PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of nihpaAbout Author manuscriptsSubmit a manuscriptNIH Public Access; Author Manuscript; Accepted for publication in peer reviewed journal;
 
Psychol Addict Behav. Author manuscript; available in PMC Feb 19, 2013.
Published in final edited form as:
PMCID: PMC3576466
NIHMSID: NIHMS443195
When in Rome: Factors associated with changes in drinking behavior among American college students studying abroad
Eric R. Pedersen,1 Mary E. Larimer,2 and Christine M. Lee2
1Department of Psychology, University of Washington
2Department of Psychiatry and Behavioral Sciences, University of Washington
Correspondence may be sent to Eric R. Pedersen, Center for the Study of Health and Risk Behaviors, 1100 NE 45th Street, Suite 300, Seattle, WA 98105. epeder/at/uw.edu
Study abroad programs have the potential to promote cultural, experiential, and personal development for escalating numbers of American college students each year. Despite reports that study abroad students may be at particular risk for increased and problematic alcohol use, there is limited empirical documentation of this risk. Thus, the present study used a longitudinal design to examine the factors associated with changes in alcohol use among college students studying in foreign countries. A sample of 177 students completed measures of demographics, drinking behavior, and perceived peer drinking behavior one month prior to departure and one-month post-study abroad return. Analyses revealed that participants more than doubled their drinking during study abroad trips and those who drank at heavier levels while abroad returned home drinking at significantly elevated levels. This pattern of increased use while abroad was moderated by several factors, with participants studying abroad in Europe (e.g., Italy, France) and Oceania (e.g., Australia, New Zealand), those under the age of 21, those with higher intentions of drinking while abroad, and those with higher drinking perceptions of other study abroad students in their host country increased their alcohol consumption to a greater extent than other participants. Results suggest drinking while abroad is a concern warranting further investigation, especially regarding how changes in drinking may contribute to the experience of alcohol-related consequences abroad. Continued identification of the risk factors associated with increased drinking can help inform targeted pre-departure preventive interventions with these students.
Keywords: alcohol, college students, perceived norms, study abroad
The majority of four-year colleges and universities in the United States (U.S.) offer study abroad programs where students temporarily attend classes in a foreign country while earning credit at their home institution. More than ¼ million U.S. college students studied abroad during the 2007–2008 academic year, a number that has been steadily increasing and is expected to reach 1 million (approximately 1 out of 18 students) by 2016–2017 (Institute of International Education [IIE], 2009; Senator Paul Simon Study Abroad Foundation Act, 2009). Research with American study abroad students suggests programs can enhance a student’s worldview, expand their global perspective, increase cross-cultural skills, deepen respect and appreciation for people in other cultures, and boost confidence and self-esteem (Carlson & Widman, 1988; Kitsantis, 2004; Lewin, 2009; McCabe, 1994; McKeown, 2009; Pitts, 2009). Although designed to promote experiential learning and a positive cultural experience, reports from study abroad personnel and media detail problematic drinking among this population and suggest alcohol abuse during study abroad trips is a serious concern that needs to be addressed (Epstein, 2005; Epstein & Rhodes, 2000; Poggioli, 2008; Vogt, 2009). These reports highlight concerns that heavy drinking while abroad can lead to violence, arrest, sexual assault, and promote negative stereotypes of Americans. Despite the increasing number of students completing study abroad programs each year, few studies examine the high-risk behavior of Americans students abroad.
Students studying abroad may be at-risk for heavy drinking and resultant consequences for a variety of reasons. For one, college drinking in general is a major concern (DeJong, Larimer, Wood, & Hartman, 2009) and there is potential for those who drink heavily in the U.S. to continue this behavior abroad. Moreover, students who intend to study abroad in college may represent a self-selecting group of heavier drinkers who experience consequences from use at a greater rate than the general student population (Pedersen, LaBrie, Hummer, Larimer, & Lee, 2009b). In addition, students’ intentions to drink alcohol while abroad relate to actual consumption levels (Pedersen, LaBrie, & Hummer, 2009a). Thus, study abroad students may be heavier drinkers already, who also intend to drink heavily while living in foreign countries.
In addition, the majority of countries to which students travel while abroad have lower drinking age limits than the U.S., allowing those under 21 to have greater access to buy alcohol and the ability to drink in public. Research with students in the U.S. suggests when they have access to alcohol (e.g., false identification), underage students report heavier drinking per occasion and greater consumption in bars compared to students 21 and older (Harford, Wechsler, & Seibring, 2002; Wechsler et al., 2002a; Wechsler, Lee, Nelson, & Kuo, 2002b). Greater access in different settings may lead to increased drinking among underage students. Alcohol use abroad may also depend on each country’s specific normative acceptance and tolerance of alcohol use. For example, it may be more acceptable for a student to drink in a European country than it would be to drink in a Middle Eastern country (World Health Organization, 2004). Thus, where students choose to study may impact their rates of drinking while abroad. Finally, perceived peer use of alcohol has also emerged as a major factor in predicting one’s own use (Borsari & Carey, 2003; Neighbors et al., 2007; Perkins, 2002) and study abroad students may adapt their own styles of drinking to match those of their peers abroad (Pedersen et al., 2009a). Perceptions of salient group referents can influence one’s behavior (Lewis & Neighbors, 2004; Martens, Dams-O’Connor, Duffy-Paiement, & Gibson, 2006) and students’ perceptions of peer drinking behavior during study abroad trips may contribute to increased drinking while abroad.
This exploratory longitudinal study was designed to empirically examine alcohol use by study abroad students prior to, during, and after return home from overseas trips. In addition, we looked at the factors associated with changes in drinking while abroad; specifically, region of study, U.S. legal drinking age status, intentions to drink while abroad, and perceptions of other study abroad student drinking. Students travelling to regions where alcohol was more normative (e.g., Europe, Australia), those who were not legally able to drink in the U.S., those with higher intentions to drink alcohol while abroad, and those with higher perceptions of study abroad peer drinking behavior were hypothesized to experience greater increases in alcohol use while abroad.
Participants and Procedures
Participants included college students participating in a small longitudinal pilot study at a large (approximately 40,000 students) public northwest university. Approximately 1,300 prospective study abroad students were recruited during a voluntary online orientation given by the Office of Global Affairs or by email invitation. Students who signed up to participate were emailed a link to an online confidential survey two weeks before their departure abroad. All participants were prompted to first read an electronic Human Subjects Review Board-approved information statement. One month after returning home from their study abroad trip, participants were emailed a link to the post-return survey. Numerical codes were used to keep data confidential. Participants were initially offered $10 for completing each of the two surveys, but due to changes in budget allowances, participants leaving for trips after the third month of data collection were entered into a drawing for a $100 Visa gift card for completing each of the surveys. While the revised incentive structure reduced participant interest in the study, drinking and demographics did not vary by incentive offered. Overall, 218 students requested to participate in the study and completed a pre-departure survey. One-hundred and seventy-seven of these completed a follow-up post-return survey (80% retention). Participants had a mean age of 21.53 (SD = 4.04) and were primarily female (83%) and Caucasian/White (73%). Other ethnicities included 16% Asian/Pacific Islander, 5% “mixed ethnicity,” and 5% “other ethnicities (e.g., Hispanic/Latino(a), Native American”). The majority of participants (75%) were of junior or senior class standing and studied abroad for a mean of 10.25 (SD = 7.80) weeks.
Measures
Pre-departure survey
Participants completed questions assessing age, sex, class year, ethnicity, length of trip, and country-specific location of study abroad program. Drinking in the past month was assessed with the Daily Drinking Questionnaire (DDQ; Collins, Parks, & Marlatt, 1985), which allowed for self-reported number of drinks for each day of a typical week in the last month (drinks per week). The DDQ was also used to compute the percentage of students who engaged in heavy episodic drinking (HED; 4/5+ drinks in one sitting for women/men) at least once in the past month. Peak drinks consumed on one occasion in the past month was also assessed with an open-ended item. A DDQ was modified for students to estimate how much they intended to drink on each day of a typical week while studying abroad (intended drinks per week). Finally, using a modified Drinking Norms Rating Form (DNRF; Baer, Stacy, & Larimer, 1991) participants reported the perceived average weekly drinking of a typical student studying abroad in their host country (perceived drinks per week).
Post-return survey
The follow-up survey contained modifications of drinking items to assess for drinking during and after the study abroad trip. A DDQ was completed for three time periods: (1) drinks per week during the first month of the trip, (2) drinks per week during the last month of the trip, and (3) drinks per week since returning home to the U.S. Participants also indicated peak drinks and the DDQ was used to determine percentage of HED while abroad. Thirty-eight participants reported going abroad for only one month. In order to control for length of time abroad and create a common variable for drinking while abroad, a drinks per week abroad variable was created with the first month abroad data for these participants and the mean of the first and last month abroad drinking for those whose trips were longer than one month (mean weeks abroad = 12.06, SD = 7.88). Drinking during the first and last month for these participants was correlated at r = .79. The same strategy was used for peak drinks (r = .68).
Analytic plan
This study was exploratory in nature and intended to provide an in-depth look at factors associated with changes in drinks per week during three time points (pre-departure, abroad, and post-return). Therefore, analyses consisted of separate repeated measures analysis of variance (ANOVAs). Sphericity was not assumed in any of the models; thus, a Greenhouse-Geisser correction was employed, ε = .75. Binary moderators were specified as fixed factors in the repeated measures ANOVAs and continuous moderators were specified as covariates. High and low values of continuous moderators were specified as one standard deviation above and below the mean in figures of interactions (Aiken & West, 1991). A correlation matrix of drinks per week and moderators is found in Table 1. For descriptive purposes, we also evaluated main effects for peak drinks and HED.
Table 1
Table 1
Correlation matrix between drinking and moderators
Changes in drinking over time
Table 2 contains means and standard deviations for drinking over time. A repeated measures ANOVA revealed a significant change in drinks per week over time, F (2, 350) = 45.88, p < .001; an effect best explained by a quadratic relationship where drinking more than doubled during trips abroad and subsequently reduced upon return to the U.S., F (1, 175) = 57.25, p < .001. The linear relationship trended toward significance, F (1, 175) = 2.42, p = .12 and was thus examined in more depth to determine for which participants drinking at post-return was significantly higher than pre-departure drinking. Using a repeated measures ANOVA with two time-points (pre-departure and post-return) and abroad drinking entered as a covariate, a significant time × abroad drinking interaction was found, F (1, 174) = 6.32, p < .05, with heavier drinkers abroad returning home drinking at higher levels (see Figure 1). A significant main effect, F (2, 352) = 21.95, p < .05, ε correction = .81, and quadratic trend, F (1, 176) = 29.17, p < .001 was observed for peak drinks. Peak drinks increased from a mean of 3.81 (SD = 3.34) to 5.26 (SD =3.97) while abroad and reduced to 3.62 (SD = 3.05) at post-return. Finally, a Wilcoxon signed rank test indicated the percentage of participants who engaged in HED increased from 22% at pre-departure to 34% while abroad, z = −2.89, p < .001.
Table 2
Table 2
Means and standard deviations of drinks per week for all participants and by region of study
Figure 1
Figure 1
Changes in drinks per week from pre-departure to post-return as a function of drinking while abroad.
Region of study
Participants traveled to multiple different countries and the sample size did not allow for comparisons of drinking by specific countries. Therefore, countries were categorized into five different world regions: Europe (e.g., Italy, France; n = 109), Asia (e.g., China, Japan; n = 28), Oceania (Australia and New Zealand; n = 7), Latin America (e.g., Ecuador, Brazil; n = 22), and non-traditional study abroad locations encompassing countries in the Middle East, Africa, South Asia, and West Asia (e.g., South Africa, Israel; n = 11). Examination of mean drinking by region revealed that participants studying abroad in Oceania and Europe drank the most while abroad, followed by Latin America, Asia, and non-traditional regions (see Table 2). Planned comparisons with orthogonal contrast coefficients were specified prior to analysis: (1) Europe vs. Oceania, (2) Europe and Oceania vs. Asia, Latin America, and non-traditional regions, (3) Latin America vs. Asia and non-traditional regions, and (4) non-traditional regions vs. Europe, Oceania, Asia, and Latin America. There was an overall time × region of study effect, F (8, 342) = 5.24, p < .001, with significant differences in drinking over time for Contrast 2, t (171) = 2.25, p < .05. While experiencing similar increases in drinking while abroad, participants studying abroad in Europe and Oceania experienced greater changes in drinking over time compared to participants in other regions. Both the linear, F (4,171) = 2.81, p < .05, and the quadratic relationships were significant for the interaction, F (4,171) = 5.91, p < .001. Further follow-up tests revealed participants studying abroad in Latin America drank at significantly higher levels at post-return than from pre-departure, t (21) = 2.35, p < .05.
U.S. legal drinking age status
To examine if underage drinking status functioned as a moderator of changes in drinking over time, participants under 21 at pre-departure (51%) were compared with those of U.S. legal drinking age. A repeated measures ANOVA with legal drinking age status (0 = under 21, 1 = 21 and older) entered as a fixed factor revealed a significant time × legal drinking age status effect, F (2, 348) = 6.87, p < .01. Despite drinking less than participants over the legal drinking age at pre-departure, underage participants experienced greater increases in drinking over time; increasing drinking while abroad by about 170% (see Figure 2). While the quadratic effect was significant for this interaction, F (1, 174) = 7.34, p < .01, there was also a significant linear relationship, F (1, 174) = 5.09, p < .05. Follow-up paired samples t-tests revealed that participants under age 21 at pre-departure increased their drinking from pre-departure to post-return, t (89) = 2.44, p < .05. This observed effect was not a function of underage participants’ change in legal drinking status at post-return.
Figure 2
Figure 2
Changes in drinks per week over time as a function of legal drinking age status in the U.S.
Intentions to drink
Pre-departure intentions to drink while abroad associated with changes in drinking over time. A repeated measures ANOVA revealed a time × intentions interaction effect, F (2, 340) = 10.39, p < .001. This effect was best explained by a quadratic relationship, F (1, 170) = 13.28, p < .001. Those with higher pre-departure intentions to drink alcohol drank more alcohol prior to trips and increased their drinking to a greater extent than those with low drinking intentions at pre-departure (see Figure 3).
Figure 3
Figure 3
Changes in drinks per week over time as a function of pre-departure intended drinking.
Perceptions of peer behavior
Participants’ perceived drinking of other study abroad students living in their host country was related to changes in drinking over time. A repeated measures ANOVA revealed a time × perceived norms interaction effect, F (2, 340) = 5.75, p < .01. This interaction effect was best explained by a quadratic relationship, F (1, 170) = 7.04, p < .01. Participants with higher perceived norms at pre-departure drank more and increased their drinking to a greater extent than those with lower perceived norms (see Figure 4).
Figure 4
Figure 4
Changes in drinks per week over time as a function of pre-departure perceptions of student abroad student peer drinking.
This study empirically supports the concerns of study abroad experts and confirms recent news reports (Epstein, 2005; Epstein & Rhodes, 2000; Poggioli, 2008; Vogt, 2009) that drinking among college students studying in foreign countries dramatically increases during study abroad trips. Participants overall increased drinking by approximately 105% during study abroad trips and those who reported drinking most heavily while abroad returned home drinking at higher levels than when they left. Changes in drinking were moderated by several factors. First, demographics such as region of study and age at pre-departure moderated increases observed over time. Students studying abroad in European and Oceanic regions experienced greater drinking increases while abroad, while those studying in Latin America increased drinking from pre-departure to post-return. Thus, where students choose to study abroad may influence their experiences with alcohol both abroad and after return home; however, further studies examining drinking by region (and more specifically by country) are needed to elaborate on these preliminary findings. Low Ns by region hindered the interpretability of preliminary analyses of region by descriptive/behavioral moderator effects (e.g., region × age, region × perceived norms) and were thus not presented here. Studies with larger sample sizes within regions/countries can examine which factors interact with location of program to determine possible self-selection effects (e.g., if certain types of drinkers choose heavier drinking locations). In addition, as all participants under the legal drinking age in the U.S. traveled to countries where they could legally drink, U.S. legal drinking age status appeared to moderate increased drinking while abroad. Despite those 21 or older drinking more at pre-departure, participants under 21 increased drinking to a greater extent while abroad and upon return home.
Beyond demographic variables and consistent with Pedersen and colleagues (2009a), greater pre-departure intentions to drink alcohol while abroad and higher perceptions of other study abroad student drinking behavior associated with greater increases in alcohol use over time. The current study extends and confirms these previous findings by using three time points in assessment and a larger sample from a different university to further highlight the importance of pre-departure attitudes on subsequent drinking while abroad. Regarding intentions, study abroad students may represent a self-selecting population of heavier drinkers (Pedersen et al., 2009b) who desire to drink at high levels during study abroad trips. For perceived norms, overestimations of drinking behavior are evident even among proximal and smaller groups (Dams-O’Connor, Martin, & Martens, 2007; Larimer, Turner, Mallet, & Geisner, 2004; Latane, 1981; Lewis & Neighbors, 2004). While prior work reveals study abroad students’ perceived drinking norms of general study abroad peers impacts behavior while abroad, this study confirms students are also impacted by perceived drinking norms of country-specific study abroad peers.
Limitations include the use of retrospective self-reports. During the post-return survey, participants were asked to recall drinking behavior over the past several months and memory effects may have impacted obtained drinking reports. While web-based reports of behavior are prominent in the college student alcohol use literature, different contexts and participant characteristics related to the abroad experience may have contributed to response bias (DelBoca & Darkes, 2003). Future work with incentives structured to collect data while students are abroad may produce more accurate real-time estimates of behavior. Finally, while recruitment numbers are similar to large web-based survey projects with college students (e.g., Larimer et al., 2009), the low recruitment rate for this small pilot study hinders the generalizability of these findings to other populations of students. Compared with national statistics (IIE, 2009), women and ethnic minorities were overrepresented in our sample. As males traditionally drink at heavier levels than females (Johnston, O’Malley, Bachman, & Schulenberg, 2008), perhaps a sample containing more male students would have yielded different results. Thus, findings should be interpreted as preliminary and future work with larger, more representative samples is needed.
In conclusion, this research demonstrates that students may increase drinking during study abroad trips, with several demographic and pre-departure factors moderating these changes in drinking over time. These findings may help structure pre-departure prevention programs, as a brief intervention at this point may represent a natural opportunity to address general and study abroad-specific drinking risks. Effective prevention may be particularly important given the unique potential negative consequences presented to study abroad students who are drinking in a foreign environment. In addition to general consequences (e.g., missed classes, fighting, injuries, regretted sexual activities) possibly being exacerbated by limited access to resources and familiar coping strategies (e.g., being far from friends/family, not knowing where the local hospital is located), study abroad students are exposed to a unique set of consequences. These include such problems as disrupted travel plans, negative interactions with local people (e.g., offending host families or other local people, fighting), perpetuating negative stereotypes of Americans, and legal consequences with a foreign government. An important next step to this research is to examine how increases in drinking associate with such consequences. A continued understanding of the specific risk and protective factors for increased and problematic drinking can help inform pre-departure programs to promote positive and safe abroad experiences for students.
Acknowledgments
This research was supported by a National Research Service Award (1F31AA018591-01) awarded to Eric Pedersen from the National Institute of Alcohol Abuse and Alcoholism (NIAAA).
  • Aiken LS, West SG. Multiple regression: Testing and interpreting interactions. Thousand Oaks, CA: Sage Publications; 1991.
  • Baer JS, Stacy A, Larimer M. Biases in the perception of drinking norms among college students. Journal of Studies of Alcohol. 1991;52:580–586. [PubMed]
  • Borsari B, Carey KB. Descriptive and injunctive norms in college drinking: A meta-analytic integration. Journal of Studies on Alcohol. 2003;64:331–341. [PMC free article] [PubMed]
  • Carlson JS, Widaman KF. The effects of study abroad during college on attitudes toward other cultures. International Journal of Intercultural Relation. 1988;12:1–18.
  • Collins RL, Parks GA, Marlatt GA. Social determinants of alcohol consumption: The effects of social interaction and model status on the self-administration of alcohol. Journal of Consulting and Clinical Psychology. 1985;53:189–200. [PubMed]
  • Dams-O’Connor K, Martin JL, Martens MP. Social norms and alcohol consumption among intercollegiate athletes: The role of athlete and nonathlete reference groups. Addictive Behaviors. 2007;32:2657–2666. [PubMed]
  • DeJong W, Larimer ME, Wood MD, Hartman R. NIAAA’s rapid response to college drinking problems initiative: Reinforcing the use of evidence-based approaches in college alcohol prevention. Journal of Studies on Alcohol and Drugs, Suppl. 2009;16:5–11. [PubMed]
  • Del Boca FK, Darkes J. The validity of self-reports of alcohol consumption: State of the science and challenges for research. Addiction. 2003;98(Suppl 2):1–12. [PubMed]
  • Epstein J. Last call for U.S. students studying abroad? Continuing concerns about alcohol use and abuse during study abroad. SAFETI On-Line Newsletter. 2005;3 (Available at http://globaled.us/safeti/v3n1_epstein.html)
  • Epstein J, Rhodes G. A discussion about alcohol and student exchange. SAFETI OnLine Newsletter. 2000;1 (Available at http://globaled.us/safeti/v1n2_rhodes_epstein.html)
  • Harford TC, Wechsler H, Seibring M. Attendance and alcohol use at parties and bars in college: A national survey of current drinkers. Journal of Studies on Alcohol. 2002;63:726–733. [PubMed]
  • Institute of International Education. Open Doors Report 2009: Americans Studying Abroad. 2009 Retrieved from the web 18 December 2009 at http://opendoors.iienetwork.org.
  • Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE. NIH Publication No 08-6418B. Bethesda, MD: National Institute on Drug Abuse; 2008. Monitoring the Future national survey results on drug use, 1975–2007. Volume II: College students and adults ages 19–45; p. 319.
  • Kitsantas A. Studying abroad: The role of college students’ goals on the development of cross-cultural skills and global understanding. College Student Journal. 2004;38:441–453.
  • Larimer ME, Kaysen D, Lee CM, Lewis MA, Dillworth T, Montoya HD, et al. Evaluating level of specificity of normative referents in relation to personal drinking behavior. Journal of Studies on Alcohol and Drugs, Suppl. 2009;16:115–121. [PubMed]
  • Larimer ME, Turner AP, Mallett KA, Geisner IM. Predicting drinking behavior and alcohol-related problems among fraternity and sorority members: Examining the role of descriptive and injunctive norms. Psychology of Addictive Behaviors. 2004;18:203–212. [PMC free article] [PubMed]
  • Latane B. The psychology of social impact. American Psychologist. 1981;36:343–356.
  • Lewin R, editor. The handbook of practice and research in study abroad: Higher education and the quest for global citizenship. Routledge: 2009.
  • Lewis MA, Neighbors C. Gender-specific misperceptions of college student drinking norms. Psychology of Addictive Behaviors. 2004;18:340–349. [PubMed]
  • Martens MP, Dams-O’Conner K, Duffy-Paiement C, Gibson JT. Perceived alcohol use among friends and alcohol consumption among college athletes. Psychology of Addictive Behaviors. 2006;20:178–184. [PubMed]
  • McCabe LT. The development of a global perspective during participation in semester at sea: A comparative global education program. Educational Review. 1994;46:275–286.
  • McKeown J. The first time effect: The impact of study abroad on college student intellectual development. State University of New York Press; 2009.
  • Neighbors C, Lee CM, Lewis MA, Fossos N, Larimer ME. Are social norms the best predictor of outcomes among heavy drinking college students? Journal of Studies on Alcohol and Drugs. 2007;68:556–565. [PMC free article] [PubMed]
  • Pedersen ER, LaBrie JW, Hummer JF. Perceived behavioral alcohol norms predict drinking for college students while studying abroad. Journal of Studies on Alcohol and Drugs. 2009a:70. [PubMed]
  • Pedersen ER, LaBrie JW, Hummer JF, Larimer ME, Lee CM. Heavier drinkers self-select into study abroad programs: Findings and implications for study abroad personnel. 2009b. Manuscript submitted for publication.
  • Poggioli S. Study-abroad students gone wild in Italy? National Public Radio; 2008. Mar 23,
  • Perkins HW. Social norms and the prevention of alcohol misuse in collegiate contexts. Journal of Studies on Alcohol. 2002:164–172. Supplement No. 14. [PubMed]
  • Pitts MJ. Identity and role of expectations, stress, and talk in short-term student sojourner adjustment: An application of the integrity theory of communication and cross cultural adaptation. International Journal of Intercultural Relations. 2009;33:450–462.
  • Senator Paul Simon Study Abroad Foundation Act. Approved as part of the Foreign Relations Authorization Act by the US House of Representatives. 2009 Information accessed from http://www.nafsa.org/public_policy.sec/commission_on_the_abraham/
  • Vogt A. After Amanda Knox, UW tightens rules for study abroad. Seattle Post Intelligence; 2009. Oct 9,
  • Wechsler H, Lee JE, Kuo M, Seibring M, Nelson TF, Lee HP. Trends in college binge drinking during a period of increased prevention efforts: Findings from four Harvard School of Public Health study surveys, 1993–2001. Journal of American College Health. 2002a;50:203–217. [PubMed]
  • Wechsler H, Lee JE, Nelson TF, Kuo M. Underage college students’ drinking behavior, access to alcohol, and the influence of deterrence policies: Findings for the Harvard School of Public Health College Alcohol Study. Journal of American College Health. 2002b;50:223–236. [PubMed]
  • World Health Organization (WHO) Global status report: Alcohol policy. Geneva: Author; 2004.