recent and diverse university sample.