Alcohol, Drugs and Student Lifestyle: a Study of the Attitudes, Beliefs and Use of Alcohol and Drugs among Swedish University Students

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Stockholm University

Alcohol, Drugs and Student Lifestyle

A Study of the Attitudes, Beliefs and Use of Alcohol and Drugs among Swedish University Students

Sandra Bullock

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Alcohol, Drugs and Student Lifestyle

Sandra Bullock

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Alcohol, Drugs and Student Lifestyle

by Sandra Bullock

SoRAD – Forskningsrapport nr 21 – 2004 SoRADs rapportserie ISSN 1650-5441

ISBN 91-975134-7

Tryck av Akademitryck AB, Edsbruk 2004

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Table of Contents

Page

List of Tables ... iii

List of Figures ... v

Acknowledgements... vi

Executive Summary... 1

Sammanfattning på Svenska... 5

1. Introduction and Method... 9

Background ... 9

Objectives of the Study ... 9

Methodology ... 9

Sample Design ... 9

Data Collection ... 10

Mail Procedures ... 11

Participation Rate ... 12

Questionnaire Content ... 13

Data Analysis ... 14

Core Measures Used in This Report... 15

Alcohol, Tobacco and Other Drug Use ... 15

Missing Data... 16

2. Sample Characteristics... 18

Age and Sex Distribution of the Students ... 18

Living Situation Prior to Age 18 ... 19

Current Social Status ... 20

Students’ Current Educational Situation ... 22

Participation in Activities at the University... 24

3. Prevalence of Alcohol and Tobacco Use ... 26

Use of Tobacco Products ... 26

Alcohol Consumption and Drinking Patterns... 28

Risk Factors for Weekly Drinking and Binge Drinking ... 30

Individual Characteristics ... 30

Pre-university Factors ... 32

University-related Characteristics ... 32

Beverage Preference ... 34

Multivariate Risk Factors for Binge Drinking ... 36

Multivariate Risk Factors for Weekly Drinking... 38

4. Prevalence and Context of Illicit Drug Use... 40

Prevalence of Drug Use ... 40

Prescription Drugs... 41

University Specific Prevalence Rates ... 42

Context and Details of Cannabis Use ... 43

Age of Debut ... 45

Context and Details of Amphetamine and Ecstasy Use ... 46

Prevalence of Use of Other Drugs ... 47

Risk Factors for Current Cannabis and Prescription Drug Use ... 48

Other Substance Use ... 53

Multivariate Risk Factors for Cannabis Use ... 54

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5. Drug and Alcohol Use Problems ... 56

The Occurrence of Substance Use-related Harms ... 56

Alcohol and Drug Harms by Site ... 57

Risk Factors for Alcohol and Drug Related Harms ... 57

Other Substance Use ... 60

The Alcohol Use Disorders Identification Test (AUDIT) ... 62

Driving Under the Influence... 62

Riding in a Car When the Driver Had Been Drinking ... 63

6. Reasons Why Students Choose NOT to Try Drugs ... 64

Desire to Try Drugs ... 64

Reasons Given by Participants for Not Using Drugs ... 64

7. Sources of Information, Help and Treatment ... 66

Previous Sources of Information and Advice ... 66

Preferred Future Sources of Information and Advice... 67

Treatment for Alcohol and Drug Problems... 68

8. Attitudes Towards Drug and Alcohol Use... 70

How Easy is it to Obtain Drugs?... 70

The Relative Importance of Student Alcohol and Drug Use in Context of Campus Life... 70

At What Age is it Acceptable to for a Person to Start Smoking, Drinking and Using Drugs? ... 72

General Attitudes Towards Drugs and Alcohol ... 73

9. Alcohol and Drug Policy and Action ... 78

Does the University Have a Drug or Alcohol Policy? ... 78

Are the Narcotics Sentences too Severe in Sweden? ... 78

How Should the University Administration Handle Drug Use Offences on Campus?... 78

What would I do?... 80

10. Summary and Conclusions... 82

References ... 84

Appendix A – Study Materials ... 85

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List of Tables

Page

Table 1.1 Response Rate ... 13

Table 1.2 Reasons for Removing Students From The Gross Sample... 13

Table 1.3 Classification of Tobacco, Alcohol and Other Drugs ... 16

Table 2.1 Age and Sex of the Study Sample, by Site ... 18

Table 2.2 Living Situation of the Study Sample Prior to Age 18, by Site ... 20

Table 2.3 Current Student Social Status, by Site... 21

Table 2.4 Educational Characteristics of the Sample by Site ... 23

Table 3.1 Percentage of Students Reporting the Use of Tobacco¹ Products, by Site... 26

Table 3.2 Percentage of Students Reporting the Use of Tobacco¹ Products, by Sex, Age and Current Living Situation, and Number of Academic Points ... 27

Table 3.3 Frequency of Alcohol Consumption and Binge Drinking by Site ... 30

Table 3.4 Individual Characteristics That Increase the Risk of Drinking Weekly and Binge Drinking by Students... 31

Table 3.5 Pre-university Factors That Increase the Risk of Drinking Weekly and Binge Drinking by Students... 33

Table 3.6 University-Related Factors That Increase the Risk of Drinking Weekly and Binge Drinking by Students... 35

Table 3.7 Multivariate Logistic Regression Identifying Risk Factors for Bi-weekly Binge Drinking Among Students ... 37

Table 3.8 Multivariate Logistic Regression Identifying Risk Factors for Weekly Drinking Among Students ... 39

Table 4.1 Prevalence of Use, for the Three Most Regularly Used Categories of Drugs, by Site... 42

Table 4.2 Agreement with Statements About Control over Cannabis Use, and Fear Of Consequences ... 46

Table 4.3 Age of Debut ... 46

Table 4.4 Drug Use Prevalence ... 48

Table 4.5 Individual Characteristics That Increase the Risk For Cannabis and Prescription Drug Use by Students... 49

Table 4.6 Pre-university Factors That Increase the Risk for Cannabis and Prescription Drug Use by Students... 51

Table 4.7 University-Related Factors That Increase the Risk for Cannabis and Prescription Drug Use by Students... 52

Table 4.8 Substance Use Correlates with the Use of Cannabis and Prescription Drugs by Students ... 53

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Table 5.1 Harms experienced by Students as a Result of Substance Use ... 56

Table 5.2 Cumulative number of areas in which students experienced Negative Consequences ... 57

Table 5.3 Percentage of Students Who Experienced at least One negative consequence due to Drinking or Drug Use in the 12 months Prior to the Study, by Site ... 58

Table 5.4 Individual Characteristics That Increase Students’ Risk of Experiencing Alcohol and Drug-related Problems ... 59

Table 5.5 Pre-university Factors That Increase Students’ Risk of Experiencing Alcohol and Drug-related Problems ... 60

Table 5.6 University-Related Factors That Increase Students’ Risk of Experiencing Alcohol and Drug-related Problems ... 62

Table 5.7 Substance Use Correlates of Experiencing Alcohol and Drug-related Problems ... 62

Table 6.1 Reasons Not to Use Drugs, by Site ... 64

Table 7.1 Past Sources of Drug-related Information and Advice ... 66

Table 7.2 Preferred Future Sources of Drug-related Information and Advice ... 68

Table 8.1 Perceived Ease of Obtaining Drugs... 70

Table 8.2 Student’s Rating of the Severity of Various Social Problems on their University Campus ... 71

Table 8.3 Relative Ranking of Social Problems... 72

Table 8.4 The Social Clock, and When Students Judge that it is Acceptable to Participate in Contested Behaviours... 73

Table 8.5 Students’ Agreement and Disagreement with Statements about Alcohol and Drug Use, Abuse and Care in Sweden ... 74

Table 8.6 Students’ Agreement Statements about Alcohol and Drug Use, Abuse and Care in Sweden, by site ... 75

Table 8.7 Students’ Agreement Statements about Alcohol and Drug Use, Abuse and Care in Sweden, by Use of Drugs... 76

Table 8.8 Students’ Agreement Statements about Alcohol and Drug Use, Abuse and Care in Sweden, by Drinking Style and Frequency ... 77

Table 9.1 Student’s Response to finding out that someone they know is involved with Drugs ... 81

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List of Figures

Page

Figure 1.1 Receipt of Questionnaires... 14

Figure 2.1 Participation in Activities on Campus (current term)... 25

Figure 3.1 How Recently Did Students Have Their Last Drink ... 29

Figure 4.1 Use of Any Drug, by Site (Excluding Prescriptives)... 41

Figure 4.2 Use of Any Drug, by Site (Including Prescriptives) ... 42

Figure 4.3 Number of Times Cannabis Has Been Used, by Site – Lifetime ... 44

Figure 4.4 Number of Times Amphetamines and Ecstasy Have Ben Used – Lifetime... 47

Figure 6.1 Top 10 Reasons Given for Not Using Drugs ... 65

Figure 9.1 Respondent’s Opinions on the Laws Regarding the Selling of Drugs and the Use of Drugs in Sweden ... 79

Figure 9.2 Students’ Views Regarding How the University Should Handle Students Who are Caught With Drugs... 79

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Acknowledgements

This study could not have been completed without the numerous students and employees at each of the four participating universities. They worked tirelessly throughout the

questionnaire development and data collection phases of the study, randomly selecting the participants, creating mailing labels and compiling and mailing questionnaire packages, receiving response cards as they were returned to the study office and preparing tracking update reports.

Thank you also to the local coordinators at University for overseeing the tremendous amount of work that had to be accomplished in a relatively short time period. The coordinators were:

Anna Sonrei from the University of Kalmar, Anna Hansen from Lund University, Claus Jochheim from Umeå University, and Elizabet Flennemo and Ulrica Olsson from Växjö University.

I would also like to thank my colleagues at The Centre for Social Research on Alcohol and Drugs (SoRAD), at Stockholm University and Pia Steen in particular, for their assistance I helping me to understand the Swedish Educational System and helping to transform the questionnaire materials from English into Swedish.

Finally, I would like to thank Mobilisering mot Narkotika (Mob) for the funds that made this study possible, and for laying the initial groundwork for it to take place. The universities also contributed to the financing of the study by contributing valuable services and materials in kind, thus keeping the overall budget to a level that was possible to reach.

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Executive Summary

This report presents the results of the Alcohol, Drugs and Student Lifestyle Study (ADSL), that was conducted in the fall of 2003, and funded by Mobilizering mot Narkotika (Mob).

The data represents responses from 4575 undergraduate university students from four universities across Sweden: The University of Kalmar, Lund University, Umeå University and Växjö University. Students from these four sites were randomly selected for participation using the university registration database (LADOK), and a response rate of 70.0% was

achieved.

This study focuses on student alcohol and other drug use, problems experienced as a result of alcohol/drug use, attitude towards use, and policies for the control of drug use. In doing so, it provides details about the use and context of drug use within the university environment.

Although the results of this study are not generalizable to all universities across Sweden, they can ultimately assist in the development of programs and policies for prevention and

treatment.

Prevalence of Drug Use

• 27.1% of the students had used an illicit drug at some point in their lives, this figure decreases to 9.8% in the 12 months prior to the survey, and 4.5% during the first few months of the fall 2003 school term. These figures do not include the use of prescription drugs irrespective of physician prescription.

• A higher percentage of the students reported using drugs, if prescription drug abuse was included in the definition. Such use of prescription drugs was to be recorded only if they were taken outside of a doctor’s orders, and not precisely as prescribed. 15.4% of the students reported using prescription drugs in this manner during their lives, 9.1% within the last 12 months, and 6.9% during the school term. Thus raising total drug use

prevalence to 36% lifetime, 17.3% 12 month, and 10.8% during the term.

• Cannabis was the most commonly reported drug at 25.3% use during the lifetime, 8.9%

during the prior 12 months, and 3.2% during the term. Amphetamines were the second most frequently used drug, at 4.1%, 0.8% and 0.3% respectively; followed by ecstasy at 3.2%, 0.9% and 0.3% respectively.

• Few students were regular consumers of drugs, data suggest that the large majority have only experimented lightly. Of the students who had tried cannabis, 35% had used it only 1-2 times, and 73.6 % had used it 10 or fewer times, in total. Similarly, 45% of students who had tried amphetamines or ecstasy had used them only 1 or 2 times; 73% of

amphetamine users and 76% of ecstasy users used them up to 10 times.

• There was variation in the prevalence of illicit drug use by university. Students at Lund were more likely to use cannabis, amphetamines and ecstasy than were students at any of the other sites. Students at Kalmar were the least likely to have tried cannabis.

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• Males and students aged 20-24 reported higher rates of use of all drugs, and cannabis in particular. During the prior 12 months, 12.2% of males used cannabis compared with 6.9% of females (use of any drug except prescription drugs: males 13.4% and females 7,6%).

• Females reported higher rates of prescription drug use than males. 10.6% of females reported prescription drug use in the prior 12 months compared with 7.3% of males.

• Students studying Humanities, Social Sciences, Technology and Economics/business reported the highest12-month rates of cannabis use.

• Several school-related factors were associated with increased rates of all drug use and cannabis use in particular. Compared with the 8.9% average rate of 12-month cannabis use, higher rates of use were reported by students who lived with roommates (15.4%) or in student corridors (14.9%); students whose primary income was via student loan (10.3%);

students taking free-standing courses (10.7%) as opposed to being enrolled in a program;

and those who had completed 40 educational credits or less prior to the fall term (12.6%).

• Students who had lived outside of the country just prior to beginning their current

education (23.9%) and those from the three largest cities in Sweden (11.7%) also reported higher rates of cannabis use in the 12 months prior to the study. In addition, students who had been guest students outside of the country during their education reported more current cannabis use (13.4%) than those who had not (7.8%); however, only 17.1% of the students who had been guest students elsewhere indicated that they had first tried drugs while abroad studying.

• 17% of students who had tried drugs had experienced harm related to their use in the past 12 months. This represents less than 2% of students overall. Further, 2.1% of students reported being a passenger in a car where the driver was known to be under the influence of an illicit drug, while just under 1% of students who had access to a car had driven under the influence of a drug (not including alcohol) during the school term in progress.

Non-use of Drugs

• 64% of students had not tried illicit drugs even once. This number increases to 72.9% if prescription drugs are not included in the estimate. 16.5% (of the 72.9%) of those that had not tried drugs indicated that they had a desire to experiment with one or more drugs.

Students who had close family members or friends who had used drugs were half as likely (13.3%) as those without (26%) to want to experiment.

• The top 5 reasons endorsed by for remaining drug free were: drugs aren’t good for your health (94.5%); one can become addicted (93.6%); I just don’t want to (92.4%); one could die (91.3%); and I don’t like how they influence one’s behaviour (82.2).

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Alcohol Consumption and Patterns of Use

• 96% of students had consumed alcohol in the 12 months prior to completing the survey;

92.7% had consumed it since the beginning of the school term. In total, only 1.8% had been life-long abstainers.

• 33% of students reported binge drinking (drinking the equivalent of a bottle of wine at a sitting) twice a month or more often. 55% had consumed this quantity at least once per month.

• Alcohol was consumed most frequently by students attending Lund, and least frequently by students attending Umeå (75.2% versus 57% drank 2 or more times per month) University.

• Binge drinking at least twice monthly, was most common at Lund (38.4%) and Växjö (37.0%) universities compared with Kalmar (32.2%) and Umeå (31.9%).

• Students who binge drank at least 2 times per month were most likely to be male (46.8%

versus 28.9% for females); aged 20 to 24 years (42.4%); live with roommates (55.0%), in a student corridor (49.4%) or in their own apartment alone (41.9%); and have a higher disposable income than those drank heavily less often. These heavy drinkers were also more likely to have lived one of Stockholm, Göteborg or Malmö prior to attending school (45.4%). Students enrolled in economics/business (51.2%), technology (42.4%), law (42.1%), and the social sciences (40.6%) were the most likely to binge drink at least twice a month. Binge drinkers also reported having more confidants (a higher level of social support) than non-binge drinkers.

• 43% of current drinkers had experienced harm related to its use in the past 12 months.

This represents 41.5% of all students surveyed. The most commonly reported harms were related to the student’s physical health (26.3%) and financial situation (25.7%).

• 4.3% of students reported being a passenger in a car where the driver was known to be under the influence of alcohol, and 1.5% of students who had access to a car during the fall 2003 term had driven under the influence alcohol during that time.

Attitudes towards Alcohol and Drug Use

• Student’s alcohol ranked first in a list when students were asked about potential problems on the student’s own university campus. Vandalism or theft of property ranked second, while student drug use ranked third. These were followed by sexual discrimination, sexual harassment, racism, and physical violence.

• 66% agreed, or strongly agreed, with the statement that alcohol is a larger problem in Sweden than are other drugs.

• 75% of students felt that drinking alcohol was a normal part of being a university student;

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• 70% of students felt that if it became permissible to use drugs, there would be a large increase in their use. This finding was in contrast with the large number of non-drug users who indicated that they had no desire to use drugs, largely for health reasons.

• 90% agreed that the misuse of prescription medicines can be as dangerous as misuse of other drugs. This percent did not differ vary depending upon whether the student reported misuse of prescription medications or not.

Policy

• 88.2% of students indicated that they did not know if their university had a policy on alcohol use. Similarly 90.9% did not know if there was a policy regarding illicit drug use.

• 27% of students felt that the university administration should be doing more to control students’ drug use. Students who had not tried drugs felt significantly stronger about this (30.4%) than students who had previously tried drugs (14.7%).

• Students where asked their opinion of what the University’s response to drug use on campus should be. For a first offence of using cannabis on campus, students felt that the University should see that the individual receives counselling (66.8%), and 31% felt that the incident should be reported to the police. If the same person was caught a second time, students’ support of counselling decreased to 62.4% and 48.8% felt the police should bee called. However if an individual was caught selling cannabis on campus, students felt that the individual should be reported to the police (84.8%), and expelled from school (34.8%).

• Students who had tried drugs were more likely to indicate that the Swedish laws for drug use were too harsh (16.4%) compared with students who had not tried drugs (3.2%);

however, a large proportion of students in each group (38.5% and 37.5% respectively) had no opinion on the matter.

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Sammanfattning på Svenska

I denna rapport presenteras resultat från en undersökning om Alkohol, droger och studentliv (ADSL), som genomfördes under hösten 2003. Materialet omfattar svar från 4575

universitetsstudenter som läste på grundnivå vid fyra svenska universitet: Högskolan i

Kalmar, Lunds universitet, Umeå universitet och Växjö universitet. Deltagarna från dessa fyra städer hade blivit slumpmässigt utvalda med hjälp av skolornas databaser (LADOK) och svarsfrekvensen blev 70,0 procent.

Studien fokuserar på studenternas bruk av alkohol och droger, problem upplevda som reslutat av detta bruk, attityder till bruket och kontrollåtgärder riktade mot bruket. På detta sätt ger den detaljerad information om kontext av drogbruket i universitetsmiljön. Även om resultaten inte kan generaliseras till alla svenska universitet, de kan ge underlag för utveckling av preventiva program och åtgärder samt behandling.

Förekomst av drogbruk

• 27,1 procent av studenterna hade testat någon otillåten drog vid något tillfälle under sin livstid. Siffran sjunker till 9,8 procent när det gäller de senaste 12 månaderna före undersökningen och till 4,5 procent under de första månaderna av höstterminen 2003.

Uppgifterna omfattar inte bruk av receptbelagda läkemedel, oavsett om de var utskrivna av en läkare eller ej.

• En högre andel studenter uppgav drogbruk när receptbelagda läkemedel inkluderades i definitionen. Sådant bruk registrerades endast om dessa läkemedel användes utan läkarrecept eller på annat sätt än ordinerat av läkare. 15,4 procent av studenterna

rapporterade sådant bruk av receptbelagda läkemedel under sin livstid, 9,1 procent under de senaste 12 månaderna och 6,9 procent under terminens gång. Det innebär en total förekomst av drogbruk bland 36 procent av studenterna under deras livstid, 17,3 procent under de senaste 12 månaderna och 10,8 procent under studieterminen.

• Cannabis var den vanligaste drogen, rapporterad av 25,3 procent när det gäller bruket under livstid, 8,9 procent under de senaste 12 månaderna och 3,2 procent under terminen.

Amfetamin var den näst vanligaste drogen, rapporterad av 4,1, 0,8 respektive 0,3 procent - följd av ecstasy, motsvarande 3,2, 0,9 respektive 0,3 procent.

• Få studenter använde droger regelbundet. Resultaten tyder på att en stor majoritet endast har erfarenhet av experimentell användning. Bland de studenter som använt cannabis hade 35 procent gjort så endast en eller två gånger och 73,6 procent hade använt den totalt tio eller mer sällan. På ett liknande sätt, 45 procent av de studenter som hade provat

amfetamin eller ecstasy hade gjort så endast 1 eller 2 gånger; 73 procent av dem som använt amfetamin och 76 procent av dem som använt ecstasy hade gjort så högst tio gånger.

• Variation kunde observeras i förekomsten av illegala droger mellan olika universitet.

Studenterna i Lund använde cannabis, amfetamin och ecstasy oftare än studenter från de

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• Män och studenter i åldrar 20-24 år uppgav högsta andelar när det gäller bruk av samtliga droger, i synnerhet bruk av cannabis. Under de senaste 12 månaderna hade 12,2 procent män provat cannabis jämfört med 6,9 procent bland kvinnor (bruk av samtliga droger förutom receptbelagda läkemedel: 13,4 procent bland män och 7,6 procent bland kvinnor).

• Fler kvinnor än män rapporterade bruk av receptbelagda läkemedel. Andelen gällande de senaste 12 månaderna var 10,6 procent jämfört med 7,3 procent bland män.

• Studenter som läste humaniora, samhällsvetenskap, teknologi och

ekonomi/marknadsföring uppvisade de högsta andelarna av cannabisbruk under de senaste 12 månaderna.

• Ett flertal skolrelaterade faktorer visade sig ha samband med högre förekomst av allt drogbruk, cannabis i synnerhet. Jämfört med den genomsnittliga andelen som provat cannabis under de senaste 12 månaderna, 8,9 procent, har högre andelar rapporterats bland dem som bodde tillsammans med rumskamrater (15,4 procent) eller i en studentkorridor (14,9 procent). Motsvarande gällde studenter som fick sin huvudsakliga inkomst från studielån (10,3 procent) samt studenter som läste fristående kurser (10,7 procent) jämfört med dem som läste en linje. Andelen var också högre än genomsnitt bland dem som hade nått högst 40 högskolepoäng innan höstterminen (12,6 procent).

• Studenter som var bosatta utanför Sverige precis innan de påbörjade sin nuvarande utbildning (23,9 procent) och de som kom från de tre största städerna i Sverige (11,7 procent) rapporterade också en högre förekomst av cannabisbruk under de senaste 12 månaderna. Också bland dem som under sin utbildning hade varit gäststudenter utanför Sverige fanns det relativt fler som uppgav att de hade provat cannabis under de senaste 12 månaderna (13,4 procent) jämfört med de som inte studerat utomlands (7,8 procent).

Samtidigt rapporterade endast 17,1 procent bland dem som varit gäststudenter att de provade droger för första gången under sina utlandsstudier.

• 17 procent bland de studenter som hade provat droger hade under de senaste 12

månaderna upplevt problem relaterat till drogbruket. Det motsvarar mindre än två procent bland samtliga studenter. Vidare uppgav 2,1 procent att de hade färdats i en bil då de visste att föraren vad drogpåverkad, medan knappt en procent bland studenter med tillgång till en bil rapporterade att de själva hade kört under drogpåverkan (omfattar inte alkohol) under den pågående terminen.

Icke-bruk av droger

• 64 procent av studenterna hade inte provat illegala droger ens en gång. Siffran ökar till 72,9 procent när receptbelagda läkemedel inte ingår i skattningen. 16,5 procent bland de som inte provat droger (d.v.s. de 72,9 procent) uttryckte att de någon gång hade haft lust att pröva en eller fler droger. Studenter som hade nära anhöriga eller vänner som hade använt droger var hälften så benägna (13,3 procent) att känt lust att prova jämfört med övriga (26 procent).

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• De fem vanligaste orsakerna som angivits när det gällde att förbli drogfri var: droger är inte bra för hälsan (94,5 procent), man kan bli beroende (93,6 procent), jag vill helt enkelt inte (92,4 procent), man kan dö (91,3 procent) och jag gillar inte hur de påverkar ens beteende (82,2 procent).

Alkoholkonsumtion och alkoholvanor

• 96 procent av studenterna hade konsumerat alkohol under de senaste 12 månaderna före genomförandet av undersökningen. 92,7 procent hade konsumerat alkohol sedan början av skolterminen. Totalt sett hade enbart 1,8 procent aldrig någonsin druckit alkohol.

• 33 procent av studenterna rapporterade intensivkonsumtion (binge drinking), d.v.s. att de drack motsvarande en flaska vin vid ett och samma tillfälle, två gånger i månaden eller oftare. 55 procent hade druckit motsvarande denna mängd minst en gång i månaden.

• Alkohol konsumerades oftast av studenter vid Lunds universitet, och minst ofta av studenter vid Umeå universitet (75,2 procent respektive 57 procent drack två gånger eller oftare per månad).

• Intensivkonsumtion minst två gånger per månad var mest vanligt vid Lunds (38,4 procent) och Växjö universitet (37.0 procent), jämfört med Högskolan i Kalmar (32,2 procent) och Umeå universitet (31,9 procent).

• 46,8 procent av männen respektive 28,9 procent av kvinnorna dricker motsvarande en flaska vin vid ett konsumtionstillfälle minst två gånger per månad. Av de i åldern 20-24 år har 42,4 procent uppgett intensivkonsumtion. 55 procent av dem som bor med

rumskamrater, 49.4 procent av dem som bor i studentkorridor, 41,9 procent av de som bor ensamma i egen lägenhet har angett intensivkonsumtion. ”Intensivkonsumenterna” har också en högre disponibel inkomst än de som dricker mer sällan. Intensivkonsumenterna var också mer sannolika att ha bott i antingen Stockholm, Göteborg eller Malmö före sina universitetsstudier (45,4 procent). Studenter som studerade ekonomi/marknadsföring (51,2 procent), teknologi (42,4 procent), juridik (42,1 procent) eller samhällsvetenskap (40,6 procent) var de som i högst utsträckning drack motsvarande en flaska vin vid ett

konsumtionstillfälle minst två gånger i månaden. Intensivkonsumenter hade fler personer som de kunde anförtro sig till än övriga alkoholkonsumenter.

• 43 procent av alkoholkonsumenterna hade upplevt skador relaterade till

alkoholkonsumtion under de senaste 12 månaderna. De motsvarar 41,5 procent av alla studenter i undersökningen. Den vanligaste skadan var relaterad till studentens fysiska hälsa (26,3 procent) och finansiella situation (25,7 procent).

• 4.3 procent av studenterna rapporterade att de varit passagerare i en bil där de vetat att föraren varit påverkad av alkohol och 1,5 procent av studenterna som hade tillgång till bil under hösten 2003 hade kört under alkoholpåverkan under den tiden.

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Attityder till alkohol- och droganvändning

• Respondenterna rangordnade studenters alkoholbruk högst när de tillfrågades om potentiella problem på det egna universitetsområdet. Vandalism/stöld av egendom

rangordnades tvåa, därefter följde sexuell diskriminering, sexuella trakasserier, rasism och (fysiskt) våld.

• 66 procent av studenterna instämde helt eller delvis i påståendet att alkohol är ett större problem än andra droger i Sverige.

• 75 procent av studenterna ansåg att alkoholkonsumtion var ett normalt beteende för en student vid ett universitet, i jämförelse med att enbart sju procent ansåg att prova droger var normal upplevelse när man är student på universitetet. Fler studenter vid Lunds universitet ansåg att prova droger var en normalt (10,4 procent) jämfört med de andra skolorna (Kalmar 4,0 procent, Umeå 4,5 procent, Växjö 5,0 procent).

• 70 procent av studenterna ansåg att om det blev tillåtet att använda droger så skulle användningen öka kraftigt. Detta resultat var i motsägelse till att de flesta studenter som inte använde droger menade att de inte hade någon önskan att prova droger, främst p.g.a.

hälsoskäl.

• 90 procent instämde i att missbruk av receptbelagda läkemedel är kan vara lika farligt som missbruk av andra droger. Denna siffra varierade inte beroende på om studenten

rapporterat eget bruk av receptbelagda läkemedel eller inte.

Policy

• 88,2 procent av studenterna svarade att de inte visste om deras universitet hade någon policy gällande alkoholkonsumtion. 91 procent visste inte om det fanns någon policy gällande otillåten droganvändning.

• 27 procent av studenterna ansåg att universitetsadministrationen borde göra mer för att kontrollera studenternas droganvändning. Studenter som inte provat droger ansåg detta signifikant mer (30,4 procent) än studenter som provat droger (14,7 procent).

• Studenterna tillfrågades om hur de tyckte att skolan skulle agera i ett antal situationer rörande droganvändning på universitetsområdet. För en förstagångsförseelse bestående av användning av cannabis på universitetsområdet ansåg 66,8 procent av studenterna att individen skulle få rådgivning och 31 procent ansåg att incidenten skulle rapporteras till polisen. Om samma person ertappades en andra gång, så minskade studenternas stöd för rådgivning till 62,4 procent och 48,8 procent ansåg att polisen skulle kontaktas. Om en person ertappades med att sälja cannabis till en vuxen person på universitetsområdet, ansåg studenterna att han eller hon skulle bli rapporterad till polisen (84,8 procent) och avstängd från skolan (34,8 procent).

• Studenter som hade provat droger var mer troliga att tycka att straffen för droganvändning var för stränga (16,4 procent) jämfört med studenter som inte provat droger (16,4 procent).

Inom båda grupperna var det emellertid många studenter (38,5 respektive 37,5 procent) som inte hade någon åsikt i frågan.

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1. Introduction and Method

Background

Although there is a long history of national and student alcohol surveys in Sweden, there is limited information available regarding illicit drug use and abuse among university students.

Information on the lifetime, 1-year, and 30-day prevalence of drug use by young adults has been measured (Guttormsson, Andersson & Hibell, 2004), students included; however, there have been no questions included which specifically address the campus environment, attitudes and related use of drugs. Results from the 2003 young adult drug use study conducted by Centralförbundet för alkohol- och narkotikauppylsning (CAN) have indicated that students between 21-24 years of age reported a higher prevalence of drug use lifetime drug use (24%) than did those the same age who were working (21%) (Guttormsson, Andersson & Hibell, 2004). Similarly current drug use (within the 12 months prior to study) was also higher for these students (11%) compared with similarly aged workers (5%). However, in both cases individuals in this age group who neither worked nor attended schools had the highest lifetime (29%) and 12-month (13%) prevalence of narcotic use. These figures suggest that narcotic use among university students is an issue in need of further study.

The Alcohol, Drugs and Student Life Survey (ADSL) was designed to address the absence of University-specific issues related to drug use and its relation to alcohol consumption by current undergraduate university students. The survey provides us with information about rates and patterns of alcohol and other drug consumption, alcohol and drug related problems experienced, as well as students’ views about alcohol and drug use and how they relate to the campus environment.

Objectives of the Study

The overriding goal of the study was to inform local development regarding drug prevention and support. To meet this goal, this project had two primary objectives. The first was to obtain accurate point estimates of current drug use (defined as use within the 12 months prior to the study) and of lifetime drug use within University and Högskola in Sweden. The second goal of the study was to examine how students use or have used drugs differ from those who have not with respect to sociodemographic characteristics, lifestyle choices (including alcohol use), school-related variables, and drug-related attitudes and policies.

These data, although non-representative of Sweden’s entire university and college

environment, can provide some guidance for priority setting and program development in individual universities or at the national level.

Methodology

Sample Design

The ADSL study employed a 2-stage selection of undergraduate students. Selection of the

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collaboration with the Alcoholkommittén, whose objective it is to support the development of evidence based and sustainable prevention at the local level. While Växjö was not among the communities involved in the “försökskommumer” initiative, the Alcoholkommittén has been active in doing work there. In choosing these sites, Mob also ensured that there was some geographical representation from the different regions of the country and across

university/college size distribution.

In the second stage of selection, a number of students enrolled in level A-D courses at each of the four sites were randomly chosen for participation by the local coordinators. Because of the wide diversity across sites in the undergraduate courses offered, students were selected randomly regardless of level of study, field or study and program involvement. All students, whether enrolled in a specific program or in free-standing courses, were eligible for

participation. Random selection was completed using the student register (LADOK) in mid October, once the information was updated to include the fall 2003 enrolment.

Minimal eligibility criteria were set for the selection of students for participation in order limit bias to the sample. Students had to be enrolled in courses in levels A through D and guest students were to be excluded, where possible, as it was unlikely that they would be able to read and write in Swedish. Ultimately, after selection and the first mailing it became known that we had inadvertently selected a number of students who were guest students at other universities during the fall 2003 term. Where this was known the student was also excluded from the sample, as his/her responses to the questions would not be reflective of current enrolment in the university/college in question.

The number of students selected for participation in the study was calculated separately for each site. This was done to ensure that there was a large enough sample in each of the sites to be able to provide accurate point prevalence estimates for one year and lifetime drug use and allow the results to be interpreted with some degree of certainty. At the same time it was necessary to recognize that the number of students attending the universities and colleges diverged widely and that drawing large samples within small universities would require a disproportionate amount of local coordination. The minimum number of completed, returned questionnaires desired from each location was 500, for larger universities this number was increased to provide completed returned questionnaires representing 5% of the undergraduate student body. In order to ensure that we achieved these numbers, the smallest number of students to be selected was 758, and the largest was 2895. An over sample was chosen, from the three larges sites, in order to involve a greater number of current drug users in the study in order to provide a high level of confidence in describing the patterns of use and attitudes of drug using students.

Each site provided a local contact person who was responsible for development of site- specific questions, reviewing study materials specific to their site, selecting the sample, tracking student participation and providing a liaison with the study office at Stockholm University. Contacts varied by site, and included individuals from health services, student unions/associations and administrative offices.

Data Collection

Data collection was conducted using a postal survey. This design was chosen after

considering a number of alternatives including 1) self completion of survey within pseudo- randomly selected classrooms; 2) telephone survey; 3) Internet-based self-completed survey;

4) face-to-face interviews; and 5) mail survey. In making this decision, the main

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consideration was how to obtain a random sample from within each school so that the

estimates provided would be reliable and reproducible. In order to do this, not only should the sample be random, but the response rate should be over 65% and be unbiased. LADOK administration personnel indicated that the student-contact information was most complete for address as opposed to telephone or e-mail; thus, face-to face interviewing and mail options were preferred. Although response rate is usually highest in surveys using face-to-face interviews (Mangione, 1995), it is not assured that this would be the case with this university- based sample. Drug use is an illegal behaviour and students could fear expulsion from school if it their use was discovered. Thus, they might be less likely to agree to be interviewed by someone who is there on-behalf of the university as opposed to providing non-personally identifying information via post. The costs of face-to-face interviews also proved to be prohibitive. Thus a postal survey was chosen.

Mail Procedures

Studies have shown that mail surveys, if done well, can obtain as high a response rate as telephone or face-to-face interview techniques (Edwards et al., 2002; Mangione, 1995;

Trinkoff & Storr, 1997). Some of the techniques that this study used to optimize the response rate included:

1) Coordinating university – The study was directed by researchers located at Stockholm University, which was not one of the four participating sites. All completed questionnaires were sent directly to Stockholm University, whereas, the names of students sampled to participate were only handled by the universities/college. As a result, anonymity of response was guaranteed as names and responses could NOT be matched.

2) Repeat mailings – There were four study mailings, each approximately 2 weeks apart.

When possible, mailings occurred midweek so that materials would be received just in advance of the weekend; however, this was not always possible in each location. The first and third mailings included full-packets of material, the second and fourth consisted of a reminder postcard (see Appendix A). The full packet included an introductory letter on university/college letterhead, a questionnaire, a business reply (svarspost) envelope and a response card.

3) Response card – The student was directed to send their completed survey, which had neither identifying features nor an identification number directly to Stockholm University in the envelope provided. At the same time, if they wanted to be eligible for a draw for prizes respondents could choose to send their response card to their home university. The response card identified the person, and by sending it in, the student indicated that they had taken part and thus would be sent no additional reminders about the study. However, the introductory letter indicated that it was not possible for either Stockholm University nor their home university to link response cards and the completed surveys together, thus maintaining anonymity of response and allowing the researchers to save money on printing, postage and allowing the individual to be included in a draw for prizes. A sample response card can be seen in Appendix A.

4) Incentives – The study included incentives for participation. Due to the prohibitive cost of providing pre-paid gifts to each of the 6539 students selected for participation, it was

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theater ticket. The number of tickets given away per site was dependent upon the sample size.

Tickets were sent to 5% of the respondents who returned their response card to their home university (Lund 95, Umeå 60, Växjö 35, Kalmar 25). While it is possible that someone who sent in a response card did not actually complete the questionnaire, this is remote, as in the literature (Mangione, 1995, Trinkoff & Storr, 1997) as well as in this case fewer response cards were received than completed questionnaires, as some students preferred not to inform their university regarding whether they had participated or not.

5) Endorsement by a recognized authority – The one-page introductory letter that was sent out in the initial questionnaire packet was sent on professionally produced letterhead provided by the university/college. This letter explained the purpose of the study and why it was

important for chosen students to participate, how names were selected, the function of the response card, maintenance of anonymity and confidentiality, and provided contact

information for the Study Director at Stockholm University as well as a local coordinator in most cases.

Participation Rate

One university that Mob initially approached was unwilling to participate in the study. The remaining four participated. Given that this study had not intended to provide results that were representative of the entire Swedish university/college population, there is no further reference to the refusal by this site and how its exclusion might have changed the findings reported herein.

Sites were initially asked to select a specific number of names for inclusion in the study. This number was chosen to meet a minimum number of completed questionnaires (5% of students or a minimum of 500), assuming a worst-case scenario of a 60% participation rate. In

particular the number of people selected from Lund was 2923, with an additional 1946 from Umeå, 1077 from Växjö, and 769 from Kalmar. Of those selected, there were a small number removed because they were found to be duplicates, students studying outside of their home university or doctoral students. As seen in Table 1.1 the final net sample sizes were 2895, 1861, 1024 and 758 respectively. Table 1.2 shows the reasons for removing students from the gross sample by study site. Since students were only removed from the gross sample if mail was retuned via the post as undeliverable, or if students (or their families) made contact with study personnel, the number of students classified as ineligible may be an underestimate.

The overall response rate was 70.0%, with similar response across sites. Table 1.1 shows the actual response rate by site.

Completed questionnaires were sent into Stockholm University rapidly during the first 2 weeks, prior to the first reminder postcard. Within 14 days of the first mailing 72.6% of the questionnaires that were ultimately received, had been received by researchers at Stockholm University (50.8% of those sent out to the net sample). This rate of return was consistent across sites; specifically by 14 days, Kalmar, Lund, Umeå and Växjö had returned 49.9%, 52.7%, 49.5% and 48.5% respectively. In all locations the rate of return diminished appreciably with each reminder mailing (see Figure 1.1).

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Table 1.1 Response Rate

University / Högskola

Kalmar Växjö Umeå Lund Total

Gross Sample 769 1038 1907 2923 6637

Net Sample ¹ 758 1024 1861 2896 6539

Questionnaires returned that were not included in the analysis ²

0 1 2 2 4

Completed analysed Questionnaires

547 702 1304 2022 4575

Response Rate ¹ 72.1% 68.6% 70.1% 69.8% 70.0%

1 The net sample excludes individuals who could not read/write Swedish, were out of the country during the data collection period, who had no current address in the computer, known doctoral students and duplicates. The response rate is calculated as completed (non falsified) questionnaires / net sample x 100.

2 Questionnaires that were clearly falsified, these are included in the net sample, but are not counted as completed in the response rate.

Table 1.2 Reasons for Removing Students From The Gross Sample University / Högskola Reason for Removal

From Gross Sample

Kalmar Växjö Umeå Lund Total

No correct address 8 13 41 24 86

Living out of the country (guest student elsewhere)

2 1 1 2 6

Could not read/write in Swedish 1 0 0 1 2

No longer studying at the university/college

0 0 2 0 2

Doctoral student 0 0 1 0 1

Duplicate selected 0 0 1 0 1

Total Removed from Gross sample

11 14 46 27 98

Questionnaire Content

The questionnaire was developed to be relatively comparable with the national telephone survey of young adults, aged 16 to 24, (Guttormsson, Andersson & Hibell, 2004), which was conducted by telephone interview in the spring of 2003. However, this questionnaire asked more in-depth questions with respect to drug use and its occurrence on college and university campuses in Sweden. The questionnaire was developed primarily by researchers located at

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Figure 1.1 Receipt of Questionnaires 0

500 1000 1500 2000

0 1 2 3 4 5 6 7 8 9 10 14

Week #

Lund Umeå Växjö Kalmar

# Questionnaires

Mail-out weeks: 0, 2, 4, 6

The questionnaire was pilot tested (except for site-dependent questions) at Stockholm University using a convenience sample of undergraduate volunteers, and modifications were made to several of the questions prior to their use in the main study.

The 20-page questionnaire was designed with nine sections. In order of appearance, the sections included:

• Background Information

• Health and Lifestyle

• Alcohol, Tobacco and Drug Use

• Questions for non-drug users

• Sources of Information, Help and Support’

• Perceptions of Drug Use in General

• Attitudes

• Policy

• Site-specific Questions

Data Analysis

The purpose of this report is to provide a description of the alcohol and drug situation in the four selected sites, both individually and in total. In order to accomplish this, estimates are provided as simple percentages. The further description of those who have tried drugs, those

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who use regularly and those who have never tried is conducted using bivariate cross-

tabulations and chi-square statistics. As this is a preliminary report only, there is limited use of multivariate statistics, such analyses will be the focus of future manuscripts.

In limited instances, this report does comment on whether the differences seen between sites are significantly different from one another. Where this is done, the data have been

standardized across site by age and gender. This was necessary because age and gender are both strongly related to the use of alcohol and drugs and they also differed by study (see chapter 2). The standardized percentages are not presented in this document, so as not to confuse the reader.

One limitation of this study is that it was not possible to weight the data to ensure that the estimates provides for each site are representative of all undergraduates in the university. It was not possible to obtain accurate data from each site with respect to age, sex and program enrolment in order to develop weights for all locations. With a 70% response rate there is a potential for biased results. However, seeing as the drug use rates are as high or higher than other studies have indicated in similarly aged populations, it is unlikely that we have

underestimated the prevalence of drug use substantially.

Core Measures Used in this Report

Each chapter in this report describes specific drug-related outcome measures, these measures will be described more fully as they are discussed in detail. However, there issues relating to question time frames and general terminology that are of importance throughout the entire report and thus are outlined in more detail here.

Alcohol, Tobacco and Other Drug Use

The term ‘drug’ was used in the survey questionnaire, and is used in this report, to refer to the consumption of any illegal or prescription drug, other than alcohol and tobacco, used in a manner NOT as prescribed by a physician. Over the counter preparations were not to be considered drugs, nor were prescription drugs that were taken as prescribed by a physician. A detailed list of the types and classification of drugs of interest in this enquiry can be seen in Table 1.3. This list was included in its entirety in the questionnaire inside back cover for easy reference by survey participants when they were completing the questionnaire.

Drug use was measured in this study using three time frames in effort to allow comparisons to be made with results from other studies. As a result, a number of other questions throughout the survey have also been asked using similar time frames to ensure that analysis remains meaningful. The three time frames that have been used are lifetime, last 12 months, and during the current school term. The school term (fall 2003) was of importance as the

universities/colleges would certainly be interested in whether and how often drugs were being used by students while students were in attendance. However, given the fact that students completed the questionnaire from two to four months into the fall school term (with more respondents completing the survey earlier than later) the point estimates for this measure of drug use can not be directly compared to the commonly asked time frame of use within the past 90 days.

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Table 1.3 Classification of Tobacco, Alcohol and Other Drugs

Catagory list

A Tobacco Cigarettes, cigarillos, cigars, pipes, snus and chewing tobacco B Alcohol Light beer (folköl) , medium and strong beer, spirits, wine, cider

snaps, brännvin and alcopops

C Cannabis Hash, hash oil, marijuana, afgan, cannabis, grass, marock, pot, weed

D Amphetamines Benzedrine (bennies), dexedrine, methamphetamines, speed, tjack

E Ecstasy Ecstasy, Extacy, X, E, MDMA, PMMA,

F Rohypnol Rohypnol

G Heroin “Chasing the dragon”, fentanyl aka / ”China white”, opium, smoke heroin, white heroin

H GHB GBL, gamma-hydroxy-butyrate, gobbe, liquid ecstasy, pro-G, scoop, easy lay

I Cocaine Snow

* do not include crack or ”free base” cocaine J Other central nervous

system (CNS) stimulants

Betelnöt, Crystal meth (ice), fenmetrazine, fenmetralin, kat, khat, metyfendiat, ritalin

* do not include amphetamines, cocaine or crack K Hallucinogenic mushrooms Only hallucinogenic mushrooms, magic mushrooms

L Pain killers Citodon, codine, darvocet darvon, dilaudid, distalgesic, fortalgesic, hydrocodone, ketobemidon, ketogan, moraphine, oxycontin, percocet/percodan, petidin, råopium, treo comp, vicodin/lortab/lorcet , m.m.

* do not include methadone, buprenorfin or subutex M Sedatives, and

tranquilizers

Alopam, alpralid, apodorm, benzodiazapines (bens), dormicum, diazepam, dumozolam, flunitrazepam, halcion, librium, mogadon, nitrazepam, oxazepam, serepax, sobril, stesolid, stilnoct, temesta, triazolam, valium, m.m.

* inkluderar inte GHB eller rohypnol N Anti-depressants Prozac, paxil, zoloft

O Other hallucinogens Acid, angel dust, DMT, LSD, meskalin, PCB, peyote, psilocybin, trip, ketamin

* inkluderar inte ecstasy eller svampar

P crack “Free base” cocaine

Q Steroids (doping) Anabolic steroids, testosterone, growth hormone R Other drugs other illegal drugs not already included above, sniffing

preparations (e.g., gas, paint thinner, etc.), methadone, buprenorfin or subutex, etc.

Missing Data

Overall, item non-response was low. In particular, only 16 people (0.35%) did not answer the drug use questions.

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The questions that received the highest rate of non-response were place of birth, mothers place of birth and fathers place of birth. These questions were left blank in 26.6% of the completed questionnaires. It is believed that a particularity in the formatting of the questionnaire caused this question to be left blank in the majority of the cases, rather than the students withholding information. In the pilot test, these questions were answered by 100% of the volunteer respondents, even though not all were born in Sweden with Swedish heritage. The format of the questionnaire did change slightly between the pilot test and the main study, causing some questions to shift in their location on the page. The changes left these three questions on the right hand column of the page, a column that did not continue all of the way down to the bottom of the page. Thus, if a respondent were following down the left hand side of the page, and not reading the questions numbers, these questions could be easily missed.

The questions with the second highest level of missing data were those in the sources of information, help and support section. Almost all of the 10.2% of the participants who left this section blank were individuals who had never tried drugs (433/466 people). It is likely that they suspected that this section did not apply to them, although there were no directions to this effect specifically stated in the instructions.

The final question area with a high rate of non-response was postal code. This was missing among 4.9% of participants. Some individuals wrote in their questionnaire that they felt that this information was too identifying for them to provide, others just left the space blank, presumably for the same reason.