Situational and contextual factors that increase the risk of harm when students drink: Case-control and case-crossover investigation

Introduction and Aims. Better understanding of the circumstances of alcohol-related adverse events experienced by university students could identify opportunities for prevention. We aimed to identify situational and contextual factors associated with unintentional injury, assault, unsafe sex, sexual assault and drink-driving/riding amongst university students. Design and Methods. We conducted a Web-based survey of full-time students aged 17-25 years at five New Zealand universities (n = 2683) and carried out between-and within-subjects comparisons (case-control and case-crossover, respectively) of situational and contextual characteristics of events in the last seven days and control drinking occasions. Results. The response fraction was 49%. For the seven days preceding the survey, 4.9% of women and 7.4% of men reported at least one of the defined events while they were drinking or soon after. The number of drinking locations and getting drunker than expected were strongly associated with risk of an event in both case-control and case-crossover models, independent of consumption. Total number of drinks, drinking later and into the morning, and drinking with close friends were also associated with increased risk in the case-control analysis. No gender difference was seen after controlling for drinking and contextual factors. Discussion and Conclusions. Strategies to reduce the duration and volume of alcohol consumption, including earlier closing of licensed premises, should be considered as countermeasures for alcohol-related adverse events. The use of two different comparison groups for the circumstances of adverse events when drinking can strengthen inferences about the contribution of contextual factors.