“Freshman’s week”: characteristics associated with participation and experiencing adverse effects

“Freshman’s week”: characteristics associated with participation and experiencing adverse... Background: “Freshman’s week” (FW) is a Norwegian initiation ritual to higher education. Previous research has suggested that FW-participation is associated with better social adjustment to the student setting, as well as heavy alcohol use both during and after the event. In this study, we aimed to identify characteristics associated with participation in FW and characteristics associated with experiencing adverse effects of alcohol use during FW. Methods: Students in the city of Bergen, Norway participated in a survey during fall 2015, shortly after FW. The current sample consisted of the first-year students (N = 4, 401, estimated response rate: 49%). The sample’s mean age was 24 years (range: 17–73 years), 65% were females, and the majority were born in Norway (93%). Logistic regressions were conducted to identify characteristics associated with participation in FW and experiencing adverse effects. Results: A total of 64% of the first-year students reported participation in FW, and 27% of these reported experiencing at least one adverse alcohol-related effect during FW. Participation in FW was positively associated with being single (OR = 1.29), extroversion (OR = 1.18), and alcohol use (OR = 1.28), and inversely associated with age (OR = 0.70), and having children (OR = 0.36). Several characteristics (e.g., alcohol use (OR = 1.84), extroversion (OR = 0.60), symptoms of depression (OR = 1.60)) were associated with an increased risk of experiencing adverse effects of alcohol use during participation. Conclusion: The current results suggest that initiatives for increasing the participation rate in FW, reducing alcohol use during FW, and decreasing the occurrence of adverse alcohol effects during FW are warranted. Aiming to reduce the focus on alcohol use during FW, and seeking to make FW more available and enjoyable for students with other priorities, students who do not match the stereotype of the typical first-year student, and less sociable students, might both increase participation rate and prevent the occurrence of adverse alcohol effects. Future studies should aim to develop and assess interventions designed to increase participation in FW and reduce the occurrence of adverse effects related to participation. Keywords: Alcohol, Students, Enrolment, First year student, Adverse effects of alcohol, Personality Background most commonly undergraduate programmes) are invited Enrolment into higher education, like American colleges, to participate in Freshman’s week (FW), which compara- represents an important transition in the life of tively converts to American hazing or the British emerging adults, often implying greater independency, “Freshers’ week” in a global context. FW compromises a identity reformations, and development of new social series of social activities and events, and typically lasts networks [1]. In Norway, students entering the first year for approximately five to six days. The first-year students of a new study programme of higher education (i.e., are typically divided into smaller groups consisting of approximately 15 first-year students. These groups are further led by about two “sponsors”, usually more senior * Correspondence: eilin.erevik@uib.no students. The sponsors introduce games, masquerades, Department of Psychosocial Science, University of Bergen, PO. Box. 7807, and parties for the new students. There are no official 5020 Bergen, Norway Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Erevik et al. Substance Abuse Treatment, Prevention, and Policy (2018) 13:21 Page 2 of 10 records of the history of FW, but the institutions for Characteristics associated with experiencing adverse higher education in Bergen, Norway, estimate that FW effects of alcohol use during FW has been a common initiation ritual to higher education Identifying factors associated with experiencing adverse in Bergen for at least 15 years. All larger institutions for effects of alcohol use, such as impaired physical or higher education in Norway have now institutionalized psychological health during FW, may provide important FW as a part of their welcome ritual for new students. information about students at risk. Thus, information FW is mainly scheduled for evening and night time, and about this could be decisive in preventing the occur- the public commonly associates the event with heavy rence of adverse alcohol effects among students. No pre- drinking. Two recent studies employing a national sam- vious study thus far has investigated characteristics ple of Norwegian students (different sample than the associated with students experiencing adverse effects of current study) have investigated demographic character- alcohol use during initiation rituals to higher education. istics, social integration and alcohol use associated with Still, characteristics associated with an increased vul- FW-participation [2, 3]. Still, several questions regarding nerability for experiencing adverse effects of alcohol the Norwegian FW remain unanswered pertaining in in general, have been identified [8–15]. The most particular to the questions of who is participating and important one is likely to be the amount of alcohol who is experiencing adverse effects of FW-participation. consumed, as higher alcohol intake has consistently been linked to increased risk of a range of negative consequences [16, 17]. Characteristics associated with participation in FW Additional factors such as gender and psychological Participation in FW has been positively associated with health can also influence how individuals react to alco- later social adjustment within the Norwegian setting of hol intake [8–11]. Men have consistently, and across higher education [2]. This association might be ex- countries, been found to report both high intake of alco- plained by selection processes. The association between hol and more adverse effects of alcohol compared to FW-participation and social adjustment might also be women [8]. While women have lower tolerance to alco- related to FW being the first opportunity to form friend- hol than men and high alcohol intake among women ships with co-students, hence those who do not partici- may be less socially accepted. It has therefore been sug- pate might have a harder time being included in gested that women experience more alcohol-related friendships groups established during FW. In this re- problems with the same consumption level as men [8]. spect, students who choose not to participate in FW Younger students may also have a higher risk of experi- may find themselves in a socially disadvantageous encing adverse effects of alcohol compared to older stu- position, and efforts to identify and arrange for these dents, in part because alcohol could be more damaging students to be included in initiation rituals such as FW to the developing brain [10]. Personality traits may pre- may be important. Very few studies have investigated dict both drinking and the level of adverse effects experi- characteristics associated with participation in FW or enced. For example, one American study reported that similar initiation rituals. A recent Norwegian study students who scored high on neuroticism tended to re- showed that single and younger students were more port more negative consequences of alcohol use [9]. likely to participate in FW (traits which are also related Moreover, depression and anxiety have been linked to to social drinking in general), and students who abstain both increased alcohol consumption and the experience from alcohol were less likely to participate [2, 4]. Being of more adverse effects of alcohol use [11–15]. born in Norway and student at a business school are ex- amples of other characteristics that might be associated Objectives with FW-participation. Norwegian culture is traditionally In this study, we aimed to delineate the characteristics regarded as a “dry” culture, where Norwegians tend to (e.g., demographic and personality factors) associated enjoy alcohol seldom while at the same time getting with participation in FW. A second aim was to identify more intoxicated when they do drink [5, 6]. Hence, characteristics associated with experiencing adverse al- foreign-born students may shy away from FW due to cohol effects during FW (including negative effects on past experiences with Norwegian’s heavy episodic alco- self-reported psychological and physical health, and hol consumption. Publicly, students at Norwegian busi- feelings of being left out). We chose a survey design to ness schools are believed to be particularly preoccupied address these questions. Surveys are a cost-effective way with FW. These students have also been found to have a of collecting a lot of data from a number participants. higher alcohol consumption than other students [7]. The We reasoned that including several variables and a high emphasise made on FW and alcohol use by business stu- number of participants were especially important given dents suggests that business students might be more the novelty of FW as a research topic. In addition, as the likely to participate in FW compared to other students. focus was on the students subjective experiences Erevik et al. Substance Abuse Treatment, Prevention, and Policy (2018) 13:21 Page 3 of 10 regarding the FW, we argue that the survey method is North America; Oceania), current religious identification appropriate. (Buddhism; Hinduism; Islam; Judaism; Catholic Chris- tianity; Orthodox Christianity; Protestant Christianity; Methods other religion; do not identify with a religious belief), re- Procedures and sample lationship status (single; in a relationship, but living All students registered at the four largest institutions of alone; cohabitant; married; other), and parental status higher education in Bergen municipality, Norway, were (do not have a child/children; have daily custody of a invited via e-mail to participate in an online survey (au- child/children; have shared custody of a child/children; tumn 2015, approximately one month after the comple- have a child/children, but not custody) [18]. We dis- tion of FW). The institutions included one public cerned the student’s educational affiliation (i.e., whether university offering a range of subjects (University of they were business or college/university students) from Bergen), one public university college offering a range of their student e-mail addresses. subjects (named Bergen University College at the time The students’ personality traits were assessed with the of the data collection), one private business school (BI 20-item Mini International Personality Item Pool (Mini-I- Norwegian Business School), and one public business PIP; [19]). The Mini-IPIP is considered a reliable and valid school (NHH Norwegian School of Economics). measure of the Five-Factor Model’s personality dimen- Non-responders were sent up to two e-mail reminders. sions: extroversion, agreeableness, conscientiousness, Those who responded to the survey took part in a neuroticism and intellect/imagination [19]. Cronbach’s lottery with two iPhone 6 s and 50 gift cards (each with alphas for the different traits ranged from: .69–.82 a value of 500 NOK = ~ 50 EUR) as prizes. (present study). The Mini-IPIP consists of statements re- The present study was part of a larger project investi- garding typical behaviour (e.g., being talkative, interested gating student health and substance use. A total of in others, organized, worried, imaginative), where the re- 28,553 students (from all years of study) were invited to spondents rate the statements’ applicability of describing participate in the survey, whereof 11,236 (39%) agreed to their behaviour. There are four statements for each of the participate. The present sample included students who five personality traits, each with response alternative ran- reported being in their freshman year in their current ging from 1 (very inaccurate) to 5 (very accurate). Thus, study programme and who answered questions regard- for each trait the composite scores range from 4 to 20. ing FW (N = 4401). A total of 425 students were ex- We assessed the students’ alcohol use by the 10-item cluded from the analyses altogether due to non-response Alcohol Use Disorders Identification Test (AUDIT; [20, on the items assessing FW-participation. The survey had 21]) - Cronbach’s alpha: .78 (present study). AUDIT a mandatory response design and the items assessing measures three dimensions of alcohol use during the FW-participation were located towards the end of the past year: Consumption (i.e., frequency of drinking, survey, hence there is little missing data altogether. The typical quantity consumed, and frequency of heavy included institutions have estimated that they had 5465 drinking), Dependency symptoms (i.e., impaired control, (the public university), 2100 (the public university col- increased salience, and morning drinking), and Harmful lege), 965 (the private business school), and 443 (the alcohol use (i.e., guilt after drinking, blackouts, public business school) first-year students in autumn alcohol-related injuries, and others being concerned 2015, respectively. In the current sample, a total of 2136 about the respondents’ drinking) [20, 21]. In the participants were registered as students at the public question regarding drinking frequency the response al- university (estimated response rate 39%), 1663 were ternatives are: Never; once a month or less; 2–4 times a registered as students at the public university college month; 2–3 times a week; 4 times a week or more. In (estimated response rate 79%), 349 at the private busi- the question regarding typical quantity consumed on a ness school (estimated response rate 36%), and 253 at single occasion the response alternatives are: 1–2 alcohol the public business school (estimated response rate units; 3–4 alcohol units, 5–6 alcohol units, 7–9 alcohol 57%), respectively. The total response rate among first units; 10 or more alcohol units. In the questions regard- year students was thus calculated to 49% (4, 401/8, 973). ing experiencing alcohol-related injuries and others be- ing concerned about own drinking, the response Measurement alternatives are: No; yes, but not during the past year; Demographics were measured by questions about sex yes, during the past years. For the other questions (i.e., (female; male), year of birth (response range: 1940– frequency of heavy drinking, the three dependency 2000), duration of study at institutions for higher educa- items, guilt after drinking, and blackouts) the response tion (response range: 0–10+ years), being a first-year alternatives are: Never; seldom; a couple of times a student (yes; no), place of birth (Norway; North of Eur- month; a couple of times a week; almost daily) The com- ope; Other parts of Europe; Asia, Africa; South America; posite AUDIT-scores range between 0 and 40 [20, 21]. Erevik et al. Substance Abuse Treatment, Prevention, and Policy (2018) 13:21 Page 4 of 10 Psychological health were measured by the 25-item status (have children vs. do not have children), Hopkins Symptoms Checklist (HSCL-25; [22]), which educational institution (business institution vs. institu- measures symptoms of anxiety and depression. Cron- tions offering a range of subjects), scores on the five per- bach’s alpha was .81 for the anxiety subscale and .89 for sonality traits, AUDIT-scores, and scores on depression the depression subscale. In HSCL-25 respondents are and anxiety symptoms. The personality, alcohol use, and asked about the level of different symptoms of anxiety psychological health scores were recalculated into (e.g., nervousness) and depression (e.g., loss of energy) z-scores before being entered to the regression model. experienced the last two weeks (response alternatives: Next, we generated three binary logistic regression not at all = 1; somewhat = 2; a great deal = 3; very models. The dependent variables were reporting im- much = 4). Total scores range between 10 and 40 for paired physical health, impaired psychological health, or the anxiety subscale, and between 15 and 60 for the feeling left out due to alcohol use during FW. The inde- depression subscale. pendent variables in these regression models were the The students were asked about participation in FW. same as the independent variables in the models investi- The students were first asked if they participated in FW gating characteristics associated with participation in as new students in autumn 2015. Students who an- FW (i.e., demographics, personality, alcohol use, and swered “yes” to this question were further asked some psychological health variables). In addition, responses re- follow-up questions: “Did you drink alcohol during garding alcohol involvement during FW (i.e., number of FW?” (yes; no). “How many days did you drink alcohol days drinking and participation in alcohol free-events) during FW?” (Response alternatives ranged from 0 to were included as independent variables. The number of 14 days). “Did you participate in any alcohol-free events days drinking during FW was transformed into z-scores during FW?” (yes; no). The students were also asked if before being included in the regression models. Only they experienced any negative effects of alcohol during those reporting participation in FW were included in FW. “Did you experience any of the following negative these analyses. In total, 289 cases (10%) were deleted aspects of alcohol use during FW?”:a) “Impaired from the analyses due to missing data on one or two of physical health?”,b) “Impaired psychological health?”,c) the included independent variables (i.e. number of days “Felt left out?”,and d) “Involved in violence/crime?” drinking and participation in alcohol free-events). (Response alternatives: yes; no) [18]. The associations between the independent and dependent variables are reported in terms of odds ratios Analysis (OR), which is considered as effect sizes. There are not All data analyses were carried out using IBM SPSS Sta- clear cut-offs for how ORs should be interpreted, but tistics 23 (IBM SPSS Statistics, New York, USA). Missing ORs of 1.5, 2.5, 4.0, and 10.0 have been suggested as data were deleted listwise (only relevant for the analyses representing small, moderate, large, and very large effect in Table 4). sizes, respectively [23–25]. We started by calculating the sample’s central tenden- cies on the demographic, personality, alcohol use, and Results psychological health measurements. We also calculated The sample’s characteristics are presented in Table 1. the FW-participants’ central tendencies on alcohol in- The sample’s mean age was 24 years (range: 17–73 years, volvement during FW and the experience of adverse ef- SD = 7.1), 65% (n = 2, 844) were females, and the major- fects during this week (i.e., impaired physical health, ity were born in Norway (93%, n = 4, 077). impaired psychological health, feeling left out, and in- Table 2 depicts the FW-participants’ responses regard- volvement in violence/crime). The readers should note ing alcohol involvement and the experience of adverse that the items assessing alcohol involvement during FW alcohol effects during FW. A total of 64% of the had some missing data. The missing data on these vari- first-year students reported that they participated in FW, ables appear to be caused by technical errors related to and 27% of these reported experiencing at least one ad- survey administration. verse alcohol-related effect during FW. A binary logistic regression was employed to investi- Table 3 shows characteristics associated with par- gate demographical, personality, alcohol use, and psy- ticipation in FW. Participation in FW was signifi- chological characteristics of students who participated in cantly (p < .05) and positively associated with being single, FW compared to nonparticipating students. Participa- having a business school affiliation, extroversion and alco- tion in FW comprised the dependent variable. The hol use, and inversely associated with age, total years spent independent variables were; sex (woman vs. man), age, studying and having child/ren. number of years spent studying, country of birth Characteristics associated with reporting different adverse (Norway vs. other), religion (religious vs. nonreligious), effects of alcohol during FW are displayed in Table 4.Total relationship status (single vs. in a relationship), parental years spent studying, business school affiliation, concurrent Erevik et al. Substance Abuse Treatment, Prevention, and Policy (2018) 13:21 Page 5 of 10 Table 1 Characteristics of the “new” students fall 2015, N = 4401 Table 3 Characteristics associated with participating in Freshman’s week (FW), total N = 4401 Mean (SD)/Percentage (95% CI) Participated in FW Demographics (n = 2835) Women 64.6% (63.2–66.0%) (Reference category: Did Age 24.4 (7.1) not participate in FW) Born in Norway 92.6% (91.9–93.4%) OR (95% CI) Demographics Religious 35.5% (34.1–37.0%) Sex Single 49.6% (48.1–51.1%) Man 1.00 Had child/children 12.1% (11.2–13.1%) Woman 0.92 (0.76–1.13) Business school affiliation 13.7% (12.7–14.7%) *** Age 0.80 (0.78–.0.83) Years in higher education 1.9 (2.2) a *** Total years spent studying 0.70 (0.67–0.74) Personality Place of birth Extroversion 14.0 (3.6) Born outside of Norway 1.00 Agreeableness 16.8 (2.8) Born in Norway 0.79 (0.57–1.09) Conscientiousness 14.6 (3.2) Religious identification Neuroticism 11.2 (3.6) Nonreligious 1.00 Intellect/imagination 14.6 (3.2) Religious 1.01 (0.84–1.21) Alcohol use Relationship status AUDIT-score 8.1 (4.8) In a relationship 1.00 Psychological health ** Single 1.29 (1.08–1.53) Depression symptoms 24.5 (7.6) Parental status Anxiety symptoms 15.1 (4.2) SD Standard deviation, CI Confidence interval, AUDIT Alcohol Use Disorders Did not have child/children 1.00 Identification Test *** a b Had child/children 0.36 (0.23–0.56) Total scores range from 4 to 20 for each personality trait, Total scores range from 0 to 40, Total scores on the depression subscale range from 15 to 60 Educational institution and total scores on the anxiety subscale range from 10 to 40 Not business school 1.00 *** alcohol use, depression and numbers of days drinking Business school 1.60 (1.23–2.08) during FW were positively associated with reports of Personality one or more adverse alcohol effects. Extroversion and ** ExtroversionZ 1.18 (1.07–1.29) participation in alcohol-free events during FW were AgreeablenessZ 1.08 (0.99–1.19) inversely associated with reports of adverse alcohol ConscientiousnessZ 1.01 (0.92–1.10) effects. NeuroticismZ 1.01 (0.90–1.13) Intellect/imaginationZ 0.96 (0.88–1.05) Table 2 Alcohol use and adverse effects of alcohol use during *** Freshman’s week (FW), n = 2835 (participated in FW) Concurrent alcohol use (AUDIT-scoreZ) 1.28 (1.16–1.41) Mean (95% CI)/Percentage Psychological health (95% CI) Depression symptomsZ 1.08 (0.94–1.23) Alcohol use during FW Anxiety symptomsZ 0.93 (0.83–1.05) Drank alcohol 93.6% (92.7–94.6%) Model, df = 16 and p < .001 Cox & Snell R = .390; Number of days drinking (among 4.1 (2.0) 2 Nagelkerke R = .536 drinkers) OR odds ratio, CI confidence interval, AUDIT Alcohol Use Disorders Participated in alcohol-free events 45.3% (43.3–47.2%) Identification Test, ** p < .01, ***p < .001, Z = z-score Adverse immediate effects Impaired physical health 21.0% (19.5–22.5%) Discussion Impaired psychological health 4.2% (3.4–4.9%) A substantial minority (i.e., 36%) of the first-year stu- Felt left out 7.2% (6.2–8.1%) dents chose not to participate in FW. Further, the em- phasis on alcohol use during FW is apparent from the Involved in violence/crime 0.4% (0.2–0.6%) a b c current results, as the vast majority of students reported CI Confidence interval, 287 missing cases, 289 missing cases, 286 missing cases drinking alcohol during the event. The mean number of Erevik et al. Substance Abuse Treatment, Prevention, and Policy (2018) 13:21 Page 6 of 10 Table 4 Characteristics associated with experiencing adverse alcohol effects during Freshman’s week (FW), total n = 2546 (participated in FW and had no missing data on any of the included variables) Impaired physical health (n = 595) Impaired psychological health (n = 118) Felt left out (n = 204) (Reference category: Did not experience (Reference category: Did not experience (Reference category: impaired physical health) impaired psychological health) Did not feel left out) OR (95% CI) OR (95% CI) OR (95% CI) Demographics Sex Man 1.00 1.00 1.00 Woman 0.93 (0.73–1.18) 0.73 (0.45–1.17) 1.16 (0.79–1.69) Age 1.00 (0.94–1.06) 0.98 (0.88–1.10) 0.95 (0.87–1.03) ** Total years spent studying 1.04 (0.95–1.13) 1.25 (1.07–1.45) 0.96 (0.84–1.10) Place of birth Born outside of Norway 1.00 1.00 1.00 Born in Norway 0.99 (0.63–1.54) 0.77 (0.33–1.77) 0.93 (0.49–1.79) Religious identification Nonreligious 1.00 1.00 1.00 Religious 0.83 (0.66–1.03) 0.91 (0.58–1.41) 1.00 (0.72–1.40) Relationship status In a relationship 1.00 1.00 1.00 Single 0.96 (0.78–1.18) 1.00 (0.66–1.52) 0.74 (0.54–1.01) Parental status Did not have child/children 1.00 1.00 1.00 Had child/children 0.71 (0.20–2.56) 1.79 (0.34–9.44) 0.26 (0.03–2.31) Educational institution Not business school 1.00 1.00 1.00 ** Business school 1.48 (1.15–1.90) 0.91 (0.54–1.51) 1.03 (0.68–1.55) Personality * *** ExtroversionZ 1.05 (0.93–1.19) 0.79 (0.64–0.99) 0.60 (0.51–0.71) AgreeablenessZ 0.99 (0.88–1.11) 1.21 (0.97–1.51) 1.01 (0.86–1.19) ConscientiousnessZ 1.12 (1.00–1.24) 1.10 (0.89–1.36) 1.06 (0.90–1.24) NeuroticismZ 1.05 (0.92–1.20) 1.24 (0.93–1.64) 1.16 (0.94–1.44) Intellect/imaginationZ 1.08 (0.97–1.20) 0.96 (0.78–1.18) 1.09 (0.93–1.27) *** *** ** Concurrent alcohol use (AUDIT- 1.67 (1.48–1.88) 1.84 (1.50–2.26) 1.31 (1.10–1.56) scoreZ) Psychological health * *** ** Depression symptomsZ 1.17 (1.00–1.36) 1.60 (1.24–2.05) 1.37 (1.13–1.68) Anxiety symptomsZ 1.05 (0.91–1.20) 1.18 (0.95–1.47) 1.19 (1.00–1.42) FW-factors *** Number of days drinking during FWZ 1.68 (1.50–1.89) 1.22 (0.98–1.51) 0.85 (0.71–1.02) Participation in alcohol-free events Did not participate in 1.00 1.00 1.00 alcohol-free events ** * ** Participated in alcohol-free 0.72 (0.58–0.88) 0.60 (0.38–0.93) 0.62 (0.44–0.86) events 2 2 2 Models, df = 18 and Cox & Snell R = .126; Cox & Snell R = .062; Cox & Snell R = .069; 2 2 2 p < .001 for all Nagelkerke R = .190 Nagelkerke R = .197 Nagelkerke R = .161 OR odds ratio, CI confidence interval, AUDIT Alcohol Use Disorders Identification Test, * p < .05, ** p < .01, ***p < .001, Z = z-score Erevik et al. Substance Abuse Treatment, Prevention, and Policy (2018) 13:21 Page 7 of 10 days drinking was four (among drinkers). Considering adverse alcohol-related effects. In addition, alcohol-free that FW usually lasts for about five to six days, four days activities could be more socially inclusive and less of drinking illustrates the overarching role of alcohol norm-breaking, and good social experiences might further during this week. About one quarter of the students act as a buffer towards adverse alcohol-related effects [27]. reported experiencing at least one adverse alcohol effect during FW. Independence from other obligations We identified several correlates of FW-participation and Several of the characteristics associated with FW-participation reports of adverse effects related to FW-participation. Our (i.e. younger age, less experience with higher education, and results are largely in line with previous findings, from a being single and childless) may also be associated with having range of countries, regarding characteristics associated fewer social or economic responsibilities. Students with more with high alcohol use (a substantial component in FW) obligations perhaps shy away from FW due to the scheduling and vulnerability to experiencing adverse effects of alcohol of the event in the evening/night time (which results in FW use in general [4, 7, 12, 13, 16, 17, 26]. The findings re- taking up quitealot sparetime) andthe heavyalcohol con- garding who participates in FW are also in accordance with sumption involved (which could negatively affect obligations two similar Norwegian studies, although the present study the next day). For instance, students with children may be less elaborates characteristics associated with FW-participation able to participate in events that take place during evening/ by including a higher number of variables than the previous night time due to family obligations. studies [2, 3]. No previous study has investigated character- istics associated with experiencing adverse effects associated Similarity with the “typical first-year student” with alcohol use during FW or similar initiation rituals, The students who chose to participate in FW were also specifically. characterised by traits (e.g. younger age) which matches the conception of the “typical first-year students” [28]. Characteristics associated with participation in FW and Students who do not match the stereotype of the first-year experiencing adverse effects of alcohol use during FW student might be hesitant to participate in FW for fear of There is a wide range of plausible explanations as to why not fitting in socially. The overrepresentation of “typical each of the identified characteristics was associated with first-years students” in FW may further result in the “atyp- participation in and/or experiencing adverse alcohol ef- ical first-year students” being ostracised. In accordance fects during FW. We will focus on four possible common with this, students with more previous study experiences explanations in the following sections: a) high alcohol use, (previous study experience might be considered as at odds b) independence from other obligations, c) similarity to with the conception of the “typical first-year student”) the “typical first-year student”, and d) sociability. were more likely to report negative psychological effects in relation to their FW-participation. High alcohol use The students who reported high alcohol use in genereal Sociability were more likely to both participate in and report ad- Several of the traits related to FW-participation and experien- verse alcohol-related effects during their participation in cing adverse effects in relation to participation could also be FW. Students who consume much alcohol may be more linked to sociability. The students who participated were likely to join in on FW because they are more comfort- more likely to have traits that could be related to an in- able with the alcohol focus of FW. The association be- creased interest in making new friendships (i.e. younger age, tween high general alcohol use and drinking more days less experience with higher education, being single, and during FW, and reports of adverse alcohol effects may extroversion) [19, 29, 30]. For instance, extroversion was come as no surprise, as alcohol’sstrainonphysical and positively associated with FW-participation. This trait is psychological health is dependent on the total amount of linked with increased sociability, and enjoyment of social set- alcohol consumed [16, 17]. Business students’ increased tings involving several individuals [19, 29], which can explain likelihood of reporting impaired physical health in relation the increased participation rate among students with higher to alcohol use during FW may also relate to alcohol use in extroversion scores. general, as these students tend to drink more and are pub- Traits inversely related to sociability (i.e. introversion licly believed to be more invested in and consume more and depression) were related to an increased risk of alcohol during FW, compared other students [7]. The experiencing adverse effects in relation to alcohol use current results suggested that participating in alcohol-free during FW. Introversion and depression have been asso- events reduced the risk of experiencing adverse effects. ciated with experiencing more distress when spending The students who participated in alcohol-free events time with, at least several, others [29, 31, 32], which might have had a lower total consumption of alcohol dur- could explain why the more introverted and depressed ing FW, which may explain why they reported fewer students reported more negative experiences during FW. Erevik et al. Substance Abuse Treatment, Prevention, and Policy (2018) 13:21 Page 8 of 10 The organisation of FW, with students put into rather which arguably should be included and controlled for in fu- large social groups (approximately 15 students per ture studies. Furthermore, the high percentage of students group) and often given tasks demanding that they stand reporting impaired physical health in relation to alcohol use out, such as singing or dancing, may further increase in- during FW suggests that future studies should look into the troverts’ discomfort with the event as introverts tend to seriousness and longevity of such effect in order to under- prefer smaller groups and staying in the background [19, stand these phenomena in more depth and determine how 29]. The introverted and depressed students’ reports of it could be avoided. Investigating whether the adverse ef- discomfort in relation to FW-participation could also be fects reported by the students are related to sexual assaults/ related to social skills, as both introverted and depressed unwanted sexual attention would be particularly timely. individuals have been found to have poorer social skills Future studies should aim to assess the effects of possible compared to extroverted and non-depressed individuals interventions designed to increase participation in initiation [31, 33, 34]. The introverted and depressed students’ in- rituals into higher education and reduce the experience of creased likelihood of reporting negative effects in rela- adverse effects in relation to participation in such events. tion to alcohol use during FW may hence be explained by their struggling to be socially accepted and included. It Limitations might be particularly unfortunate that introverted students The present study had a cross-sectional design, which were less likely to participate in FW, and that introverted impedes deductions of directionality and causality. Still, and depressed students were more likely to report negative several of the measured factors (e.g., demographics, per- effects in relation to their FW-participation, as these stu- sonality characteristics) are likely to have existed before dents might have benefitted the most from participating in FW and they were measured shortly after the event and establishing good social relations during FW. which supports directional order. However, causality cannot be established by the current design as potential, Implications unmeasured third variables may explain both the inde- Participation in the Norwegian FW has been associated pendent variables and the dependent variables. The rela- with better social adjustment within the setting of higher tively large sample size and the vast number of variables education [2], hence the high non-participant rate may included are strengths of the current study as this de- be unfortunate. The percentage of students reporting creases the risk of making type II errors and makes it impaired physical or psychological health, or feeling left less likely that the identified associations might be ex- out in relation to alcohol use during FW could be con- plained by third variables. It is important to emphasize sidered as worrisome. Hence, the current findings imply nonetheless, that the high number of significance tests that measures to improve FW are warranted. Our find- conducted also entail an elevated risk of conducting ings suggest that initiatives to reduce alcohol use during Type I errors. It should also be noted that most of the FW, to make FW more available for students with other effect sizes of the observed associations were within the obligations and characteristics than the “typical first-year range of what is often considered as small or very small, student”, and to make FW a better experience for stu- although the interpretation of ORs is ambiguous. The dents who are less sociable might be reasonable strat- size of the associations may limit the practical import- egies for increasing the FW-participation rate and ance of our findings. We would, however, argue that decreasing the occurrence of negative experiences. For identifying correlates of FW-participation and experien- instance, might increasing the number of day-time activ- cing adverse effects in relation to FW-participation is ities during FW, spreading the activities over more days, important, even if these associations might be small, due and arranging more alcohol-free events all be possible the popularity of FW, the lack of research on this topic, strategies for making FW more accessible to students and the potential pervasiveness of the social relations with other obligations, as well as for reducing alcohol and alcohol habits established during FW [2, 3]. use during FW. Dividing the students into smaller The measurements we used in the present study in- groups than the present norm, and having more volve some limitations as well. One shortcoming is the group-based tasks and games (as opposed to tasks re- lack of information regarding the quantities of alcohol quiring the individual to stand out) might be possible consumed during FW, the specific amount of alcohol strategies for making less sociable students more com- consumed during FW may explain the experience of fortable with the event. some of the adverse effects. The measurements of ad- Our results may also have implications for other verse effects were also quite broad and it is hard to de- researchers investigating FW or similar events. Firstly, our termine whether these were caused by or merely results elucidate several potential common factors (e.g. age, co-occurrences with alcohol use. Furthermore, all relationship and parental status, and extroversion) in the measurements were based on self-report, which may relationship between alcohol use and FW-participation, be influenced by social desirability and memory biases Erevik et al. Substance Abuse Treatment, Prevention, and Policy (2018) 13:21 Page 9 of 10 [35, 36]. Responses in web-based surveys (like the current initiation rituals. Students with high alcohol consump- one) may, however, be less influenced by social desirability tion and fewer obligations (e.g. childcare responsibil- bias than other modes of inquiry [37, 38]. Another im- ities), students with characteristics matching the portant limitation of the self-report design is that it was stereotypical first-year student, and sociable students the students themselves who defined themselves as were more likely to participate in FW. Further, students first-year students. Different students may have different with high alcohol consumption, students with character- opinions on what constitutes a “first-year”.Some students istics that do not match the stereotypical first-year stu- may consider having their first year in a master dent, and less sociable students were more likely to programme as “first-year”, while others may not. A limita- report experiencing adverse alcohol effects during FW. tion with the current study is accordingly that the The current results suggest that initiatives aiming at first-year students may represent a rather heterogeneous increasing the participation rate in FW, reducing alcohol group. Moreover, some institutions mark the transition to use during FW, and decreasing the occurrence of ad- their master programmes with a FW and the students are verse alcohol effects during FW are warranted. Further- put in completely new social groups, while other institu- more, the results suggest that reducing the focus on tions and study programmes may have a less distinct tran- alcohol use during FW and making the event more avail- sition from bachelor to master. In this realm, we would able and enjoyable for students with several other obli- argue that it could be regarded as reasonable to let the gations, students who differ from the “typical first-year students decide and define their student category. student”, and less sociable students, might increase par- The generalisability of the current results should also ticipation rate and prevent the occurrence of adverse al- be commented on. In this realm, it is important to con- cohol effects. Future studies should aim to evaluate the sider the response rate. One limitation regarding this is effectiveness of possible interventions designed to in- that we do not know the exact response rate among crease participation in initiation rituals into higher edu- first-year students. The estimated response rate of 49% cation and reduce the risk of students experiencing among the first-year students is, however, within the adverse effects during such events. range of what is often considered as acceptable, and the Abbreviations response rate is quite good compared to a similar Nor- AUDIT: Alcohol use disorders identification test; FW: Freshman’sweek; wegian study and compared to the response rates ob- HSCL-25: Hopkins symptoms checklist; Mini-IPIP: Mini international tained in online surveys internationally [18, 39]. personality item pool; OR: Odds ratio Furthermore, we do not have any information about the Acknowledgements students who chose not to participate in the survey, We would like to thank Trude Remme for her contributing effort in the data which renders the generalisability of the results somewhat collection process. unclear. The participating students had similar character- Funding istics as those found in other studies among Norwegian This study was funded by a PhD grant given to the first author from the students in terms of sex, age, relationship status, and alco- University of Bergen, Norway and Bergen municipality. The funding sources hol use [18, 40]. This may imply that the study is general- had no involvement in any stages of the data collection or manuscript preparation. isable to, at least, the Norwegian student population. Whether the results are generalisable to other student Availability of data and materials populations are harder to determine. FW is a local The participants in the current study and the ethical committee which Norwegian custom. Abundance of partying and alcohol approved the study have been guaranteed that only three named researchers will have access to the dataset, hence the data used in this study consumption seem, nevertheless, to be common denomi- is not available for other researchers. nators in the transition to higher education and student life around the world, and have been reported in countries Authors’ contributions such as the US, UK, and Denmark [1, 3, 41, 42]. In addition, SP, EKE, TT, CSA, and ØV designed the study. EKE, SP, and TT collected the data. EKE analysed the data. All the authors have participated in the alcohol habits are getting increasingly homogenous inter- manuscript preparation and approved the final manuscript. nationally, and the traditional borders between “wet” and “dry” cultures appear to be evaporating [5, 6]. From this Ethics approval and consent to participate perspective, the findings from the current study may be All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and relevant for understanding initiation rituals to higher educa- national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). tion in other student populations as well. Informed consent was obtained from all participants for being included in the study. The study protocol was approved by the Regional Committee for Medical and Health Related Ethics, Western Norway (no. 2015/1154). Conclusion Some students may feel excluded from initiation rituals Consent for publication and certain individuals seem to be especially vulnerable Identifiable information and details have been removed from this manuscript to experiencing adverse effects of drinking during to ensure anonymity so that the consent to publish is not applicable. 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“Freshman’s week”: characteristics associated with participation and experiencing adverse effects

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Abstract

Background: “Freshman’s week” (FW) is a Norwegian initiation ritual to higher education. Previous research has suggested that FW-participation is associated with better social adjustment to the student setting, as well as heavy alcohol use both during and after the event. In this study, we aimed to identify characteristics associated with participation in FW and characteristics associated with experiencing adverse effects of alcohol use during FW. Methods: Students in the city of Bergen, Norway participated in a survey during fall 2015, shortly after FW. The current sample consisted of the first-year students (N = 4, 401, estimated response rate: 49%). The sample’s mean age was 24 years (range: 17–73 years), 65% were females, and the majority were born in Norway (93%). Logistic regressions were conducted to identify characteristics associated with participation in FW and experiencing adverse effects. Results: A total of 64% of the first-year students reported participation in FW, and 27% of these reported experiencing at least one adverse alcohol-related effect during FW. Participation in FW was positively associated with being single (OR = 1.29), extroversion (OR = 1.18), and alcohol use (OR = 1.28), and inversely associated with age (OR = 0.70), and having children (OR = 0.36). Several characteristics (e.g., alcohol use (OR = 1.84), extroversion (OR = 0.60), symptoms of depression (OR = 1.60)) were associated with an increased risk of experiencing adverse effects of alcohol use during participation. Conclusion: The current results suggest that initiatives for increasing the participation rate in FW, reducing alcohol use during FW, and decreasing the occurrence of adverse alcohol effects during FW are warranted. Aiming to reduce the focus on alcohol use during FW, and seeking to make FW more available and enjoyable for students with other priorities, students who do not match the stereotype of the typical first-year student, and less sociable students, might both increase participation rate and prevent the occurrence of adverse alcohol effects. Future studies should aim to develop and assess interventions designed to increase participation in FW and reduce the occurrence of adverse effects related to participation. Keywords: Alcohol, Students, Enrolment, First year student, Adverse effects of alcohol, Personality Background most commonly undergraduate programmes) are invited Enrolment into higher education, like American colleges, to participate in Freshman’s week (FW), which compara- represents an important transition in the life of tively converts to American hazing or the British emerging adults, often implying greater independency, “Freshers’ week” in a global context. FW compromises a identity reformations, and development of new social series of social activities and events, and typically lasts networks [1]. In Norway, students entering the first year for approximately five to six days. The first-year students of a new study programme of higher education (i.e., are typically divided into smaller groups consisting of approximately 15 first-year students. These groups are further led by about two “sponsors”, usually more senior * Correspondence: eilin.erevik@uib.no students. The sponsors introduce games, masquerades, Department of Psychosocial Science, University of Bergen, PO. Box. 7807, and parties for the new students. There are no official 5020 Bergen, Norway Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Erevik et al. Substance Abuse Treatment, Prevention, and Policy (2018) 13:21 Page 2 of 10 records of the history of FW, but the institutions for Characteristics associated with experiencing adverse higher education in Bergen, Norway, estimate that FW effects of alcohol use during FW has been a common initiation ritual to higher education Identifying factors associated with experiencing adverse in Bergen for at least 15 years. All larger institutions for effects of alcohol use, such as impaired physical or higher education in Norway have now institutionalized psychological health during FW, may provide important FW as a part of their welcome ritual for new students. information about students at risk. Thus, information FW is mainly scheduled for evening and night time, and about this could be decisive in preventing the occur- the public commonly associates the event with heavy rence of adverse alcohol effects among students. No pre- drinking. Two recent studies employing a national sam- vious study thus far has investigated characteristics ple of Norwegian students (different sample than the associated with students experiencing adverse effects of current study) have investigated demographic character- alcohol use during initiation rituals to higher education. istics, social integration and alcohol use associated with Still, characteristics associated with an increased vul- FW-participation [2, 3]. Still, several questions regarding nerability for experiencing adverse effects of alcohol the Norwegian FW remain unanswered pertaining in in general, have been identified [8–15]. The most particular to the questions of who is participating and important one is likely to be the amount of alcohol who is experiencing adverse effects of FW-participation. consumed, as higher alcohol intake has consistently been linked to increased risk of a range of negative consequences [16, 17]. Characteristics associated with participation in FW Additional factors such as gender and psychological Participation in FW has been positively associated with health can also influence how individuals react to alco- later social adjustment within the Norwegian setting of hol intake [8–11]. Men have consistently, and across higher education [2]. This association might be ex- countries, been found to report both high intake of alco- plained by selection processes. The association between hol and more adverse effects of alcohol compared to FW-participation and social adjustment might also be women [8]. While women have lower tolerance to alco- related to FW being the first opportunity to form friend- hol than men and high alcohol intake among women ships with co-students, hence those who do not partici- may be less socially accepted. It has therefore been sug- pate might have a harder time being included in gested that women experience more alcohol-related friendships groups established during FW. In this re- problems with the same consumption level as men [8]. spect, students who choose not to participate in FW Younger students may also have a higher risk of experi- may find themselves in a socially disadvantageous encing adverse effects of alcohol compared to older stu- position, and efforts to identify and arrange for these dents, in part because alcohol could be more damaging students to be included in initiation rituals such as FW to the developing brain [10]. Personality traits may pre- may be important. Very few studies have investigated dict both drinking and the level of adverse effects experi- characteristics associated with participation in FW or enced. For example, one American study reported that similar initiation rituals. A recent Norwegian study students who scored high on neuroticism tended to re- showed that single and younger students were more port more negative consequences of alcohol use [9]. likely to participate in FW (traits which are also related Moreover, depression and anxiety have been linked to to social drinking in general), and students who abstain both increased alcohol consumption and the experience from alcohol were less likely to participate [2, 4]. Being of more adverse effects of alcohol use [11–15]. born in Norway and student at a business school are ex- amples of other characteristics that might be associated Objectives with FW-participation. Norwegian culture is traditionally In this study, we aimed to delineate the characteristics regarded as a “dry” culture, where Norwegians tend to (e.g., demographic and personality factors) associated enjoy alcohol seldom while at the same time getting with participation in FW. A second aim was to identify more intoxicated when they do drink [5, 6]. Hence, characteristics associated with experiencing adverse al- foreign-born students may shy away from FW due to cohol effects during FW (including negative effects on past experiences with Norwegian’s heavy episodic alco- self-reported psychological and physical health, and hol consumption. Publicly, students at Norwegian busi- feelings of being left out). We chose a survey design to ness schools are believed to be particularly preoccupied address these questions. Surveys are a cost-effective way with FW. These students have also been found to have a of collecting a lot of data from a number participants. higher alcohol consumption than other students [7]. The We reasoned that including several variables and a high emphasise made on FW and alcohol use by business stu- number of participants were especially important given dents suggests that business students might be more the novelty of FW as a research topic. In addition, as the likely to participate in FW compared to other students. focus was on the students subjective experiences Erevik et al. Substance Abuse Treatment, Prevention, and Policy (2018) 13:21 Page 3 of 10 regarding the FW, we argue that the survey method is North America; Oceania), current religious identification appropriate. (Buddhism; Hinduism; Islam; Judaism; Catholic Chris- tianity; Orthodox Christianity; Protestant Christianity; Methods other religion; do not identify with a religious belief), re- Procedures and sample lationship status (single; in a relationship, but living All students registered at the four largest institutions of alone; cohabitant; married; other), and parental status higher education in Bergen municipality, Norway, were (do not have a child/children; have daily custody of a invited via e-mail to participate in an online survey (au- child/children; have shared custody of a child/children; tumn 2015, approximately one month after the comple- have a child/children, but not custody) [18]. We dis- tion of FW). The institutions included one public cerned the student’s educational affiliation (i.e., whether university offering a range of subjects (University of they were business or college/university students) from Bergen), one public university college offering a range of their student e-mail addresses. subjects (named Bergen University College at the time The students’ personality traits were assessed with the of the data collection), one private business school (BI 20-item Mini International Personality Item Pool (Mini-I- Norwegian Business School), and one public business PIP; [19]). The Mini-IPIP is considered a reliable and valid school (NHH Norwegian School of Economics). measure of the Five-Factor Model’s personality dimen- Non-responders were sent up to two e-mail reminders. sions: extroversion, agreeableness, conscientiousness, Those who responded to the survey took part in a neuroticism and intellect/imagination [19]. Cronbach’s lottery with two iPhone 6 s and 50 gift cards (each with alphas for the different traits ranged from: .69–.82 a value of 500 NOK = ~ 50 EUR) as prizes. (present study). The Mini-IPIP consists of statements re- The present study was part of a larger project investi- garding typical behaviour (e.g., being talkative, interested gating student health and substance use. A total of in others, organized, worried, imaginative), where the re- 28,553 students (from all years of study) were invited to spondents rate the statements’ applicability of describing participate in the survey, whereof 11,236 (39%) agreed to their behaviour. There are four statements for each of the participate. The present sample included students who five personality traits, each with response alternative ran- reported being in their freshman year in their current ging from 1 (very inaccurate) to 5 (very accurate). Thus, study programme and who answered questions regard- for each trait the composite scores range from 4 to 20. ing FW (N = 4401). A total of 425 students were ex- We assessed the students’ alcohol use by the 10-item cluded from the analyses altogether due to non-response Alcohol Use Disorders Identification Test (AUDIT; [20, on the items assessing FW-participation. The survey had 21]) - Cronbach’s alpha: .78 (present study). AUDIT a mandatory response design and the items assessing measures three dimensions of alcohol use during the FW-participation were located towards the end of the past year: Consumption (i.e., frequency of drinking, survey, hence there is little missing data altogether. The typical quantity consumed, and frequency of heavy included institutions have estimated that they had 5465 drinking), Dependency symptoms (i.e., impaired control, (the public university), 2100 (the public university col- increased salience, and morning drinking), and Harmful lege), 965 (the private business school), and 443 (the alcohol use (i.e., guilt after drinking, blackouts, public business school) first-year students in autumn alcohol-related injuries, and others being concerned 2015, respectively. In the current sample, a total of 2136 about the respondents’ drinking) [20, 21]. In the participants were registered as students at the public question regarding drinking frequency the response al- university (estimated response rate 39%), 1663 were ternatives are: Never; once a month or less; 2–4 times a registered as students at the public university college month; 2–3 times a week; 4 times a week or more. In (estimated response rate 79%), 349 at the private busi- the question regarding typical quantity consumed on a ness school (estimated response rate 36%), and 253 at single occasion the response alternatives are: 1–2 alcohol the public business school (estimated response rate units; 3–4 alcohol units, 5–6 alcohol units, 7–9 alcohol 57%), respectively. The total response rate among first units; 10 or more alcohol units. In the questions regard- year students was thus calculated to 49% (4, 401/8, 973). ing experiencing alcohol-related injuries and others be- ing concerned about own drinking, the response Measurement alternatives are: No; yes, but not during the past year; Demographics were measured by questions about sex yes, during the past years. For the other questions (i.e., (female; male), year of birth (response range: 1940– frequency of heavy drinking, the three dependency 2000), duration of study at institutions for higher educa- items, guilt after drinking, and blackouts) the response tion (response range: 0–10+ years), being a first-year alternatives are: Never; seldom; a couple of times a student (yes; no), place of birth (Norway; North of Eur- month; a couple of times a week; almost daily) The com- ope; Other parts of Europe; Asia, Africa; South America; posite AUDIT-scores range between 0 and 40 [20, 21]. Erevik et al. Substance Abuse Treatment, Prevention, and Policy (2018) 13:21 Page 4 of 10 Psychological health were measured by the 25-item status (have children vs. do not have children), Hopkins Symptoms Checklist (HSCL-25; [22]), which educational institution (business institution vs. institu- measures symptoms of anxiety and depression. Cron- tions offering a range of subjects), scores on the five per- bach’s alpha was .81 for the anxiety subscale and .89 for sonality traits, AUDIT-scores, and scores on depression the depression subscale. In HSCL-25 respondents are and anxiety symptoms. The personality, alcohol use, and asked about the level of different symptoms of anxiety psychological health scores were recalculated into (e.g., nervousness) and depression (e.g., loss of energy) z-scores before being entered to the regression model. experienced the last two weeks (response alternatives: Next, we generated three binary logistic regression not at all = 1; somewhat = 2; a great deal = 3; very models. The dependent variables were reporting im- much = 4). Total scores range between 10 and 40 for paired physical health, impaired psychological health, or the anxiety subscale, and between 15 and 60 for the feeling left out due to alcohol use during FW. The inde- depression subscale. pendent variables in these regression models were the The students were asked about participation in FW. same as the independent variables in the models investi- The students were first asked if they participated in FW gating characteristics associated with participation in as new students in autumn 2015. Students who an- FW (i.e., demographics, personality, alcohol use, and swered “yes” to this question were further asked some psychological health variables). In addition, responses re- follow-up questions: “Did you drink alcohol during garding alcohol involvement during FW (i.e., number of FW?” (yes; no). “How many days did you drink alcohol days drinking and participation in alcohol free-events) during FW?” (Response alternatives ranged from 0 to were included as independent variables. The number of 14 days). “Did you participate in any alcohol-free events days drinking during FW was transformed into z-scores during FW?” (yes; no). The students were also asked if before being included in the regression models. Only they experienced any negative effects of alcohol during those reporting participation in FW were included in FW. “Did you experience any of the following negative these analyses. In total, 289 cases (10%) were deleted aspects of alcohol use during FW?”:a) “Impaired from the analyses due to missing data on one or two of physical health?”,b) “Impaired psychological health?”,c) the included independent variables (i.e. number of days “Felt left out?”,and d) “Involved in violence/crime?” drinking and participation in alcohol free-events). (Response alternatives: yes; no) [18]. The associations between the independent and dependent variables are reported in terms of odds ratios Analysis (OR), which is considered as effect sizes. There are not All data analyses were carried out using IBM SPSS Sta- clear cut-offs for how ORs should be interpreted, but tistics 23 (IBM SPSS Statistics, New York, USA). Missing ORs of 1.5, 2.5, 4.0, and 10.0 have been suggested as data were deleted listwise (only relevant for the analyses representing small, moderate, large, and very large effect in Table 4). sizes, respectively [23–25]. We started by calculating the sample’s central tenden- cies on the demographic, personality, alcohol use, and Results psychological health measurements. We also calculated The sample’s characteristics are presented in Table 1. the FW-participants’ central tendencies on alcohol in- The sample’s mean age was 24 years (range: 17–73 years, volvement during FW and the experience of adverse ef- SD = 7.1), 65% (n = 2, 844) were females, and the major- fects during this week (i.e., impaired physical health, ity were born in Norway (93%, n = 4, 077). impaired psychological health, feeling left out, and in- Table 2 depicts the FW-participants’ responses regard- volvement in violence/crime). The readers should note ing alcohol involvement and the experience of adverse that the items assessing alcohol involvement during FW alcohol effects during FW. A total of 64% of the had some missing data. The missing data on these vari- first-year students reported that they participated in FW, ables appear to be caused by technical errors related to and 27% of these reported experiencing at least one ad- survey administration. verse alcohol-related effect during FW. A binary logistic regression was employed to investi- Table 3 shows characteristics associated with par- gate demographical, personality, alcohol use, and psy- ticipation in FW. Participation in FW was signifi- chological characteristics of students who participated in cantly (p < .05) and positively associated with being single, FW compared to nonparticipating students. Participa- having a business school affiliation, extroversion and alco- tion in FW comprised the dependent variable. The hol use, and inversely associated with age, total years spent independent variables were; sex (woman vs. man), age, studying and having child/ren. number of years spent studying, country of birth Characteristics associated with reporting different adverse (Norway vs. other), religion (religious vs. nonreligious), effects of alcohol during FW are displayed in Table 4.Total relationship status (single vs. in a relationship), parental years spent studying, business school affiliation, concurrent Erevik et al. Substance Abuse Treatment, Prevention, and Policy (2018) 13:21 Page 5 of 10 Table 1 Characteristics of the “new” students fall 2015, N = 4401 Table 3 Characteristics associated with participating in Freshman’s week (FW), total N = 4401 Mean (SD)/Percentage (95% CI) Participated in FW Demographics (n = 2835) Women 64.6% (63.2–66.0%) (Reference category: Did Age 24.4 (7.1) not participate in FW) Born in Norway 92.6% (91.9–93.4%) OR (95% CI) Demographics Religious 35.5% (34.1–37.0%) Sex Single 49.6% (48.1–51.1%) Man 1.00 Had child/children 12.1% (11.2–13.1%) Woman 0.92 (0.76–1.13) Business school affiliation 13.7% (12.7–14.7%) *** Age 0.80 (0.78–.0.83) Years in higher education 1.9 (2.2) a *** Total years spent studying 0.70 (0.67–0.74) Personality Place of birth Extroversion 14.0 (3.6) Born outside of Norway 1.00 Agreeableness 16.8 (2.8) Born in Norway 0.79 (0.57–1.09) Conscientiousness 14.6 (3.2) Religious identification Neuroticism 11.2 (3.6) Nonreligious 1.00 Intellect/imagination 14.6 (3.2) Religious 1.01 (0.84–1.21) Alcohol use Relationship status AUDIT-score 8.1 (4.8) In a relationship 1.00 Psychological health ** Single 1.29 (1.08–1.53) Depression symptoms 24.5 (7.6) Parental status Anxiety symptoms 15.1 (4.2) SD Standard deviation, CI Confidence interval, AUDIT Alcohol Use Disorders Did not have child/children 1.00 Identification Test *** a b Had child/children 0.36 (0.23–0.56) Total scores range from 4 to 20 for each personality trait, Total scores range from 0 to 40, Total scores on the depression subscale range from 15 to 60 Educational institution and total scores on the anxiety subscale range from 10 to 40 Not business school 1.00 *** alcohol use, depression and numbers of days drinking Business school 1.60 (1.23–2.08) during FW were positively associated with reports of Personality one or more adverse alcohol effects. Extroversion and ** ExtroversionZ 1.18 (1.07–1.29) participation in alcohol-free events during FW were AgreeablenessZ 1.08 (0.99–1.19) inversely associated with reports of adverse alcohol ConscientiousnessZ 1.01 (0.92–1.10) effects. NeuroticismZ 1.01 (0.90–1.13) Intellect/imaginationZ 0.96 (0.88–1.05) Table 2 Alcohol use and adverse effects of alcohol use during *** Freshman’s week (FW), n = 2835 (participated in FW) Concurrent alcohol use (AUDIT-scoreZ) 1.28 (1.16–1.41) Mean (95% CI)/Percentage Psychological health (95% CI) Depression symptomsZ 1.08 (0.94–1.23) Alcohol use during FW Anxiety symptomsZ 0.93 (0.83–1.05) Drank alcohol 93.6% (92.7–94.6%) Model, df = 16 and p < .001 Cox & Snell R = .390; Number of days drinking (among 4.1 (2.0) 2 Nagelkerke R = .536 drinkers) OR odds ratio, CI confidence interval, AUDIT Alcohol Use Disorders Participated in alcohol-free events 45.3% (43.3–47.2%) Identification Test, ** p < .01, ***p < .001, Z = z-score Adverse immediate effects Impaired physical health 21.0% (19.5–22.5%) Discussion Impaired psychological health 4.2% (3.4–4.9%) A substantial minority (i.e., 36%) of the first-year stu- Felt left out 7.2% (6.2–8.1%) dents chose not to participate in FW. Further, the em- phasis on alcohol use during FW is apparent from the Involved in violence/crime 0.4% (0.2–0.6%) a b c current results, as the vast majority of students reported CI Confidence interval, 287 missing cases, 289 missing cases, 286 missing cases drinking alcohol during the event. The mean number of Erevik et al. Substance Abuse Treatment, Prevention, and Policy (2018) 13:21 Page 6 of 10 Table 4 Characteristics associated with experiencing adverse alcohol effects during Freshman’s week (FW), total n = 2546 (participated in FW and had no missing data on any of the included variables) Impaired physical health (n = 595) Impaired psychological health (n = 118) Felt left out (n = 204) (Reference category: Did not experience (Reference category: Did not experience (Reference category: impaired physical health) impaired psychological health) Did not feel left out) OR (95% CI) OR (95% CI) OR (95% CI) Demographics Sex Man 1.00 1.00 1.00 Woman 0.93 (0.73–1.18) 0.73 (0.45–1.17) 1.16 (0.79–1.69) Age 1.00 (0.94–1.06) 0.98 (0.88–1.10) 0.95 (0.87–1.03) ** Total years spent studying 1.04 (0.95–1.13) 1.25 (1.07–1.45) 0.96 (0.84–1.10) Place of birth Born outside of Norway 1.00 1.00 1.00 Born in Norway 0.99 (0.63–1.54) 0.77 (0.33–1.77) 0.93 (0.49–1.79) Religious identification Nonreligious 1.00 1.00 1.00 Religious 0.83 (0.66–1.03) 0.91 (0.58–1.41) 1.00 (0.72–1.40) Relationship status In a relationship 1.00 1.00 1.00 Single 0.96 (0.78–1.18) 1.00 (0.66–1.52) 0.74 (0.54–1.01) Parental status Did not have child/children 1.00 1.00 1.00 Had child/children 0.71 (0.20–2.56) 1.79 (0.34–9.44) 0.26 (0.03–2.31) Educational institution Not business school 1.00 1.00 1.00 ** Business school 1.48 (1.15–1.90) 0.91 (0.54–1.51) 1.03 (0.68–1.55) Personality * *** ExtroversionZ 1.05 (0.93–1.19) 0.79 (0.64–0.99) 0.60 (0.51–0.71) AgreeablenessZ 0.99 (0.88–1.11) 1.21 (0.97–1.51) 1.01 (0.86–1.19) ConscientiousnessZ 1.12 (1.00–1.24) 1.10 (0.89–1.36) 1.06 (0.90–1.24) NeuroticismZ 1.05 (0.92–1.20) 1.24 (0.93–1.64) 1.16 (0.94–1.44) Intellect/imaginationZ 1.08 (0.97–1.20) 0.96 (0.78–1.18) 1.09 (0.93–1.27) *** *** ** Concurrent alcohol use (AUDIT- 1.67 (1.48–1.88) 1.84 (1.50–2.26) 1.31 (1.10–1.56) scoreZ) Psychological health * *** ** Depression symptomsZ 1.17 (1.00–1.36) 1.60 (1.24–2.05) 1.37 (1.13–1.68) Anxiety symptomsZ 1.05 (0.91–1.20) 1.18 (0.95–1.47) 1.19 (1.00–1.42) FW-factors *** Number of days drinking during FWZ 1.68 (1.50–1.89) 1.22 (0.98–1.51) 0.85 (0.71–1.02) Participation in alcohol-free events Did not participate in 1.00 1.00 1.00 alcohol-free events ** * ** Participated in alcohol-free 0.72 (0.58–0.88) 0.60 (0.38–0.93) 0.62 (0.44–0.86) events 2 2 2 Models, df = 18 and Cox & Snell R = .126; Cox & Snell R = .062; Cox & Snell R = .069; 2 2 2 p < .001 for all Nagelkerke R = .190 Nagelkerke R = .197 Nagelkerke R = .161 OR odds ratio, CI confidence interval, AUDIT Alcohol Use Disorders Identification Test, * p < .05, ** p < .01, ***p < .001, Z = z-score Erevik et al. Substance Abuse Treatment, Prevention, and Policy (2018) 13:21 Page 7 of 10 days drinking was four (among drinkers). Considering adverse alcohol-related effects. In addition, alcohol-free that FW usually lasts for about five to six days, four days activities could be more socially inclusive and less of drinking illustrates the overarching role of alcohol norm-breaking, and good social experiences might further during this week. About one quarter of the students act as a buffer towards adverse alcohol-related effects [27]. reported experiencing at least one adverse alcohol effect during FW. Independence from other obligations We identified several correlates of FW-participation and Several of the characteristics associated with FW-participation reports of adverse effects related to FW-participation. Our (i.e. younger age, less experience with higher education, and results are largely in line with previous findings, from a being single and childless) may also be associated with having range of countries, regarding characteristics associated fewer social or economic responsibilities. Students with more with high alcohol use (a substantial component in FW) obligations perhaps shy away from FW due to the scheduling and vulnerability to experiencing adverse effects of alcohol of the event in the evening/night time (which results in FW use in general [4, 7, 12, 13, 16, 17, 26]. The findings re- taking up quitealot sparetime) andthe heavyalcohol con- garding who participates in FW are also in accordance with sumption involved (which could negatively affect obligations two similar Norwegian studies, although the present study the next day). For instance, students with children may be less elaborates characteristics associated with FW-participation able to participate in events that take place during evening/ by including a higher number of variables than the previous night time due to family obligations. studies [2, 3]. No previous study has investigated character- istics associated with experiencing adverse effects associated Similarity with the “typical first-year student” with alcohol use during FW or similar initiation rituals, The students who chose to participate in FW were also specifically. characterised by traits (e.g. younger age) which matches the conception of the “typical first-year students” [28]. Characteristics associated with participation in FW and Students who do not match the stereotype of the first-year experiencing adverse effects of alcohol use during FW student might be hesitant to participate in FW for fear of There is a wide range of plausible explanations as to why not fitting in socially. The overrepresentation of “typical each of the identified characteristics was associated with first-years students” in FW may further result in the “atyp- participation in and/or experiencing adverse alcohol ef- ical first-year students” being ostracised. In accordance fects during FW. We will focus on four possible common with this, students with more previous study experiences explanations in the following sections: a) high alcohol use, (previous study experience might be considered as at odds b) independence from other obligations, c) similarity to with the conception of the “typical first-year student”) the “typical first-year student”, and d) sociability. were more likely to report negative psychological effects in relation to their FW-participation. High alcohol use The students who reported high alcohol use in genereal Sociability were more likely to both participate in and report ad- Several of the traits related to FW-participation and experien- verse alcohol-related effects during their participation in cing adverse effects in relation to participation could also be FW. Students who consume much alcohol may be more linked to sociability. The students who participated were likely to join in on FW because they are more comfort- more likely to have traits that could be related to an in- able with the alcohol focus of FW. The association be- creased interest in making new friendships (i.e. younger age, tween high general alcohol use and drinking more days less experience with higher education, being single, and during FW, and reports of adverse alcohol effects may extroversion) [19, 29, 30]. For instance, extroversion was come as no surprise, as alcohol’sstrainonphysical and positively associated with FW-participation. This trait is psychological health is dependent on the total amount of linked with increased sociability, and enjoyment of social set- alcohol consumed [16, 17]. Business students’ increased tings involving several individuals [19, 29], which can explain likelihood of reporting impaired physical health in relation the increased participation rate among students with higher to alcohol use during FW may also relate to alcohol use in extroversion scores. general, as these students tend to drink more and are pub- Traits inversely related to sociability (i.e. introversion licly believed to be more invested in and consume more and depression) were related to an increased risk of alcohol during FW, compared other students [7]. The experiencing adverse effects in relation to alcohol use current results suggested that participating in alcohol-free during FW. Introversion and depression have been asso- events reduced the risk of experiencing adverse effects. ciated with experiencing more distress when spending The students who participated in alcohol-free events time with, at least several, others [29, 31, 32], which might have had a lower total consumption of alcohol dur- could explain why the more introverted and depressed ing FW, which may explain why they reported fewer students reported more negative experiences during FW. Erevik et al. Substance Abuse Treatment, Prevention, and Policy (2018) 13:21 Page 8 of 10 The organisation of FW, with students put into rather which arguably should be included and controlled for in fu- large social groups (approximately 15 students per ture studies. Furthermore, the high percentage of students group) and often given tasks demanding that they stand reporting impaired physical health in relation to alcohol use out, such as singing or dancing, may further increase in- during FW suggests that future studies should look into the troverts’ discomfort with the event as introverts tend to seriousness and longevity of such effect in order to under- prefer smaller groups and staying in the background [19, stand these phenomena in more depth and determine how 29]. The introverted and depressed students’ reports of it could be avoided. Investigating whether the adverse ef- discomfort in relation to FW-participation could also be fects reported by the students are related to sexual assaults/ related to social skills, as both introverted and depressed unwanted sexual attention would be particularly timely. individuals have been found to have poorer social skills Future studies should aim to assess the effects of possible compared to extroverted and non-depressed individuals interventions designed to increase participation in initiation [31, 33, 34]. The introverted and depressed students’ in- rituals into higher education and reduce the experience of creased likelihood of reporting negative effects in rela- adverse effects in relation to participation in such events. tion to alcohol use during FW may hence be explained by their struggling to be socially accepted and included. It Limitations might be particularly unfortunate that introverted students The present study had a cross-sectional design, which were less likely to participate in FW, and that introverted impedes deductions of directionality and causality. Still, and depressed students were more likely to report negative several of the measured factors (e.g., demographics, per- effects in relation to their FW-participation, as these stu- sonality characteristics) are likely to have existed before dents might have benefitted the most from participating in FW and they were measured shortly after the event and establishing good social relations during FW. which supports directional order. However, causality cannot be established by the current design as potential, Implications unmeasured third variables may explain both the inde- Participation in the Norwegian FW has been associated pendent variables and the dependent variables. The rela- with better social adjustment within the setting of higher tively large sample size and the vast number of variables education [2], hence the high non-participant rate may included are strengths of the current study as this de- be unfortunate. The percentage of students reporting creases the risk of making type II errors and makes it impaired physical or psychological health, or feeling left less likely that the identified associations might be ex- out in relation to alcohol use during FW could be con- plained by third variables. It is important to emphasize sidered as worrisome. Hence, the current findings imply nonetheless, that the high number of significance tests that measures to improve FW are warranted. Our find- conducted also entail an elevated risk of conducting ings suggest that initiatives to reduce alcohol use during Type I errors. It should also be noted that most of the FW, to make FW more available for students with other effect sizes of the observed associations were within the obligations and characteristics than the “typical first-year range of what is often considered as small or very small, student”, and to make FW a better experience for stu- although the interpretation of ORs is ambiguous. The dents who are less sociable might be reasonable strat- size of the associations may limit the practical import- egies for increasing the FW-participation rate and ance of our findings. We would, however, argue that decreasing the occurrence of negative experiences. For identifying correlates of FW-participation and experien- instance, might increasing the number of day-time activ- cing adverse effects in relation to FW-participation is ities during FW, spreading the activities over more days, important, even if these associations might be small, due and arranging more alcohol-free events all be possible the popularity of FW, the lack of research on this topic, strategies for making FW more accessible to students and the potential pervasiveness of the social relations with other obligations, as well as for reducing alcohol and alcohol habits established during FW [2, 3]. use during FW. Dividing the students into smaller The measurements we used in the present study in- groups than the present norm, and having more volve some limitations as well. One shortcoming is the group-based tasks and games (as opposed to tasks re- lack of information regarding the quantities of alcohol quiring the individual to stand out) might be possible consumed during FW, the specific amount of alcohol strategies for making less sociable students more com- consumed during FW may explain the experience of fortable with the event. some of the adverse effects. The measurements of ad- Our results may also have implications for other verse effects were also quite broad and it is hard to de- researchers investigating FW or similar events. Firstly, our termine whether these were caused by or merely results elucidate several potential common factors (e.g. age, co-occurrences with alcohol use. Furthermore, all relationship and parental status, and extroversion) in the measurements were based on self-report, which may relationship between alcohol use and FW-participation, be influenced by social desirability and memory biases Erevik et al. Substance Abuse Treatment, Prevention, and Policy (2018) 13:21 Page 9 of 10 [35, 36]. Responses in web-based surveys (like the current initiation rituals. Students with high alcohol consump- one) may, however, be less influenced by social desirability tion and fewer obligations (e.g. childcare responsibil- bias than other modes of inquiry [37, 38]. Another im- ities), students with characteristics matching the portant limitation of the self-report design is that it was stereotypical first-year student, and sociable students the students themselves who defined themselves as were more likely to participate in FW. Further, students first-year students. Different students may have different with high alcohol consumption, students with character- opinions on what constitutes a “first-year”.Some students istics that do not match the stereotypical first-year stu- may consider having their first year in a master dent, and less sociable students were more likely to programme as “first-year”, while others may not. A limita- report experiencing adverse alcohol effects during FW. tion with the current study is accordingly that the The current results suggest that initiatives aiming at first-year students may represent a rather heterogeneous increasing the participation rate in FW, reducing alcohol group. Moreover, some institutions mark the transition to use during FW, and decreasing the occurrence of ad- their master programmes with a FW and the students are verse alcohol effects during FW are warranted. Further- put in completely new social groups, while other institu- more, the results suggest that reducing the focus on tions and study programmes may have a less distinct tran- alcohol use during FW and making the event more avail- sition from bachelor to master. In this realm, we would able and enjoyable for students with several other obli- argue that it could be regarded as reasonable to let the gations, students who differ from the “typical first-year students decide and define their student category. student”, and less sociable students, might increase par- The generalisability of the current results should also ticipation rate and prevent the occurrence of adverse al- be commented on. In this realm, it is important to con- cohol effects. Future studies should aim to evaluate the sider the response rate. One limitation regarding this is effectiveness of possible interventions designed to in- that we do not know the exact response rate among crease participation in initiation rituals into higher edu- first-year students. The estimated response rate of 49% cation and reduce the risk of students experiencing among the first-year students is, however, within the adverse effects during such events. range of what is often considered as acceptable, and the Abbreviations response rate is quite good compared to a similar Nor- AUDIT: Alcohol use disorders identification test; FW: Freshman’sweek; wegian study and compared to the response rates ob- HSCL-25: Hopkins symptoms checklist; Mini-IPIP: Mini international tained in online surveys internationally [18, 39]. personality item pool; OR: Odds ratio Furthermore, we do not have any information about the Acknowledgements students who chose not to participate in the survey, We would like to thank Trude Remme for her contributing effort in the data which renders the generalisability of the results somewhat collection process. unclear. The participating students had similar character- Funding istics as those found in other studies among Norwegian This study was funded by a PhD grant given to the first author from the students in terms of sex, age, relationship status, and alco- University of Bergen, Norway and Bergen municipality. The funding sources hol use [18, 40]. This may imply that the study is general- had no involvement in any stages of the data collection or manuscript preparation. isable to, at least, the Norwegian student population. Whether the results are generalisable to other student Availability of data and materials populations are harder to determine. FW is a local The participants in the current study and the ethical committee which Norwegian custom. Abundance of partying and alcohol approved the study have been guaranteed that only three named researchers will have access to the dataset, hence the data used in this study consumption seem, nevertheless, to be common denomi- is not available for other researchers. nators in the transition to higher education and student life around the world, and have been reported in countries Authors’ contributions such as the US, UK, and Denmark [1, 3, 41, 42]. In addition, SP, EKE, TT, CSA, and ØV designed the study. EKE, SP, and TT collected the data. EKE analysed the data. All the authors have participated in the alcohol habits are getting increasingly homogenous inter- manuscript preparation and approved the final manuscript. nationally, and the traditional borders between “wet” and “dry” cultures appear to be evaporating [5, 6]. From this Ethics approval and consent to participate perspective, the findings from the current study may be All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and relevant for understanding initiation rituals to higher educa- national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). tion in other student populations as well. Informed consent was obtained from all participants for being included in the study. The study protocol was approved by the Regional Committee for Medical and Health Related Ethics, Western Norway (no. 2015/1154). Conclusion Some students may feel excluded from initiation rituals Consent for publication and certain individuals seem to be especially vulnerable Identifiable information and details have been removed from this manuscript to experiencing adverse effects of drinking during to ensure anonymity so that the consent to publish is not applicable. 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Substance Abuse Treatment, Prevention, and PolicySpringer Journals

Published: May 29, 2018

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