DRUNKOREXIA and COLLEGE STUDENTS by Jennifer Anne Miller Drinking and Eating

ABSTRACT

WHEN CHOOSING TO PUT ALCOHOL BEFORE FOOD: DRUNKOREXIA AND COLLEGE STUDENTS

by Jennifer Anne Miller

Drinking and eating behaviors continue to be issues on college campuses. Overall, the results from this study did not yield supporting data for drunkorexia. However, it still brings to light that more studies should be done to investigate the relationship between disordered eating and alcohol consumption behaviors. Upon review of the data, several aspects stand out besides not identifying drunkorexia in this data set; the first being that no gender difference was seen between men and women in the many ways drunkorexia was assessed. Giles et al. (2009) reported a difference in men and women -- finding that women were are higher risk for memory loss, being injured, or being taken advantage of sexually, while men were more likely to get into physical fights. The pressure of college may bridge the gap between men and women when it comes to eating and alcohol consumption behaviors. The current study failed to find a difference between men and women. Additional research is needed.

WHEN CHOOSING TO PUT ALCOHOL BEFORE FOOD: DRUNKOREXIA AND COLLEGE STUDENTS

A Thesis

Submitted to the

Faculty of Miami University

in partial fulfillment of

the requirements for the degree of

Master of Science

Jennifer Anne Miller

Miami University

Oxford, Ohio

2016

Advisor: Rose Marie Ward

Reader: Patricia Troesch

Reader: Mark Walsh

This thesis titled

WHEN CHOOSING TO PUT ALCOHOL BEFORE FOOD: DRUNKOREXIA AND COLLEGE STUDENTS

Jennifer Anne Miller

has been approved for publication by

College of Education, Health, and Society

and

Department of Kinesiology and Health

______Rose Marie Ward, PhD

______Patricia Troesch, MA

______Mark Walsh, PhD

Table of Contents Page Chapter 1: Introduction 1 Alcohol and College Students 2 Eating Disorders and College Students 4 Overlap Between Eating Disorders and Alcohol 5 Clinical Samples 5 College Settings 6 A New Trend -- Drunkorexia 7 Research Questions 9 References 10 Chapter 2: Research Methods 13 Participants 13 Procedure 13 Measures 14 References 15 Chapter 3: Results 18 Chapter 4: Conclusion 20 References 22 Appendix A: Consent Form 23 Appendix B: Demographic Variables 25 Appendix C: Alcohol Frequency Variables 28 Appendix D: Drunkorexia Scale 29 Appendix E: Rutgers Alcohol Problem Index 31 Appendix F: Eating Attitudes Test 32 Appendix G: Debriefing Sheet 33

iii

List of Tables Page Table 1. Participant Demographics 17

Chapter 1: An Examination of Drunkorexia and Its Relationship with Alcohol-Related Negative Consequences Alcohol consumption has a long standing research history. Everything from how if physiologically effects the body, to the social implications has been researched (Sullivan et al., 2010; Wechsler et al., 1994). Alcohol use has also been examined over a variety of age groups, one of which being college students, specifically the implications that alcohol can have on college students. Alcohol can affect grades, contribute to students getting in trouble with the law, and even play a part in unwanted sexual encounters (Wechsler et al 1994, 1995, 2000). With such negative impacts for college students, it is important to further understand their motives for drinking and participate in a drinking culture to better programs and information available to help prevent negative consequences from drinking in the future. Eating disorders can also be a topic of concern on college campuses due to the increase risk of eating disorders during adolescent year (Budd, 2007). Many times the pressures of going to college for the first time and trying to fit into a new environment can have detrimental effects on the eating habits of college students. New environmental factors, such as Greek life, and new peer groups in may also contribute to the development of eating disorders, or disordered eating on college campuses (Giles et al., 2007). Students may perceive that they are overweight and feel the need to change their appearance in order to better fit in (Eisenberg et al., 2011). A healthy diet is imperative to keep the body functioning properly, and without it, grades, self-esteem, and overall wellbeing can suffer. Educating students on the dangers and consequences of eating disorders or disordered eating can help them make better life choices while they are away from home for the first time. Alcohol consumption and disordered eating can have detrimental consequences when combined. If students fail to consume calories before partaking in a night of drinking, they may be more likely to experience blacking out, as well as experience unwanted sexual experiences. The term that is being used to describe the combination of the disordered eating and alcohol consumption is Drunkorexia (Burke et al., 2010; Giles et al., 2009). It is a term that is fast gaining recognition in the past few years as a slang term on college campuses (Jennings, 2010; Kershaw, 2010). Students may have different reasons for not eating before drinking including saving money, getting drunk faster, and saving calories, but practicing such a habit is not good

1 for one’s health and students should be aware of the consequences of their behaviors (Burke et al., 2009; Giles et al., 2009). Alcohol and College Students Alcohol continues to be a topic of concern on many college campuses. This concern is due in part to alcohol consumption’s role in many dangerous behaviors among college students, including engaging in unplanned sexual behaviors, getting into fights, and getting injured (Wechsler et al., 1994). More specifically, these behaviors have been linked to higher levels of alcohol consumption or binge drinking, which has been defined as at least five drinks in a row for men and four drinks in a row for women (Wechsler et al., 2002). In a landmark study, Wechsler and colleagues (1994) examined the rates of binge drinking on college campuses. Surveys were sent out to one hundred and forty U.S. colleges, collecting data from 17,592 college students. It was estimated that 44% of the college students were binge drinkers according to the aforementioned definition, and that 19% of the students were frequent binge drinkers. Frequent binge drinkers were seven to ten times more likely than non-binge drinkers to have unprotected sex, engage in unplanned sexual activity, and get in trouble with the law. In addition, men were more likely to binge drink than women. This study helped shed light on the extent of binge drinking on college campuses, and the problems that can be associated with it. It seems that more males report drinking alcohol, and more males participating in binge drinking; however, there are a growing number of women that are drinking alcohol, and binge drinking (NCASA, 2007). In 2005, 83% of students drank alcohol in the last month, and 40.2% participated in binge drinking. These statistics alone are enough to bring attention to the extent alcohol is present on a college campus. Even more concerning is the idea that 41% of males and 34% of females admitted to drinking at or above what is considered binge drinking. From the same study in 2005, it was noted that 82.4% of college men reported drinking in the past year, and 70.5% reported drinking in the past month. That is in comparison to the 83.4% of college women who reported drinking in the past year and the 66.4% who reported drinking in the past month. Another study that supports the high rate that men and women consumption of alcohol was done by O’Malley and Johnson (2002). According to O’Malley and Johnson (2002), two out of every five students could be termed as binge drinkers. With respect to gender differences, this study also found that men and women had difference in consumption. Approximately, 73% of

2 men drank in the past month, compared to 67% of women. When comparing the statistics of having five or more drinks at once, 50% of men and 34% of women seem to participate. With such a high prevalence rate of alcohol consumption on college campuses, the consequences of that drinking need to be examined. College student’s consequences of drinking can span anywhere from losing personal belongings to being physically injured (NCASA, 2007). If students perceive these consequences to be severe they may be deterred from drinking in the future, however if the consequences experienced aren’t considered negative, it may have no effect on drinking behaviors (Park, 2004). Students may not perceive consequences of drinking alcohol to be negative (Mallett et al., 2011). Some students may feel that drinking consequences can be positive, such as being more sociable, or feeling more relaxed after drinking alcohol (Lee et al., 2010). For example, those who drank more on a daily basis perceived more positive fun and social consequences than negative ones. In addition, one study found that students who rated consequences as more positive than negative drank on more days and drank an increased amount of alcohol compared to those who rated more negative consequences than positive (Patrick et al., 2011). Another study by Park et al. (2005), found that men and women both reported experiencing more positive alcohol related consequences more frequently than negative alcohol related consequences. It was reported that the most frequently reported positive consequences were feeling related and forgetting about school problems. Finally, Mallett et al. (2011) determined that no consequence was unanimously reported as negative, and even some of the students rated hangovers as a positive consequence. These feelings of having more positive consequences can mask some of the issues that can arise with the negative consequences of drinking. In the literature, negative consequences of drinking can fall in a wide range from being hung over, to missing class, to being sexually assaulted or arrested (Weschler et al., 1994, 1995, 2000). The prevalence of such consequences has been looked at by numerous studies. For example, Wechsler et al. (1994) found that binge drinkers were seven to ten times more likely to experience consequences such as having unprotected sex, getting into trouble with police or getting hurt or injured. Additionally, frequent binge drinkers were more likely to report driving while under the influence. In a similar study conducted by Wechsler and colleagues, it was again seen that binge drinkers were more likely to experience consequences of drinking alcohol (Weschler et al. 2000). Occasional binge drinkers were five times as likely to experience

3 consequences, than nondrinkers; frequent binge drinkers were 21 times more likely to experience alcohol related problems than nondrinkers. Eating Disorders and College Students College students not only face the pressures of drinking, but can also face the pressures of maintaining a certain body image. Eating disorders and disordered eating can be an issue on college campuses. There are three main categories of eating disorders as defined by the Diagnostic and Statistical Manual (DSM-IV, 1994). The first is Anorexia Nervosa, which is when an individual does not maintain a normal body weight, and is fearful of gaining weight. Those with Anorexia Nervosa also have a poor perception of the shape and size of his or her body, and women with Anorexia Nervosa also exhibit amenorrhea. The second eating disorder is Bulimia Nervosa, which is defined as binge eating and compensating for that eating in inappropriate ways to avoid gaining weight at least twice a week for three months. Those individuals with Bulimia Nervosa tend to be ashamed of their eating and try to conceal their habits. The third eating disorder is the Eating Disorder Not Otherwise Specified, which is a category that includes eating disorders that no not meet the prior two criteria. Such examples of an Eating Disorder Not Otherwise Specified include those who exhibit habits of anorexia nervosa, but are within normal body weight, or have regular menses. It can also include those who meet the criteria for Bulimia Nervosa, but do it less frequently than twice a week for three months (DSM-IV, 1994). Currently the lifetime prevalence rates according to the DSM-IV (1994) for Anorexia Nervosa, are 0.5%-1.0%. The onset for Anorexia Nervosa is around 17 years of age, and can often times be associated with a stressful life event such as starting college. When looking at the prevalence of Bulimia Nervosa, it is seen mostly in adolescent and young adult females around 1-3%, and in males it is about one-tenth of that. Given the breadth of the definition, there are no prevalence rates given by the DSM-IV for Eating Disorder Not Otherwise Specified. Prevalence of these eating disorders is mostly seen in adolescents and young adults, so it is important to take a closer look at the rate of these eating disorders on college campuses, where the stress of a new environment can trigger an eating disorder. It is suggested that as many as 13.5% of undergraduate females and 3.6% of undergraduate males were positively screened for symptoms of eating disorders in one study (Eisenburg et al., 2011). In the same study, it was seen that about 4% of females and .2% of males reported having received an eating disorder

4 diagnosis. Eisenberg and colleagues used the SCOFF screening which is a 5-item questionnaire to identify the likelihood that a subject as an eating disorder, a positive indication on three of the questions suggests a higher likelihood of an eating disorder. The two most commonly responded to questions were “Do you believe yourself to be fat when other’s say you are thin?” and “Do you worry you have lost control over how much you eat?” (Eisenburg et al., 2011). There are many different ways in which students may change their eating habits to achieve a perceived goal weight or to look a certain way. In one study that examined 185 college females of a variety of different BMI measurements, 83% said that they dieted to lose weight, and 80% of them used physical activity for weight loss. Some of the different ways that were reported for dieting were eating less than they wanted to, using artificial sweeteners, and skipping breakfast (Malinauskas et al., 2006). What is important to note is that without dieting practices, these students felt they would weigh more than their current weight, and that using items such as artificial sweeteners may have health effects in the long run. Another study that examines different ways that women may restrict their calories or diet was done by Rideout (2004). In the study, the women were provided with different food choices for 24 hours and were observed as to what choices they made. Women who had been categorized as high restraint eaters by a previous questionnaire were seen to consume less fat and over all calories than the women classified as low restraint. This study was done during a normal day for the college women, and is an example of some of the restrictive behaviors that may be seen in those concerned about physical appearance.

Overlap of Eating Disorders and Alcohol Clinical Settings. Whereas there have not been studies to show the relationship between restricting calories and binge drinking, there are many examples of a possible relationship between eating disorders and alcohol abuse. Clinical settings are one place that this relationship has been observed. One example the frequency of eating disorders and disordered eating behaviors among women who were alcohol dependent has been examined (Clark. 1997). In a sample of 25 Caucasian women between the ages of 20 and 40 years seeking treatment for alcohol dependence, Clark (1997) used the Eating Attitudes Test (EAT-26) and structured interviews to obtain the information. The study found that 40% of the women reported a history of self-induced vomiting after eating, and that 32% of the women reported excessive exercise in

5 order to lose weight. The results of the study suggest that there might be some common ground for eating and alcohol behaviors. Moreover, Phil et al. (1986) examined the incidence and type of eating disorders that could possibly correlate a pattern between eating and drinking, specifically bulimia. This study took females between the age of 15-45 that had been diagnosed as an alcoholic and interviewed them about their eating behaviors. The definition for bulimia in this study was “binge eating usually ended in vomiting, pain, or sleep, and displaced a normal structured meal pattern associated with it must be a feeling of losing control and usually a dysphonia also; the total being described by the patient as disturbing. This eating pattern must be present for at least 6 months.” (Phil et al., 1986). Twenty-seven women were interviewed and had a mean age of 32. Seven women at the time of the interviews reported binge eating, and four of the women described a past history of it. Of the total 12 women that reported binge-eating behavior, 11 reported vomiting to prevent weight gain. This study found 40% of the sample to be binge eaters, and might suggest a relationship between eating and drinking pathologies. Whereas Phil et al. (1986) and Clark (1997) found there to be some possible correlations between the two behaviors, Bulik et al. (1994) did not find significant differences in women who had a history of alcohol abuse and those who did not have a history of alcohol abuse when looking at eating disorders. Bulik and colleagues looked at the difference in clinical characteristics and temperament in impatient woman with bulimia nervosa with and without comorbid alcohol abuse. Thirty-two women who were admitted to an impatient eating disorder unit with a history of bulimia nervosa were examined. The DSM-III-R was used to determine if the women had bulimia nervosa, as well as if they had a history of alcohol abuse. College Settings. Along with studies looking at the overlap of eating disorders and alcohol in clinical settings, studies have examined the prevalence in college settings. Dunn (2002) examined college females that met the DSM-IV (1994) criteria for Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder, and the related consequences of alcohol. Eating behaviors were assessed using the Eating disorder Diagnostic Scale, and drinking was assessed with questions that related to the participants typical drinking habits. The results of the study indicated that eating disordered females did not drink more frequently of in greater quantity than non-eating disordered females; however those females with possible eating disorders were more likely to have more severe alcohol related consequences.

Another study that examines the relationship between eating and drinking in college students examined dieting, binge eating, and alcohol use among first year female students at a Midwestern University (Krahn, 2005). The study broke down dieting categories into non-dieters, casual dieters, intense dieters, and at-risk dieters. The survey also asked questions regarding alcohol consumption including frequency, prevalence of heavy drinking, and prevalence of multiple consequences of drinking. The study found that in terms of diet behaviors 22% of the women were at risk dieters, 44% were intense dieters, 26% were causal dieters, and 8% were non-dieters. When looking at alcohol behaviors, it was found that 61% of the women had consumed alcohol within the past month prior to the survey, and 35% consumed alcohol weekly. In regards to negative consequences, the most commonly reported were drinking more than planned (22%), blackouts (13%), needing more alcohol to feel high (12%), and unwanted or unintended sex (12%). When comparing the relationship between dieting and drinking behaviors, it was seen that the risk of drinking among at risk dieters was 50% higher than that among non-dieters. It was also seen that intense and at-risk dieters were at significantly greater risk of reporting three or more negative consequences of alcohol use in the past 6 months. A New Trend -- Drunkorexia A new trend that is being seen has been given that name Drunkorexia, which describes someone who restricts food intake to reserve those calories for alcohol consumption that will occur in the near future. This term has been seen in news sources such as ABC, and the New York Times, and seems to be closely related to habits of those on college campuses (Jennings, 2010; Kershaw, 2010). There have been few studies that look at this phenomenon directly. For example, Giles et al. (2009) identified the prevalence and reasons for restricting calories on drinking days; the goal was to determine whether restricting calories on drinking days is associated with the frequency of getting drunk, and to examine if college students who do restrict calories on drinking days experience greater negative consequences. A survey was used to assess the amount of drinking the individuals partook in, and if they restricted calories on the days they drank. It was also asked if they did in fact restrict calories, in what way they did so, and how often. When looking at negative consequences, 6 items were used which included, doing something they later regretted, experienced memory loss, was hurt or injured, was involved in a physical fight, was taken advantage of sexually, and had unprotected sex. Approximately, 39% of the students that reported drinking in the past month also reported restricting food, fat, or

7 caloric intake. When examining the data by year of school, 40% of freshmen and sophomores, 36% of juniors, and 37% of seniors reported restricting before drinking. Another interesting aspect was that half of Greek pledges and 46% of Greek members restricted before drinking. Most students reported that the reason for restricting calories was for weight control, whereas a small portion reported that it was to get drunk faster. Finally, the consequences seen with drunkorexia are varied between men and women. For women, when restricting before drinking, there was an association with memory loss, being injured, being taken advantage of sexually, and having unprotected sex. It was also noted that women who did restrict their calories before drinking reported drinking less, but having more consequences. When looking at consequences for males, it was seen that restricting calories resulted in getting into physical fights. However, the Giles et al. (2009) used a limited alcohol-related negative consequence measure. The current study seeks to expand on the Giles’ study by using a more comprehensive Drunkorexia measurement and the standard measurement in the field to measure alcohol-related negative consequences (i.e., the Rutgers Alcohol Problem Index). Burke et al. (2010) also examined Drunkorexia. They examined the frequency of disordered eating behaviors specifically restricting caloric intake on days when heavy alcohol consumption was expected, looking specifically at freshman in college. The study consisted of a survey and interviews. The survey found that 14% of the freshmen reported restricting calories on the days they knew they were going to drink. The two main reasons for restricting calories were to avoid gaining weight, and to better feel the effects of alcohol. A smaller portion of the students were interviewed, and five main themes arose from the interviews. Those themes were; an increased ability to drink, prevention of being sick, forgetting to eat, not being hungry, and lacking money. The two most common responses were to prevent getting sick and to increase their ability to drink more. Only one student reported in the interview that they restricted calories to account for the extra calories in alcohol. Whereas initial investigations into the concept of Drunkorexia have been established, a comprehensive assessment of the behavior is needed. In addition, Giles et al. (2009) and Burke et al. (2010) did not examine the Drunkorexia behaviors in the context of eating disorders nor did they use the standard in the literature to examine alcohol-related negative consequences. The proposed investigation will examine the prevalence of Drunkorexia at a mid-sized Midwestern

8 university and will examine the relationship between drunkorexia and alcohol consumption, alcohol-related negative consequences, and eating disorder tendencies.

Research Questions Research Question One: In replication of the Burke et al. (2010) and Giles et al. (2009) studies, the current proposal seeks to examine the prevalence of drunkorexia habits at a mid- sized Midwestern University. Research Question Two: Consistent with gender differences in alcohol consumption (i.e., males tend to drink more than females, NCASA, 2007) and eating disorders (90% of people with eating disorders are female), it is anticipated that there will be gender differences on the drunkorexia behaviors as well. Research Question Three: In replication and extension of Giles et al. (2009), the current proposal will examine the relationship between drunkorexia and alcohol-related negative consequences utilizing comprehensive measures for both variables. Research Question Four: To extend our understanding of drunkorexia, the behaviors will be examined with respect to eating disorder tendencies and alcohol consumption behaviors.

References Budd, G. (2007). Disordered eating: Young women’s search for control and connection. Journal of Child and Adolescent Psychiatric Nursing, 20(2), 96-106. Bulik, C. M., Sullivan, P.F, McKee, M., Weltin, T. E., & Kaye, H. W. (1994). Characteristics of bulimic women with and without alcohol abuse. American Journal of Drug and Alcohol Abuse, 20 (2), 273-283. Burke, S., Cremeens, J., Vail-Smith, K., & Woolsey, C. (2010). Drunkorexia: Calorie restriction prior to alcohol consumption among college freshman. Journal of alcohol and drug education, 54(2), 17-34. Clark, K. (1997). Disordered eating behaviors and bone-mineral density in women who misuse alcohol. Western Journal of Nursing Research, 32, 32-55. Dunn, E., Larimer, M., & Neighbors, C. (2002). Alcohol and drug-related negative consequences in college students with bulimia nervosa and eating disorder. International Journal Eating Disorders, 32, 171-178. Eisenburg, D., Nickett, E., Roeder, K., & Kirz, N. (2011). Eating disorder symptoms among college students: Prevalence persistence, correlates, and treatment-seeking. Journal of American College Health, 59(8), 700-707. Giles, S. Helme, D., & Kcrmar, M. (2007). Predicting disordered eating intentions among incoming college freshman: An analysis of social norms and body esteem. Communication Studies, 58(4), 395-410. Giles, S.M., Champion, H., Sutfin, E.L., McCoy, T., & Wagoner, K. (2009). Calorie restriction on drinking days: An examination of drinking consequences among college students. Journal of American College Health, 57(6), 603-609. Jennings, A. (2010, October 21). Drunkorexia: alcohol mixes with eating disorders. ABC News. Retrieved from http://abcnews.go.com/Health/drunkorexia-alcohol-mixes-eating- disorders/story?id=11936398 Kershaw, S. (2008, March 2). Starving themselves, cocktail in hand. New York Times. Retrieved from http://www.nytimes.com Krahn, D., Kurth, C., Demitrack, M., & Drewnowski, A. (1992). The relationship of dieting severity and bulimic behaviors to alcohol and other drug use in young women. Journal of Substance Abuse, 4, 341-353.

Krahn, D., Kurth, C., Gomberg, E., & Drewnowski, A. (2005). Pathological dieting and alcohol use in college women- A continuum of behaviors. Eating Behaviors, 6, 43-52. Lee, C., Patrick, M., Neighbors, C., Lewis, M., & Tollison, S. (2010) Exploring the role of positive and negative consequences in understanding perceptions and evaluation of individual drinking events. Addictive Behaviors, 35, 764-770. Malinauskas, B., Raedeke, T., Aeby, V., Smith, J., & Dallas, M. (2006). Dieting practices, weight perceptions, and body composition: A comparison of normal weight, overweight, and obese college females. Nutrition Journal, 5(11), 1-8. Mallett, K., Bachrach, R., & Turrisi, R. (2008). Are all negative consequences truly negative? Assessing variations among college students’ perception of alcohol related consequences. Addictive Behaviors, 33,1375-1381. Mallett, K., Marzell, M., Varvil-Weild, L., Turrisi, R., & Guttman, K. (2011). One-time or repeat offenders? An examination of the patterns of alcohol-related consequences experienced by college students across the freshman year. Addictive Behaviors, 36, 508-511. O’Malley, P., & Johnston, L. ( 2002). Epidemiology of alcohol and other drug use among American college students. Journal of Studies on Alcohol, 14, 23-39. Park, C., & Grant, C. (2005). Determinants of positive and negative consequences of alcohol consumption in college students: Alcohol use, gender, and psychological characteristics. Addictive Behaviors, 30, 755-765. Patrick, M., & Maggs, J. (2011). College students’ evaluations of alcohol consequences as positive and negative. Addictive Behaviors, 36, 1148-1153. Rideout, C., McLean, J., & Barr, S. (2004). Women with high scores for cognitive dietary restraint choose foods lower in fat and energy. Journal of the American Dietetic Association, 104(7), 1154-1157. Sullivan, E., Harris, A., & Pfefferbaum, A. (2010). Alcohol’s effects on brain and behavior. Alcohol Research & Health, 33, 127-143. Wechsler, H., Lee, J., Kuo, M., & Lee, H. (2000). College and binge drinking in the 1990s: A continuing problem. Journal of American College Health, 48, 199-210. Wechsler, W., Davenport, A., Dowdall, G., Moeykens, B., & Castillo, S. (1994). Health and behavioral consequences of binge drinking in college. Journal of American Medical Association, 272(21), 1672-1677.

Wechsler, W., Dowdall, G., Davenport, A., & Castillo, S. ( 1995). Correlates of college student binge drinking. American Journal of Public Health, 85(7), 921-926.

Chapter Two: Research Methods Methods Participants The current study recruited college students (n = 254). They had a mean age of 20.36 (SD = 3.31). The majority of the students were female (69.7%, n = 177). Participants reported being Caucasian (90.2%), heterosexual (92.5%), not married (92.9%), with a mean GPA of 3.27 (SD = .44). A variety of academic majors were represented in the sample. The majority of participants indicated that they had had sexual intercourse (69.3%, n = 176); however, the majority of participants were not in a committed relationship (56.3%, n = 143). Approximately, 42.1% (n = 107) were members of Greek organizations with an addition 2.8% (n = 7) indicated that they intend on pledging a Greek Organization. Approximately 11% (n = 28) of the sample indicated that they participated in a varsity sport. With respect to receiving treatment for eating disorders, 1.6% (n = 4) reported receiving treatment. A majority of the participants reported that their parents were still married (71.7%) and well educated (Mother education – college or above, 68.1%; Father education – college or above, 73.2%). Additional sample demographics are in table 1. Procedure Participants for this cross-sectional study were recruited via a snowball method. The faculty adviser on the project sent out an email invitation to the study. The invitation contained a link to the online study and explained that the participants had approximately one week to complete the survey. Email invitations were posted on a variety of listservs, electronic course sites, and announced in class. Participants were eligible for extra credit in a select number of classes and for a random drawing for four $50 giftcards to local establishments. The primary author’s institutional review board approved all of the procedures. See appendix A and G for consent form and debriefing sheet. Measures Demographics. The participants completed a series of measures as part of a larger study, including a demographic information sheet (i.e., age, year in school, family income, ethnicity, sorority affiliation). See appendix B for a complete list of demographic questions. Alcohol Frequency Variables. Prior to answering questions about their alcohol behaviors, the following message was displayed “The following questions are about your use of

13 alcoholic beverages (beer, wine, wine coolers, malt liquor, hard liquor, mixed drinks, or shots). A drink is defined as one 12-ounce bottle of beer, one one-ounce shot of liquor, or a four-ounce glass of wine.” Several questions assessed alcohol consumption history (e.g., “Have you ever had a drink containing alcohol?” “How old were you when you had your first drink of alcohol?”). In addition, participants reported the highest drinking occasion in the last 30 days. See appendix C for a complete listing of the alcohol quantity frequency variables. Drunkorexia Scale. The Drunkorexia Scale (Burke, Cremeens, Vail-Smith, & Woolsey, 2010) was revised and expanded for the current investigation. It examines the behaviors of participants who restrict the amount of calories, fat, or food on days that they plan to drink. It also assesses the frequency of these behaviors. Participants are provided with the following scenario “It is a typical Saturday during the school year. You know that you are going to a party tonight and that you will be drinking. Which of the following best describes how you would most likely eat that day.” See appendix D for the questions. Rutgers Alcohol Problems Inventory (RAPI; White & Labouvie, 1989). The RAPI is a 23-item screening tool that identifies alcohol-related negative consequences in adolescent individuals. The participants indicate on a five-point scale from “Never (0)” to “Greater than 10 times (4)” that a problem incident has happened to them while drinking or as a result of their alcohol use in the last three years. Items in the scale include “Got into fights, acted bad, or did mean things” and “passed out or fainted suddenly.” Higher scores (scores are summated across items) suggest higher levels of problem drinking and alcohol-related negative consequences. See appendix E for the questions. Eating Attitudes Test (EAT; Garner, Olmsted, Bohr & Garfinkel, 1982). The EAT is a 26 item questionnaire used to measure abnormal eating habits and concerns about weight. Participants are asked to rate their intensity of attitudes and behaviors toward food and weight using response options from “never,” “rarely,” “sometimes,” “often,” “very often,” and “always.” The first factor concerning Dieting includes items such as “I am terrified about being overweight.” The second factor concerns Bulimia and a preoccupation with food (example item: “I vomit after I have eaten”). Finally, the third factor is Oral Control (example item: “Other people think I am too thin”) and measures the participants perceived control over eating and pressure from others to gain weight. This scale is scored with the responses involving never, rarely, or sometimes scored as zero, with responses of often, very often, and always scored as 1,

2, and 3 respectively. A score exceeding 20 is considered an indicator of an eating disorder problem.

References Burke, S., Cremeens, J., Vail-Smith, K., & Woolsey, C. (2010). Drunkorexia: Calorie restriction prior to alcohol consumption among college freshman. Journal of Alcohol and Drug Education, 54(2), 17-34. Garner, D., Olmsted, M., Bohr, Y., & Garfinkel, P. (1982). The Eating Attitudes Test: Psychometric features and clinical correlates. Psychological Medicine, 12(4), 871-878. White, H., & Labouvie, E. (1989). Towards the assessment of adolescent problem drinking. Journal of Studies on Alcohol, 50, 30–37.

Table 1. Participant Demographics Category Percent Year in School Freshmen 21.7 (n = 55) Sophomore 26.0 (n = 66) Junior 23.2 (n = 59) Senior 25.2 (n = 64) Super Senior (5th year) 2.0 (n = 5) Graduate Student 0.8 (n = 2) Ethnicity African American 4.3 (n = 11) Asian American 2.8 (n = 7) Hispanic 2.8 (n = 7) White (Caucasian) 90.2 (n = 229) Family Income Above $200,000 21.3 (n = 54) $150,001 - $200,000 8.7 (n = 22) $100,001 - $150,000 13.8 (n = 35) $75,001 - $100,000 8.7 (n = 22) $50,001 - $75,000 3.5 (n = 9) $25,001 - $50,000 7.1 (n =18) Below $25,000 3.1 (n = 8) Don’t know 21.3 (n = 54) Parents’ Marital Status Married 71.7 (n = 182) Divorced 19.3 (n = 49)

Chapter 3: Results All variables were examined for normality and tests of assumptions. Specificity, means, standard deviations, skew, and kurtosis were determined for all of the variables. In addition, all variables were correlated to examine the interrelationships between the constructs. Research Question One: The analysis examined the prevalence of Drunkorexia habits at a mid-sized Midwestern University. To examine this question, the Drunkorexia scale was scored in two manners. First, it scored according to the Giles et al. (2009) study (using only the original items). A Cronbach’s alpha was calculated to determine the internal consistency of the items. Second, it was scored utilizing the additional questions (i.e., restricting calories and fat items). A Cronbach’s alpha was calculated to determine the internal consistency of these items. Percentages and means were calculated for both scales (Drunkorexia and Drunkorexia Modified). These were contrasted with the values in the Giles et al. (2009) study. The Drunkorexia scale consisted of 2 items (A=.84) and the Drunkorexia modified scale consisted of 7 items. (A=.90) Research Question Two: It was anticipated that there would be gender differences on the Drunkorexia behaviors. Independent t tests (gender as the IV and Drunkorexia scales as the DV) assessed the gender differences on the Drunkorexia behaviors on the continuous items. For the categorical items, chi-square tests of independence assessed the gender differences. An independent t-test was conducted to evaluate the hypothesis that there would be a difference in gender and Drunkorexia behaviors on the continuous items. There was no significance found t(148)=.79, p=.43 (Male M = 14.48, SD = 6.65; Female M=13.60, SD=5.83). A chi-squared test was used to analyze gender and eating habits before a night of drinking. The percentage of participants that changed their eating habits before a night of drinking did not differ by gender, χ2 (2,n=160) = 1.69, p= .43. A chi-squared test was used to analyze gender and fat consumption habits before a night of drinking. The percentage of participants that changed their eating habits before a night of drinking did not differ by gender, χ2 (2,n=158) = .764, p= .682. A chi-squared test was used to analyze gender and eating habits before a night of drinking. The percentage of participants that changed their eating habits before a night of drinking did not differ by gender, χ2 (2,n=158) = .295, p= .863.

Research Question Three: The analysis examined the relationship between Drunkorexia and alcohol-related negative consequences (i.e., RAPI). The RAPI was scored according to the procedure outlined in White & Labouvie (1989). The continuous items from the Drunkorexia scale were correlated with the RAPI. Oneway ANOVAs examined the categorical Drunkorexia items (IV -- Drunkorexia items; DV -- RAPI score). A one way ANOVA was used to test for the relationship between drunkorexia food consumption behavior and alcohol-related negative consequences. Food consumption behavior was not significant across the three ways, F(2,149) =.88, p=.42. A one way ANOVA was used to test for the relationship between drunkorexia fat consumption behavior and alcohol-related negative consequences. Fat consumption behavior was not significant across the three ways, F(2,147) =.62, p=.54. A one way ANOVA was used to test for the relationship between drunkorexia calorie consumption behavior and alcohol-related negative consequences. Calorie consumption behavior was not significant across the three ways, F(2,147) =.25, p=.78.

Research Question Four: To extend our understanding of Drunkorexia, the behaviors were examined with respect to eating disorder tendencies and alcohol consumption behaviors. The EAT was scored according to the procedure outlined by Garner, Olmsted, Bohr & Garfinkel (1982). The continuous items from the Drunkorexia scale was correlated with the EAT and alcohol consumption items. Oneway ANOVAs examined the categorical Drunkorexia items (IV -- Drunkorexia items; DV -- EAT score or alcohol consumption items).

A one way ANOVA was used to test for the relationship between drunkorexia food consumption behavior and eating disorder behaviors. Food consumption behavior was not significant across the three ways, F (2,136) =2.8, p=.07 A one way ANOVA was used to test for the relationship between drunkorexia fat consumption behavior and eating disorder behaviors. Fat consumption behavior was not significant across the three ways, F (2,135) =3.5, p=.03 A one way ANOVA was used to test for the relationship between drunkorexia calorie consumption behavior eating disorder behavior. Calorie consumption behavior was not significant across the three ways, F (2,135) =4.3, p=.02.

Chapter 4: Conclusion Drinking and eating behaviors continue to be issues on college campuses. In contrast to Giles et al. (2009) and Burke et al. (2010), the results from this study did not yield supporting data for drunkorexia. The previous research was able to identify that drunkorexia mainly effected women. However, however it still brings to light that more studies should be done to investigate the relationship between disordered eating and alcohol consumption behaviors. Upon review of the data, several aspects stand out besides not identifying drunkorxia in this data set; the first being that no gender difference was seen between men and women in the many ways drunkorexia was assessed. Giles et al (2009), saw a difference in men and women, finding that women were are higher risk for memory loss, being injured, or being taken advantage of sexually, while men were more likely to get into physical fights. Part of this difference in data may be that there were nearly twice as many women polled as men, so there was not a large enough sample size of men to see a difference. The pressure of college may bridge the gap between men and women when it comes to eating and alcohol consumption behaviors. It was also not seen that people who practice drunkorexia behaviors have more or less alcohol related problems. Previous research (Giles et al 2009) have shown that there is a correlation to more alcohol related problems with those who practice drunkorexia. One consideration for the difference in results may have been that alcohol related problems were under reported by students taking the survey. Another consideration may be a difference in the interpretation of alcohol related problems from those completing the survey. It was discovered, in the data that people who change their eating habits on days that they plan to drink have higher disordered eating. The data captured this aspect and was seen in the instance of both restricting fat consumption and calorie consumption on drinking days. These results may suggest that underlying disordered eating can influence how individual may approach their relationship with alcohol as well. Further research should be done to evaluate if this is more closely related to drunkorexia than those who do not exhibit disordered eating along with alcohol consumption. In order to continue to evaluate drunkorexia, several aspects should be considered in future research. The first would be to look at eating and drinking behaviors through a larger

20 scope, where individuals may plan their entire week around their eating and drinking habits instead of just one day. Another aspect to examine would be using compensatory behaviors such as a change in exercise to compensate for drinking days. The current data set focused mainly on food, calorie, and fat restriction, but did not take into account the role that exercise could play in conjunction with those aspects. Overall, it is important to continue to evaluate the prevalence of eating and drinking disorders to have a better understanding of what may cause the disorders to occur. This knowledge may help many college organizations to inform students on the risks of drinking and eating disorders, as well as how to treat, and even prevent them from occurring.

References Burke, S., Cremeens, J., Vail-Smith, K., & Woolsey, C. (2010). Drunkorexia: Calorie restriction prior to alcohol consumption among college freshman. Journal of alcohol and drug education, 54(2), 17-34. Giles, S.M., Champion, H., Sutfin, E.L., McCoy, T., & Wagoner, K. (2009). Calorie restriction on drinking days: An examination of drinking consequences among college students. Journal of American College Health, 57(6), 603-609.

Appendix A: Informed Consent Form MULTIPLE HEALTH BEHAVIORS Dear Participant: You have been asked to take part in the research project described below. If you have any questions, please feel free to call Dr. Rose Marie Ward, the person mainly responsible for the study.

Description of the research: The purpose of the study is to gather information from students about issues of spirituality, alcohol use, eating behaviors, and behaviors displayed while intoxicated. You will be asked questions concerning your drinking consumption, academic entitlement, eating disorder tendencies, drinking motives, alcohol expectancies, drinking problems, and alcohol questions derived from the Transtheoretical Model. Although every effort will be done to ensure confidentiality of your responses, all Internet-based communication is subject to the remote likelihood of tampering from an outside source. IP addresses will not be investigated and data will be removed from the server.

1. YOU MUST BE AT LEAST 18 YEARS OLD to be in this research project.

2. Research procedures: If you decide to take part in this study, your participation will involve filling out a survey pertaining to issues of spirituality, academic entitlement, alcohol use, eating behaviors, and behaviors displayed while intoxicated. This survey will ask you about your motives and expected outcomes regarding alcohol use. Some questions will ask about your behaviors, specifically alcohol use history. In addition, some questions will ask about your personality.

3. Time required for participation: The survey will take approximately 40-50 minutes to complete.

4. Potential risks: The possible risks or discomforts of the study are minimal, although you may feel some embarrassment answering some of the questions about private matters. Participants might find that some of the questions that are related to behaviors while intoxicated might make them feel uncomfortable. In addition, some of the questions ask you to admit to potentially incriminating behavior. Resources are provided at the conclusion of this consent form. Previous participants have reported learning a lot about their health behaviors from reading these questions. While extremely unlikely, someone might try to identify you based on your demographic answers and link your identity to your survey responses. Data confidentially is of the utmost importance for this data collection. We are taking a number of steps to protect your responses.

5. Potential benefits: Although there are no direct benefits of the study, your answers may increase your awareness of issues that arise in college. Your answers will serve as a basis for understanding college student health behaviors in the literature. You will also be directed to an unconnected page that will prompt you for your contact information to be entered into a drawing for a chance to win a $50 gift card (The previous statement will not be shown to those getting EHS research pool credit). Your contact information and responses will not be linked.

6. Confidentiality: Your part in the study is confidential. That means your answers to all questions are private. No one else can find out what your answers are. Scientific reports (writing by Dr. Ward or one of her research assistants) will be based on group data and will not identify you or any individual as being in this project.

7. Voluntary participation: You do not have to participate and you can refuse to answer any question.

8. Compensation for injury: Participation in this study is not expected to be harmful or injurious to you. However, if this study causes you any injury, you should write or call Dr. Rose Marie Ward at (513) 529-9355.

9. Contact information: If you have questions about the study you can contact the investigator, Dr. Rose Marie Ward, 513-529-9355 or [email protected].

If you have any questions or concerns about your rights as a subject, you may contact Miami University's Office for the Advancement of Research and Scholarship, (513) 529-3600 or [email protected].

You are at least 18 years old. You have read the consent form and your questions have been answered to your satisfaction. Your filling out the survey implies your consent to participate in this study.

If these questions are upsetting and you want to talk, please use the phone numbers below: Miami University Student Counseling Service 529-4634 Psychology Clinic Psychology Building 529-2423 Community Counseling and Crisis Center 523-4146 Thank you, Rose Marie Ward, Ph.D. Principal Investigator

Appendix B: Demographic Variables 1. What year are you in school?

o Freshman (1st year) o Senior o Sophomore o Super Senior (5th Year) o Junior o Graduate Student o Non Matriculated 2. What is your academic major? 3. What is your age (in years)? ______years old 4. What is your gender? o Male o Female 5. What is your marital status? (check one)

o Married o Divorced o Not married, but living with partner o Widowed

o Not married o Don’t know

o Separated 6. What is your race? (Please check all that apply)

o Asian or Asian American o American Indian or Alaskan Native

o Black, African American or Haitian o White (Caucasian)

o Native Hawaiian or Other Pacific Islander o Other ______

6b What is your ethnicity?

o Hispanic or Latino (Latina) o Not Hispanic or Latino (Latina) 7. Have you had sexual intercourse (vaginal or anal)? o Yes o No 8. Are you currently in a committed romantic/dating relationship or marriage? o Yes o No 9. Do you participate in intercollegiate, NCAA varsity sports? o Yes, I am a o No member 10 Do you intend on pledging a sorority or fraternity or are you currently part of a sorority or fraternity? o Yes o Yes, I o No plan to pledg e 11 What is your height, in feet and inches? _____ feet _____ inches 12. What is your current weight in pounds? ______pounds Rate your happiness with your current weight Completely unhappy, somewhat unhappy, neither unhappy or happy, somewhat happy, completely happy I am currently seeking treatment for an eating Yes/No disorder 13. What is your current GPA? ______25

Completely heterosexual, mostly heterosexual, What is your sexual orientation equally heterosexual and homosexual, mostly homosexual, completely homosexual 14. Are both of your parents living? o Yes o No 15. Do you currently have a leadership position on No campus? o Yes o 16. Do you live with your…. (Please check all that apply) Father Mother o o o Other o Steps 17. What is your parents’ marital status?

o Married o Divorced, neither remarried o Separated o Parents never married o Divorced, one or both parents remarried o Other ______18. Are you currently in the military or ROTC?

Yes, the ROTC Yes, the military o No o o

19. What is the highest level of education your mother has obtained?

o Home schooled/Never attended o Some college o Some high school o College degree/ vocational degree o High school diploma/GED o Advanced degree (Masters, Specialist, Doctorate) 20. What is the highest level of education your father has obtained?

o below $25,000 o $80,001 – $100,000 o $25,001 – $50,000 o $100,001 - $150,000 o $50,001 – $65,000 o $150,001 - $200,000 o $65,001 – $80,000 o above $200,000

o don’t know 22. What is your mother’s income?

o below $25,000 o $80,001 – $100,000 o $25,001 – $50,000 o $100,001 - $150,000 o $50,001 – $65,000 o $150,001 - $200,000 o $65,001 – $80,000 o above $200,000 don’t know 23. What is your father’s income?

o below $25,000 o $100,001 - $150,000 o $25,001 – $50,000 o $150,001 - $200,000 o $50,001 – $65,000 o above $200,000 o $65,001 – $80,000 o don’t know o $80,001 – $100,000

Appendix C: Alcohol Frequency Questions The following questions are about your use of alcoholic beverages (beer, wine, malt liquor, hard liquor, or mixed drinks). A drink is defined as one 12 oz. bottle of beer, one 1 oz. shot of liquor, or a 4 oz. glass of wine.

1. Have you ever had an alcoholic beverage to drink? a. Yes b. No 2. In a typical week, on how many days do you have at least one drink containing alcohol? 3. How many drinks do you have on a typical day when you are drinking? 4. During the last 30 days, what is the highest number of drinks that you drank on any one occasion? 5. Please indicate how many drinks you have on average for each day of the week

Appendix D: Drunkorexia Scale (Modified) Consider this scenario: It is a typical Saturday during the school year. You know that you are going to a party tonight and that you will be drinking. Which of the following best describes how you would most likely eat that day. o I would eat the same amount as I normally eat on any Saturday. The fact that I knew I would be drinking that night wouldn’t change my eating behavior. o I would eat less than I normally eat if I knew I was going to be drinking that night. o I would eat more than I normally eat if I knew I was going to be drinking that night. Consider this scenario: It is a typical Saturday during the school year. You know that you are going to a party tonight and that you will be drinking. Which of the following best describes how you would most likely eat that day. o I would eat the same amount of FAT as I normally eat on any Saturday. The fact that I knew I would be drinking that night wouldn’t change my eating behavior. o I would eat less FAT than I normally eat if I knew I was going to be drinking that night. o I would eat more FAT than I normally eat if I knew I was going to be drinking that night. Consider this scenario: It is a typical Saturday during the school year. You know that you are going to a party tonight and that you will be drinking. Which of the following best describes how you would most likely eat that day. o I would consume the same amount of CALORIES as I normally consume on any Saturday. The fact that I knew I would be drinking that night wouldn’t change my eating behavior. o I would consume less CALORIES than I normally consume if I knew I was going to be drinking that night. o I would consume more CALORIES than I normally consume if I knew I was going to be drinking that night.

1. How often do you restrict eating before drinking in order to avoid gaining weight? (never, seldom, sometimes, often, very often) 2. How often do you restrict eating before drinking in order to feel the effects of alcohol better or more? (never, seldom, sometimes, often, very often) 3. How often do you restrict your fat intake before drinking in order to avoid gaining weight? (never, seldom, sometimes, often, very often) 4. How often do you restrict your fat intake before drinking in order to feel the effects of alcohol better or more? (never, seldom, sometimes, often, very often) 5. How often do you restrict your caloric intake before drinking in order to avoid gaining weight? (never, seldom, sometimes, often, very often) 6. How often do you restrict your caloric intake before drinking in order to feel the effects of alcohol better or more? (never, seldom, sometimes, often, very often) 7. How often do you restrict eating before drinking because of other reasons? Please explain. 8. How often do you intentionally eat before drinking so that you won’t be drinking on an empty stomach? (never, seldom, sometimes, often, very often)

Appendix E: Rutgers Alcohol Problem Index White, H.R. & Labouvie, E.W. (1989). Towards the assessment of adolescent problem drinking. Journal of Studies on Alcohol, 50, 30-37.

Different things happen to people while they are drinking ALCOHOL or because of their ALCOHOL drinking. Several of these things are listed below. Indicate how many times each of these things happened to you WITHIN THE LAST YEAR.

How many times did the following things happen to you while you were drinking alcohol or because of your alcohol use during the last year? 0- Never 1- 1-2 times 2- 3-5 times 3- 6-10 times 4- More than 10 times 1. Not able to do your homework or study for a test 2. Got into fights, acted bad, or did mean things 3. Missed out on other things because you spent too much money on alcohol 4. Went to work or school high or drunk 5. Caused shame or embarrassment to someone 6. Neglected your responsibilities 7. Relatives avoided you 8. Felt that you needed more alcohol than you used to use in order to get the same effect 9. Tried to control your drinking by trying to drink only at certain times of the day or certain places 10. Had withdrawal symptoms, that is, felt sick because you stopped or cut down on drinking 11. Noticed a change in your personality 12. Felt that you had a problem with alcohol 13. Missed a day (or part of a day) of school or work 14. Tried to cut down or quit drinking 15. Suddenly found yourself in a place that you could not remember getting to 16. Passed out or fainted suddenly 17. Had a fight, argument or bad feelings with a friend 18. Had a fight, argument or bad feelings with a family member 19. Kept drinking when you promised yourself not to 20. Felt you were going crazy 21. Had a bad time 22. Felt physically or psychologically dependent on alcohol 23. Was told by a friend or neighbor to stop or cut down drinking

Appendix F: Eating Attitudes Test Check a response for each of the following statements: (Always, Usually, Often, Sometimes, Rarely, Never) 1. I Am terrified about being overweight. 2. I Avoid eating when I am hungry. 3. I Find myself preoccupied with food. 4. I Have gone on eating binges where I feel that I may not be able to stop. 5. I Cut my food into small pieces. 6. I Aware of the calorie content of foods that I eat. 7. I Particularly avoid food with a high carbohydrate content (i.e. bread, rice, potatoes, etc.) 8. I Feel that others would prefer if I ate more. 9. I Vomit after I have eaten. 10. I Feel extremely guilty after eating. 11. I Am occupied with a desire to be thinner. 12. I Think about burning up calories when I exercise. 13. I Other people think that I am too thin. 14. I Am preoccupied with the thought of having fat on my body. 15. I Take longer than others to eat my meals. 16. I Avoid foods with sugar in them. 17. I Eat diet foods. 18. I Feel that food controls my life. 19. I Display self-control around food. 20. I Feel that others pressure me to eat. 21. I Give too much time and thought to food. 22. I Feel uncomfortable after eating sweets. 23. I Engage in dieting behavior. 24. I Like my stomach to be empty. 25. I Have the impulse to vomit after meals. 26. I Enjoy trying new rich foods.

Appendix G: Debriefing Sheet Research Description: Click on the link to be entered into the drawing for a $50 gift card. NOTE: The above link will not be shown for people taking the survey as part of the EHS research pool Thank you for helping us with our study. The purpose of the study is to gather information from students about issues of alcohol use, gender roles, leadership, and the Greek community. You were asked questions concerning your drinking consumption, eating behaviors, drinking motives, alcohol expectancies, drinking problems, and alcohol questions derived from the Transtheoretical Model. It is our hope that through the answers we get from you and others like you, we will begin to understand the issues surrounding college student health behaviors. Your answers provide us with a bridge to understanding these issues. Alcohol use among college students is a serious health concern on college campuses, especially heavy episodic alcohol consumption (Hustad et al., 2010). Approximately 40% of all college students engage in heavy episodic drinking, which is defined as consuming 5 for more drinks for men and 4+ for women in one drinking episode (Hustad et al.,2010). This type of behavior is related to a number of consequences, including academic difficulties, property damage, risky sexual activity, blackouts, alcohol poisoning, and death (Hingson et al., 2002; Jackson, Sher & Park, 2005; Wechsler & Isaac, 1992). Understanding the relationship between gender roles, leadership, the Greek community, and alcohol use may provide insight into this dangerous collegiate cocktail. Your answers can help us build intervention programs that decrease the likelihood of these outcomes. We appreciate your participation in this study. If these questions were upsetting and you want to talk, please use the phone numbers below: Miami University Student Counseling Service 529-4634 Psychology Clinic Psychology Building 529-2423 Community Counseling and Crisis Center 523-4146 If you would like more information concerning our theories, please read: Hustad, J.T.P., Barnett, N.P, Borsari, B., & Jackson, K.M. (2010). Web-based alcohol prevention for incoming college students: a randomized controlled trial. Addictive Behaviors, 35, 183-189. Kuntsche, E., & Cooper, M.L. (2010). Drinking to have fun and to get drunk: motives as predictors of weekend drinking over and above usual drinking habits. Drug and Alcohol Dependence, 110, 259-262. Schaus, J.F, Sole, M.L., McCoy, T.P., Mullett, N., & Bolden, J. (2009). Screening for high-risk drinking in a college student health center: characterizing students based on quantity, frequency and harms. Journal of Studies on Alcohol and Drugs, 16, 34-44. Steele, C.M., & Josephs, R.A. (1990). Alcohol myopia: its prized and dangerous effects. American Psychologist Association, 45 (8), 921-933.

If you have questions/comments, or if you are interested in getting information about the results, please call Dr. Ward at 529-9355 or e-mail [email protected]. Please print this for your records.