This was a cross-sectional structured web-based survey of a sample of current medical students (1st – 4th year medical student during the 2004–2005 academic school year) from 36 accredited U.S. M.D.-granting medical schools across the country. No individual was excluded based on age, sex, race, or any other demographic profile. The Associate Dean of Student Affairs, or equivalent official, was asked to forward an e-mail to their respective student body explaining the purpose of the study and a web link to the online survey. A cover letter posted on the online survey clearly stated the purpose of the survey was to study the lifestyle behaviors of medical students in an effort to encourage medical schools to provide resources that are attuned to the lifestyles of medical students. It was further mentioned that no incentive was offered for participation and that the study was conducted under the approval of the Charles Drew University of Medicine and Science Institutional Review Board.
The online questionnaire required approximately 10 minutes to complete and was available for 10 weeks between April 9, 2005 and June 18, 2005. No identifiers such as the individual’s name, IP address, or location at time of submission were recorded.
Alcohol Use Disorders Identification Test (AUDIT) was used to assess at-risk drinking in the past 12 months (20
). AUDIT is a ten-item screening tool developed by the World Health Organization to detect at-risk, hazardous, and alcohol dependence based on an individual’s total score (22
). It has questions on quantity and frequency of alcohol consumption, drinking behavior, and alcohol-related problems. Responses to each question were scored from 0 to 4. The AUDIT has been reported to have high sensitivity (92%) and specificity (94%) at the cutoff point of 8 (20
). Subjects who scored less than 8 were classified as “Low-risk drinkers” and set as the reference group while subjects scoring 8 or greater classified as “At-risk drinkers”.
Other aspects of student lifestyle, including tobacco use, illicit drug use, risky sexual behavior, and gambling, were measured to assess whether variations in at-risk drinking follow a pattern similar to variations in other measures of lifestyle. Current tobacco use was derived from the following question: “From the list of tobacco products which have you used during the last 30 days?” (i.e., cigarettes, bidis, cigars, blunts, chewing tobacco, clove cigarettes, snuff, and other). Respondents who scored 0 were classified as “No tobacco users” while respondents who scored 1 or greater were classified as “Tobacco users”.
Current drug use was derived from the following question: “During the last 12 months did you take any or use any of the following: sedatives, analgesics or other prescription painkillers, speed or amphetamines, cocaine or crack, tranquilizers, heroin or opium, methadone, marijuana or tetrahydrocannabiol, PCP or other hallucinogen, or other drugs. Prescribed use of psychotherapeutic drugs were not included in the assessment of drug use. Respondents who scored 0 were classified as “No drug users” while respondents who used 1 or more of the drugs were classified as “Illicit drug users”.
The level of risky sexual behavior was measured by the following questions; in the last 6 months: 1) “Have you had sex (oral, vaginal or anal sex)?”; 2) “How many sexual partners, regular or casual, have you had?”; 3) “How often have you used condoms when having sex with your regular partner?”; and 4) “How often have you used condoms when you had sex with a casual partner?”. Response categories included: “never”, “rarely”, “sometimes”, “most of the time”, or “every time”. Respondents were classified in a “Low-risk” group if they met any of the following criteria: 1) reported having no sexual activities; 2) reported having one “regular partner” in the last 6 months regardless of their condom use; or 3) reported having one regular or casual partner in the last 6 months but “often” or “always” used condom. On the other hand, respondents were assigned to a “High-risk” group if they met any of the following conditions: 1) reporting having one “casual partner” and responded “sometimes”, “rarely”, or “never” using condoms; 2) reporting two or three sexual partners in the last 6 months and responded “sometimes”, “rarely”, or “never” using condom with regular or casual partner; or 3) reported having four or more sexual partners in the last 6 months regardless of their condom use. A similar measure of risky sexual behavior has been used in other studies (23
The South Oaks Gambling Screen was used to measure gambling. It is a twenty-item screening tool which can detect a serious gambling problem based on an individual’s total score (25
). Subjects who scored less than 5 were classified as “Not pathological gambler” while subjects who scored 5 or greater classified as “Probable pathological gambler”.
Several measures used by previous studies were utilized to assess the role of potential psychosocial covariates such as depression, stress, impulsivity, and risk perception on at-risk drinking. Depression was measured by the Center for Epidemiologic Studies Depression Scale (CES-D), a scale measuring the level of depressive symptomatology over the last 7 days (26
). Respondents with the overall sum 19 or less were classified as “Not depressed” while respondents with the overall sum more than 19 were classified as “Depressed”.
The Social Readjustment Rating Scale (SRRS), a 43-item scale was used to measure participants’ level of stress (27
). Using this scale, an individual’s stress score was computed by adding predefined values for each question a respondent endorsed “yes” as an answer. For example, “Death of a spouse” was scored 100 representing the most stressful event one could report, and “Minor violation of laws” was scored 11 representing the least stressful event a respondent could report. Respondents’ total scores ranged from 0 to 683. Individuals with the score less than 300 were categorized as “Low to mild stressed” group, and those with the score 300 or above were categorized as “Major stress” group. Social support was measured using a 15-item Likert scale with a possible score ranging from 15 to 75. Subjects who scored greater than the group mean (> 63) were classified as having “more support” while subjects who scored equal or less than the group mean (≤ 63) were classified as having “less support”.
Impulsivity was measured by a 10-item, 4-point Likert scale with a possible score ranging from 10 to 40 (29
). Subjects who scored equal or less than the group mean (≤ 20) were classified as being “less impulsive” while those who scored greater than the group mean (> 20) were classified as being “more impulsive”.
Risk Perception was measured using a 6-item, 4-point Likert scale with a possible score ranging from 6 to 24 (29
). Participants were instructed to respond to how likely something bad would happen to them under different risky conditions. Subjects who scored equal or greater than the mean (≥ 14.76) were classified as having “High risk perception” while subjects who scored less than the group mean (< 14.76) classified as having “Low risk perception.”
Year of medical school was measured as 1st & 2nd = 0 vs. 3rd & 4th = 1 corresponding to pre-clinical and clinical years, respectively. Other potential covariates in the model include age, gender, and marital status.
All statistical procedures were performed using the Statistical Package for Social Science (SPSS) software (version 12.0, SPSS Inc., Chicago, IL). In addition to descriptive statistics, bivariate and chi square-tests were used to assess the relation between the at-risk drinking and variables listed in . In addition, multiple logistic regression analyses were conducted to adjust for other potential confounding variables.
Unadjusted linear regression to determine factors associated with at-risk drinking (n=417).