1. HAZARDOUS ALCOHOL USE AND CULTURAL ADJUSTMENT AMONG U.S. COLLEGE STUDENTS ABROAD IN ITALY Michael A. Mitchell, MA VA Pittsburgh’s Interdisciplinary Program Addictions Education and Research (“VIPER”) VA Pittsburgh Healthcare System, Pittsburgh, PA Co-authors: Poyrazli, S. & Broyles, L.M.

2. Disclaimer The views expressed in this presentation are those of the authors and do not necessary reflect the position or policy of the Department of Veterans Affairs or the United States government.

3. Acknowledgements Funding This material is based upon work supported by the Office of Academic Affiliations (Mitchell), Health Services Research and Development (Broyles, CDA 10-014) and with resources and the use of facilities at VA Pittsburgh Healthcare System. Authors have no conflict of interest to disclose. 3

4. Background Italy a top destination for U.S. college students studying abroad Staff, international news provide anecdotal accounts about the severity and types of alcohol-related problems Students with hazardous alcohol consumption (e.g., binge drinking) may experience direct/indirect adverse consequences Heavier drinkers more intentions to go abroad, may be responsible for “transporting” cultural norm

7. Purpose Assess the prevalence of hazardous alcohol use and recent binge drinking in a sample of U.S. college students studying abroad in Italy Identify the relationships between drinking and cultural adjustment Determine which sociocultural factors predict binge drinking

8. Design and Methods Cross-sectional, web-based survey Students studying abroad in Italy between 2012-2013 2 institutions from Northeast U.S. Convenience sampling recruitment procedures with study abroad advisors as gatekeepers

9. Alcohol Misuse Hazardous alcohol consumption Alcohol Use Disorders Identification Test (AUDIT) Cut-off score >8 Binge drinking Gender-specific item (>5 drinks/male, >4 drinks/female) Saunders J. B., Aasland, O. G., Babor, T. F., de la Fuente, J. R., & Grant, M. (1993). Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption — II. Addiction, 88, 791-803.

10. Cultural Adjustment Pedersen, E. R., Neighbors, C., Larimer, M. E., & Lee, C. M. (2011). Measuring Sojourner Adjustment among American students studying abroad. International Journal of Intercultural Relations, 35(6), 881-889. Sojourn Adjustment Measure (SAM) 24 items, 7-point Likert scale (Strongly disagree  Strongly agree) FactorExample Social interaction with host nationals Had meaningful social interactions with local people Cultural understanding, participation Actively tried to learn more about local customs, traditions in my host country Language development, use Used my host country’s language (or dialect/idioms) to communicate with local people Host culture identification Behaved in ways that are typical of members of my host country Social interaction with co-nationals Socialized a good deal with other Americans Homesickness or feeling out of place Felt sad or depressed about being far from home

11. Analysis Descriptive statistics Bivariate analyses for correlations Logistic regression

12. Sample Characteristics Demographics (n= 111) Female76% Age, mean (SD)20.17 (1.06) White/Caucasian91% Heterosexual96% Single67% Location Rome47% Florence38% Junior year51%

13. Hazardous Alcohol Use AUDIT score, Mean (SD) (Range)8.02 (4.85) (1-22) Male9 Female6 % with AUDIT >846% Binge Drinking % Binge Drinking63% Male65% Female63%

14. Associations between Alcohol Use and Cultural Adjustment Binge drinking associated with: Hazardous alcohol use (r =.62**) Social interaction with American peers (r =.42**) Social interaction with Italian nationals (r =.21*) Social interaction with American peers associated with: Hazardous alcohol use (r =.30*) Host culture identification (r =.32*) * p <.05, ** p <.001

15. Predictors for Binge Drinking Abroad Students socializing with American peers while abroad had a 19% increase in the odds of binge drinking (Factor 5) (OR = 1.192, CI = 1.087 - 1.306, p =.000) Socializing with American peers was the only variable factor in the multivariable model that predicted binge drinking

16. Discussion Sizeable proportion students self-reported recent binge drinking Nearly half considered hazardous drinkers Binge drinking and hazardous alcohol use linked to socializing with American peers Social interaction with peers associated with greater understanding Italian culture

17. Implications Alcohol education Partnerships with local community about cultural awareness Alcohol intervention/research Partnerships with regional study abroad organizations for further research, evaluation Qualitative and mixed-method research studies for more in-depth understanding Vulnerable student groups, e.g. student veterans, women

18. Contact Information Michael A. Mitchell, MA Michael.mitchell10@va.gov VA Pittsburgh Healthcare System (VAPHS) University Drive (151C), Building 30, 2 nd Floor Pittsburgh, PA 15240 412-360-2139 (office)

19. Cafe500

20. “Nella fabrrica delle notti shot degli americani” http://corrierefiorentino.corriere.it/firenze/notizie/cronaca/2 010/26-aprile-2010/nella-fabbrica-notti-shot- 1602906420327.shtml http://corrierefiorentino.corriere.it/firenze/notizie/cronaca/2 010/26-aprile-2010/nella-fabbrica-notti-shot- 1602906420327.shtml