Social Cognitive Theory Based Predictors of Alcohol Use and Binge Drinking Among Asian Indian International Students in Mid-Western Universities Samrat Yeramaneni, MBBS Manoj Sharma, MBBS, CHES, PhD Donald I. Wagner, HSD

Alcohol? Top five risk factors for disease burden (Rehm et al., 2004) Globally - One-third (4%) burden of disease (Rehm et al., 2004) Highest rate of alcohol use and associated problems – 18-24 yrs age group (Ham & Hope, 2003) Most popular substance abuse among college students (Prendergast, 1994) Alcohol use - 95% college students (Yu & Shacket, 2001) Factor aggravating the seriousness of problem - Binge Drinking Binge drinking - 42% to 44% college students (Wechsler et al., 2000)

Alcohol Related Tragedies Alcohol related problems - 18% college students (Slutske, 2005) Academic, psychosocial, and health consequences (Delva et al., 2004) Drinking and Driving – Over one half million injured (Leppel, 2006) Alcohol related traffic fatalities - 1,400 college students (Hingson et al., 2002) Second hand effects – higher police visits, disruption of sleep, property damage, verbal, physical, and sexual violence (Hingson et al., 2002)

Problem Statement The purpose of the study was to determine, If the problem of alcohol use and binge drinking existed among Asian Indian International college students Role and relation of situational perceptions, expectations (outcome expectancies * outcome expectations), self-efficacy and self-control as predictors of alcohol use and binge drinking based on Social Cognitive Theory

Asian Indian International Students? Limited studies among international college students Few studies done among Asian Pacific Islanders (APIs) No studies done among Asian Indian college students 94.5% lifetime prevalence and 78.6% current prevalence (past 30 days) of alcohol use; among Asian American college students (So & Wong, 2006) Percentage of drinkers and percentage of heavy drinking in APIs were lower when compared to the Caucasians (Makimayoto,1998) Generality of results to all subgroups Diverse predictors 5

Methodology Design: Cross sectional study Convenience sample Sample size was calculated with an alpha of 0.05 and power of 0.80 with an projected effect size of 0.20. This way a sample size of 197 was arrived (Polit & Hungler, 1999, P. 495) Institutional Review Board (IRB) approval from University of Cincinnati and Ohio State University International student’s office & Indian Students' Association – Weekly newsletter Informed Consent Confidentiality and Anonymity Duration of study – 12 weeks (March’ 08 – June’ 08) 6

Instrumentation Survey instrument: 46- item scale was developed and validated for face and content validity by a panel of six experts in a two round process Six sections Demographics Frequency of Alcohol use and Binge drinking Situational perceptions Expectations (Outcome Expectations x Outcome Expectancies) Self-efficacy Self-control Cronbach’s alpha and test-retest reliability coefficients for all the subscales were found to be over 0.75 Web based/Online – Survey Monkey TM http://www.surveymonkey.com/s.aspx?sm=i_2b2w_2f9J1rlnVvY8yHHA1ag_3d_3d 7

Demographics of the sample Age: Mean – 25 yrs Gender: Males – 68.2% Females – 31.8% Class: Graduates – 63.7% Doctoral – 21.6% Alcohol use: Male – 65.3% Female – 55.1% Total – 62% Marital Status Single – 87.8% Married – 9.4% GPA Mean – 3.61 Number of years stayed in USA Mean – 5 years & 6 months

Mean and Standard Deviations Dependent Variables: Average number of alcoholic drinks consumed in a typical week Binge drinking - Over the last 30 days, number of days one had five or more drinks (male) and four or more drinks (female) Number of days alcohol consumed during the past 30 days Variables N Minimum Maximum Mean Std. Deviation Average drinks consumed in a week 152 1 31 4.02 4.479 Binge drinking 12 1.69 2.517 Number of days alcohol consumed during the past 30 days 27 6.05 4.680

Mean and Standard Deviations Number of years since drinking alcohol Age at which Indian students started drinking alcohol Variables N Minimum Maximum Mean Std. Deviation Number of years since drinking alcohol 152 1 15 4.66 2.836 Age at which drinking alcohol was started 10 34 20.63 2.783

Mean and Standard Deviations SCT constructs (Independent variables): Total Situational Perceptions (Total SP) Total Expectations (Total EXP) Total Self-Efficacy (Total SE) Total Self-Control (Total SC) Variables N Possible Range Observed Range Mean Std. Deviation Total SP 131 0 – 20 0 – 15 8.05 3.158 Total EXP 0 – 128 34.23 29.001 Total SE 0 – 24 16.19 6.152 Total SC 0 – 28 0 - 28 18.74 7.542

Cross Tabulations Cross tabs for Gender * Do you drink alcohol Gender Chi-Square p - value Yes No Total 2.322 0.128 Male Count 109 58 167 % within gender 65.3% 34.7% 100.0% % within drinking alcohol 71.7% 62.4% 68.2% Female 43 35 78 55.1% 44.9% 28.3% 37.6% 31.8% 152 93 245 62.0% 38.0%

Cross Tabulations cont.. Cross tabs for Gender * Dependent Variables Gender * Variable Chi-Square df p - value Gender * Average number of drinks consumed in a week 21.530 14 0.089 Gender * Binge drinking 23.162 11 0.017 Gender * number of days alcohol consumed during the past 30 days 19.479 19 0.427

Cross Tabulations cont.. Cross tabs for Gender * Independent Variables Gender * Variable Chi-Square df p - value Gender * Total SP 23.398 14 0.054 Gender * Total EXP 63.695 66 0.558 Gender * Total SE 33.075 23 0.080 Gender Total SC 25.879 24 0.359

Multiple Regressions Multiple regressions for average number of drinks consumed in a week & Independent variables with Gender Model Unstandardized Coefficients Standardized Coefficients t p - value B Std. Error Beta (Constant) Total SE 0.095 0.021 0.085 0. 005 0.357 1.109 4.339 0.270 0.000 Total SC 0.321 0.020 -0.011 0.115 0.005 0.004 0.340 -0.229 2.795 4.234 -2.855 0.006 Variable Adjusted R2 Total SE 0.121 Total SC 0.167

Multiple Regressions cont.. Multiple Regressions for binge drinking & Independent variables with Gender Model Unstandardized Coefficients Standardized Coefficients t p - value B Std. Error Beta (Constant) Total SE 0.335 0.088 0.628 0. 036 0.209 0.534 2.431 0.594 0.016 Variable Adjusted R2 Total SE 0.036

Multiple Regressions cont.. Multiple regressions for number of days alcohol consumed in the past 30 days & Independent variables with Gender Model Unstandardized Coefficients Standardized Coefficients t p - value B Std. Error Beta (Constant) Total SE 0.358 0.019 0.077 0. 004 0.360 4.661 4.383 0.000 Total SC 0.577 0.018 -0.011 0.103 0.004 0.342 -0.246 5.606 4.285 -3.079 Variable Adjusted R2 Total SE 0.123 Total SC 0.177

Conclusions cont.. No significant relationship (p>0.05) was found between gender and alcohol use No significant relationship (p>0.05) was found between gender and average number of drinks consumed in a typical week No significant relationship (p>0.05) was found between gender and number of days alcohol consumed in the past 30 days Significant relationship was found (p<0.01) between gender and binge drinking in the past 30 days

Conclusions cont.. No significant relationship (p>0.05) was found between gender and the four constructs of SCT; Situational Perceptions, Expectations, Self-efficacy and Self Control In case of average number of drinks consumed in a week, the significant predictors were Self-efficacy (p<0.00) and Self Control (p<0.005) In case of Binge drinking, the only significant predictor was Self-efficacy (p<0.01) In case of number of days alcohol consumed in the past 30 days, the significant predictors were Self-efficacy (p<0.00) and Self Control (p<0.00)

Implications for Practice Publicize the actual facts and correct damaging misperceptions Intervention programs at university level are needed that focus primarily on: Insights pertaining to alcohol use and its habits students expectancies as well as the valuations of their expected drinking outcomes Self-efficacy Self Control Social Cognitive Theory (SCT) – Excellent framework to design such interventions Internet based initiatives

Implications for Practice Special emphasis should be focused on strengthening the intercultural competencies of the international students Cognitive –behavioral skills based programs should be implemented Interventions focusing on student’s perceptions and constructions Emphasis on changing characteristics of individual drinkers, such as their knowledge, attitudes, and perceptions Additional constructs associated with alcohol use needed to be studied cognitive and evaluate constructs - Perceived control & Perceived norms) psychosocial variables - Anxiety, Social Support & Acculturation)

Limitations There was no random selection of subjects introducing selection bias in the study Data were all based on self-report One day memory recall Reading and understanding ability of participants The findings presented here are limited to two universities located in one unique region of the United States Because of the cross-sectional nature of the data, there is a major concern for causal direction Research needs to be done to identify and develop more valid measures of the construct of binge drinking