Factors Associated with College Students\u27 Excessive Alcohol Consumption Within the Occupational Therapy Practice Framework: an Epidemiological Analysis

OBJECTIVE: The purpose of this study was to estimate the relative influence of predictor variables on excessive alcohol consumption among college students for providing effective prevention and intervention. Also, this study suggests the roles of occupational therapy in Health promotion and Well-being. METHOD: The data from 7,166 college students (3,176 males, 3,990 females) aged between 18 - 25 years from the 2012 National Survey on Drug Use and Health (NSDUH) conducted by the US Department of Health and Human Services was used. Two criterion variables, binge drinking and heavy drinking, were used as indicators of excessive alcohol consumption. There were 12 predictor variables within four Context and Environment classifications as described by the Occupational Therapy Practice Framework (OTPF): Domain and Process (AOTA, 2008a). Multiple logistic regression analyses were conducted to estimate associations between excessive alcohol consumption and predictor variables, adjusting for other predictor variables. Hierarchical Regression was conducted stepwise in four Context and Environment classifications. RESULTS: Perceived risk of excessive drinking and importance of religious beliefs were strong negative predictors of excessive alcohol consumption. The Cultural classification provided the largest influence on excessive alcohol consumption in both males and females. The second largest classifications influencing binge drinking differed based upon gender. Personal classification was the second largest one for males, while Temporal classification was the second largest one for females. Occupational therapy can play significant roles in Health promotion and Well-being by helping people to actively engage in their meaningful occupations. CONCLUSION: Cultural factors among college students should be managed to prevent excessive alcohol consumption among them. Occupational therapists can provide prevention programs by using knowledge on the OTPF: Domain and Process

Tobacco Policy Influence on Denormalisation of Smoking

The social norms concept provides a fresh basis for thinking about how public health policies and campaigns impact health behaviour. Social norms offer much promise to the field of public health, nonetheless, the potential role of norms in changing health behaviour have not been fully embraced. This thesis demonstrates that one of the mechanisms by which national level policies (e.g. tobacco control) can promote health behaviour change, such as an increase in quit intentions, is by making smoking less normative and an undesirable behaviour. This study is vital as it provides a broad conceptualization of tobacco denormalisation and shows how its reasoning is able to influence normative beliefs and smoking behaviour. A review of literature was carried out to establish the generic origins of denormalisation as well as demonstrate that this approach (i.e. social norms) has been widely adopted in schools and college settings to influence health behaviour. As a broader perspective of this thinking was imperative to address public health issues at a societal level, tobacco control was employed to investigate how individual polices influence behaviour and normative beliefs. The research methodology used was pluralistic in nature, given that the majority of past tobacco control policy studies employed either quantitative or qualitative methods. Thus adopting both methods a richer amount of data would be obtained in order to generate an improved understanding of how public policy affects norms and smoking behaviour. To empirically examine the relationship between public policy, social norms and smoking behaviour a broad conceptualization was developed to investigate the normative pathways between national level tobacco policy effects on youth and adults’ smoking behaviour. Quantitative results from the longitudinal study, the International Tobacco Control (ITC) Scotland/UK survey, indicate that a comprehensive smoke-free law that covers, without exception, an entire nation (i.e. Scotland) has increased adult smokers’ perceived social unacceptability of smoking, to some extent higher in Scotland than rest of the UK which, in turn, is associated with quit intentions at follow-up, in both countries. The examination of data from the UK Youth Tobacco Policy Study (YTPS) also demonstrated that the influence of tobacco marketing awareness on adolescents’ smoking intentions is mediated by perceived norms. Prior to the enactment of the UK Tobacco Advertising and Promotion Act (TAPA), higher levels of awareness of tobacco advertising and promotion were independently associated with higher levels of perceived sibling approval which, in turn, were positively related to smoking intentions. Independent paths from perceived smoking prevalence and benefits fully mediated the effects of advertising and promotion awareness on intentions, during and after the enactment of the TAPA. Results from the qualitative study generally supported the quantitative findings and provided new insights into how adolescents’ normative beliefs and smoking behaviour are influenced by tobacco control policies. The qualitative group discussion suggests that smoke-free legislation and anti-smoking ads influence perceptions of prevalence, acceptability and smoking behaviour. A number of theoretical implications were presented, including the belief that social norms campaigns and interventions must be focal and salient in individuals’ consciousness so as to effect the desired behaviour change. A theoretical framework of the various normative mechanisms should consequently be integrated into tobacco control policies and norm-based interventions to work in a synergistic manner to influence health-related behaviour. Practical implications of this conceptualization include the view that, instead of public health interventions focusing on conventional approaches (for example, scare tactics), an appropriate strategy would be to incorporate specific information that corrects normative misperceptions and ambiguities among referent populations at individual and societal levels, with consequential normative and health behaviour change. It is recommended that future research employing tobacco industry perceptions and possibly a descriptive norm as additional normative mediators, aside from unacceptability, would be of value to examine whether smoke-free legislation influences quitting partly via changing favourable tobacco industry perceptions, social acceptability of smoking and perceived prevalence of smoking. To sum up, the findings demonstrate that societal level policy measures such as smoke-free legislation and the TAPA are critical elements of a comprehensive tobacco control program that can significantly influence adult smokers’ quit intentions and reduce adolescents’ smoking intentions respectively, by signifying smoking to be less normative and to be socially unacceptable