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True gentlemen : the broken pledge of America's fraternities
\"College fraternity culture has never been more embattled. Once a mainstay of campus life, fraternities are now subject to withering criticism for reinforcing white male privilege and undermining the lasting social and economic value of a college education. No fraternity embodies this problem more than Sigma Alpha Epsilon, a national organization with more than 15,000 undergraduate brothers spread over 230 chapters nationwide. While SAE enrollment is still strong, it has been pilloried for what John Hechinger calls \"the unholy trinity of fraternity life\": racism, deadly drinking, and misogyny. Hazing rituals have killed ten undergraduates in its chapters since 2005, and, in 2015, a video of a racist chant breaking out among its Oklahoma University members went viral. That same year, SAE was singled out by a documentary on campus rape, The Hunting Ground. Yet despite these problems and others, SAE remains a large institution with strong ties to Wall Street and significant political reach. In True Gentlemen, Hechinger embarks on a deep investigation of SAE and fraternity culture generally, exposing the vast gulf between its founding ideals and the realities of its impact on colleges and the world at large. He shows how national fraternities are reacting to a slowly dawning new reality, and asks what the rest of us should do about it. Should we ban them outright, or will they only be driven underground? Can an institution this broken be saved? With rare access and skillful storytelling, Hechinger draws a fascinating and necessary portrait of an institution in deep need of reform, and makes a case for how it can happen\"-- Provided by publisher.
Book
Comparative Effectiveness of Brief Alcohol Interventions for College Students: Results from a Network Meta-Analysis
Late adolescence is a time of increased drinking, and alcohol plays a predominant role in college social experiences. Colleges seeking to prevent students’ hazardous drinking may elect to implement brief alcohol interventions (BAIs). However, numerous manualized BAIs exist, so an important question remains regarding the comparative effectiveness of these different types of BAIs for college students. This study uses network meta-analyses (NMA) to compare seven manualized BAIs for reducing problematic alcohol use among college students. We systematically searched multiple sources for literature, and we screened studies and extracted data in duplicate. For the quantitative synthesis, we employed a random-effects frequentist NMA to determine the effectiveness of different BAIs compared to controls and estimated the relative effectiveness ranking of each BAI. A systematic literature search resulted in 52 included studies: On average, 58% of participants were male, 75% were binge drinkers, and 20% were fraternity/sorority-affiliated students. Consistency models demonstrated that BASICS was consistently effective in reducing students’ problematic alcohol use (ES range: g = − 0.23, 95%CI [− 0.36, − 0.16] to g = − 0.36, 95% CI [− 0.55, − 0.18]), but AlcoholEDU (g = − 0.13, 95%CI [− 0.22, − 0.04]), e-CHUG (g = − 0.35, 95%CI [− 0.45, − 0.05]), and THRIVE (g = − 0.47, 95%CI [− 0.60, − 0.33]) were also effective for some outcomes. Intervention rankings indicated that BASICS, THRIVE, and AlcoholEDU hold the most promise for future trials. Several BAIs appear effective for college students. BASICS was the most effective but is resource intensive and may be better suited for higher risk students; THRIVE and e-CHUG are less resource intensive and show promise for universal prevention efforts.
Journal Article
Age Specificity of Effects of Health Problems on Drinking Reduction: A Lifespan Developmental Analysis
Older adult drinking poses a growing public health concern, especially given the ongoing aging of the United States population. As part of a larger lifespan developmental project contrasting predictors of drinking reductions across different periods of adulthood, we tested age differences in effects of health problems on drinking declines across young adulthood, midlife, and older adulthood. We predicted these effects to be developmentally specific to midlife and older adulthood. We also tested moderation by alcohol use disorder (AUD) symptomatology and by indices of sociodemographic disadvantage (sex and race/ethnicity). Analyses used data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), leveraging NESARC’s vast age range (18–90 + ; N = 43,093) and two waves of longitudinal data. Multiple-group cross-lag models tested differences across age groups in cross-lag paths between health problems and alcohol consumption. As hypothesized, health problem effects on drinking reductions were developmentally specific to midlife and older adulthood. However, models testing moderation by AUD symptomatology showed that these adaptive effects of health problems on drinking reductions did not extend to those with one or more AUD symptoms. Little evidence was found for moderation by sex or race/ethnicity. Findings support the notion of health concerns as a pathway to drinking reduction that increases in importance across the adult lifespan. However, given the moderation by AUD symptoms, findings also highlight a need to understand barriers to health-related pathways to drinking reduction among relatively severe midlife and older adult drinkers. These findings hold implications for lifespan developmental tailoring of clinical, public health, and policy interventions.
Journal Article
Combined universal and selective prevention for adolescent alcohol use: a cluster randomized controlled trial
No existing models of alcohol prevention concurrently adopt universal and selective approaches. This study aims to evaluate the first combined universal and selective approach to alcohol prevention.
A total of 26 Australian schools with 2190 students (mean age: 13.3 years) were randomized to receive: universal prevention (Climate Schools); selective prevention (Preventure); combined prevention (Climate Schools and Preventure; CAP); or health education as usual (control). Primary outcomes were alcohol use, binge drinking and alcohol-related harms at 6, 12 and 24 months.
Climate, Preventure and CAP students demonstrated significantly lower growth in their likelihood to drink and binge drink, relative to controls over 24 months. Preventure students displayed significantly lower growth in their likelihood to experience alcohol harms, relative to controls. While adolescents in both the CAP and Climate groups demonstrated slower growth in drinking compared with adolescents in the control group over the 2-year study period, CAP adolescents demonstrated faster growth in drinking compared with Climate adolescents.
Findings support universal, selective and combined approaches to alcohol prevention. Particularly novel are the findings of no advantage of the combined approach over universal or selective prevention alone.
Journal Article
Assessing maternal alcohol consumption in pregnancy: does phosphatidylethanol measured from day 5 newborn blood spot cards have any value? An observational, population-based study
ObjectivePrenatal alcohol exposure (PAE) places children at risk of fetal alcohol spectrum disorder (FASD) but ascertainment of PAE is problematic. Early intervention for children at risk of FASD may help mitigate long-term difficulties. Phosphatidylethanol (PEth), a metabolite of alcohol, is incorporated into red cell membranes and can be measured in dried blood spot (DBS) cards. In the UK, DBS samples are collected on day 5 for routine newborn screening. We sought to examine if PEth measured from DBS correlates with postnatal maternal self-report of alcohol consumption in pregnancy.DesignObservational population-based study. Comparison of infant PEth concentration and self-report of maternal alcohol use during pregnancy.SettingLarge maternity unit in Glasgow, Scotland.ParticipantsAll singleton mother–infant dyads delivered during each fourth consecutive 24-hour period.InterventionsMother: direct, confidential, immediate postnatal interview by a single researcher examining alcohol use during pregnancy. Infant: one extra DBS collected coincident with routine newborn screening if bleeding continued.Results92.5% of eligible mothers agreed to participate. 510 DBS were obtained of which 502 were successfully analysed. 216 (43%) samples contained PEth at a concentration of ≥8 ng/mL and 148 (29.5%) at ≥20 ng/mL. The sensitivity of PEth ≥8 ng/mL and ≥20 ng/mL in identifying women who self-reported modest alcohol use after 36 weeks’ gestation was 50% and 36.4%, respectively.ConclusionPEth measured from DBS obtained on day 5 of life does not reliably identify modest PAE after 36 weeks’ gestation from maternal self-report.
Journal Article
Evaluation of Digital Interventions for Reducing Alcohol Consumption: A Meta-Analysis Study
Introduction As technology develops rapidly, social structures and individuals’ needs for health services also change. In line with this change, digitalization stands out as an important step in the delivery of health services. This study aims to evaluate the efficacy of digital interventions designed to mitigate alcohol use relative to non-digital interventions. Methods This meta-analysis includes RCTs published between 2014 and 2023, systematic searches in Scopus, PubMed, and Web of Science. Studies related to comorbid or additional diseases were excluded. No restrictions were placed on the type of digital intervention employed. Only studies that reported an intention-to-treat analysis were included. Outcome measures included changes in alcohol consumption, problematic drinking, and scores on the AUDIT. A total of 22 eligible studies were included and analyzed using STATA. The authors declare no competing interests. Results The analysis spans 12 countries, featuring one multicenter study. Internet-based interventions were the most frequently employed (54.5%). The weighted effect size for studies assessing overall alcohol consumption was 0.21 (95% CI: 0.13-0.29) favoring digital interventions. For problematic drinking, the effect size was 0.30 (95% CI: 0.11-0.49). The effect sizes were statistically significant yet slightly lower in young adults (0.13 and 0.11, respectively). Furthermore, the change in AUDIT scores revealed an effect size of 0.23 (95% CI: 0.16-0.30). Conclusions Although their effectiveness is modest, digital interventions represent a valuable asset in reducing alcohol consumption and serve as a complementary approach to traditional public health methods. With growing integration of technology in healthcare, digital strategies are expected to play an increasingly vital role in addiction prevention and treatment. Public health stakeholders should consider incorporating these interventions into alcohol reduction policies and programs. Key messages • Digital interventions offer a modest but significant reduction in alcohol consumption, making them a valuable complement to traditional methods in public health strategies for alcohol harm reduction. • As technology advances, integrating digital interventions into healthcare systems can enhance alcohol prevention and treatment efforts.
Journal Article
Improving alcohol health literacy and reducing alcohol consumption: recommendations for Germany
Background
Although the detrimental health effects of alcohol are well established, consumption levels are high in many high-income countries such as Germany. Improving alcohol health literacy presents an integrated approach to alcohol prevention and an important complement to alcohol policy. Our aim was to identify and prioritize measures to enhance alcohol health literacy and hence to reduce alcohol consumption, using Germany as an example.
Methods
A series of recommendations for improving alcohol health literacy were derived from a review of the literature and subsequently rated by five experts. Recommendations were rated according to their likely impact on enhancing (a) alcohol health literacy and (b) reducing alcohol consumption. Inter-rater agreement was assessed using a two-way intra-class correlation coefficient (ICC).
Results
Eleven recommendations were established for three areas of action: (1) education and information, (2) health care system, and (3) alcohol control policy. Education and information measures were rated high to increase alcohol health literacy but low to their impact on alcohol consumption, while this pattern was reversed for alcohol control policies. The ratings showed good agreement (ICC: 0.85–0.88).
Conclusions
Improving alcohol health literacy and reducing alcohol consumption should be considered complementary and become part of a comprehensive alcohol strategy to curb the health, social, and economic burden of alcohol.
Journal Article
Substance use and academic performance among university students: systematic review and meta-analysis
Background
Substance use is a widespread concern among young adults and is particularly significant among college students. Substance use in this population is associated with several academic, physical, mental, and social difficulties. This systematic review and metanalysis explores whether there is an effect of the legal and illegal substance and alcohol consumption behaviors on academic achievement among university students.
Methods
The databases searched were MEDLINE, CINHAL, Scopus, ERIC, and PROSPERO, updated in January 2025. The risk of bias was assessed using the Edwards score. We used a random-effects model. The protocol of this review was registered in the Open Science Framework.
Results
The systematic review included 21 studies, while the meta-analysis included four studies. In a sample of 1,219 subjects in the control group and 350 legal and illegal substances consumers, there is a negative and significant association of substances consumption on academic achievement [SMD = − 0.61 (95% CI − 0.84 to − 0.38;
p
= 0.008). In a subgroup analysis, a sample of 2,479 subjects in the control group and 7,134 alcohol consumers, there is a non-statistically significative association of alcohol consumption on academic achievement [SMD = − 0.24 (95% CI -0.51 to 0.04;
p
= 0.073).
Conclusions
Despite the limitations of this study, this systematic review provides quantitative evidence on the relationship between legal and illegal use of substances among university students and academic achievement. Specifically, we found a significant medium association of substance use in general and a small effect for alcohol consumption on academic achievement.
Clinical trial number
Not applicable.
Journal Article
Trajectories of College Alcohol Involvement and Their Associations with Later Alcohol Use Disorder Symptoms
Little is known about what differentiates individuals whose drinking patterns escalate into problematic use following the transition out of college compared to those who learn to drink in a way that is consistent with independent adult roles. Patterns of alcohol use and problems during college may pre-sage progression toward problem drinking in adulthood. The present study sought to examine such patterns in an effort to delineate those at greatest risk. Research has not yet elucidated whether, when, and how these groups diverge. Our results indicate that students who report AUD symptoms one year following graduation reported greater alcohol involvement from the first semester and escalated their involvement with alcohol at a more rapid pace. We observed marked and measurable differences in drinking patterns between those who go on to exhibit AUD symptoms following college and those who do not. A close inspection of these differences reveals that relatively small absolute differences in alcohol consumption add up to large differences in alcohol-related consequences. Thus, markers of longer-term risk are present early in college, and greater escalation of drinking across college is an indicator that intervention is needed. Brief Motivational Interventions could help students to anticipate some of the challenges ahead as they transition from the college environment, as well as the potential deleterious effects of immoderate alcohol use on making a successful transition into adult roles. In addition to the beginning of college, our findings also point to critical periods during which screening and brief intervention may be optimally timed.
Journal Article
The Universal and Primary Prevention of Foetal Alcohol Spectrum Disorders (FASD): A Systematic Review
Foetal alcohol spectrum disorder (FASD) comprises multiple neurodevelopmental disorders caused by alcohol consumption during pregnancy. With a global prevalence rate of 7.7 per 1000 population, FASD is a leading cause of prenatal developmental disorders. The extent of physical, mental, and social consequences for individuals with FASD can be vast and negatively affect their social environment, daily life, school, relationships, and work. As treatment for FASD is labour- and cost-intensive, with no cure available, prevention is key in reducing FASD prevalence rates. As most systematic reviews conducted so far have focused on specific FASD risk groups, we investigated the effectiveness of universal FASD prevention and primary preventive strategies. We identified a total of 567 potentially pertinent records through PubMed, Cochrane Library, EBSCO, PubPsych, and DAHTA published from 2010 to May 2020, of which 10 studies were included in this systematic review. Results showed a substantial heterogeneity in the studies’ quality, although all preventive measures, except one, proved effective in both increasing knowledge and awareness of FASD, as well as decreasing the risk of an alcohol exposed pregnancy. Limiting factors such as small sample sizes and a lack of behavioural change testing require further studies to support existing evidence for FASD prevention and its implementation, as well as detecting the best course of action for FASD prevention when creating and implementing prevention and intervention approaches.
Journal Article