High-Risk Alcohol Consumption among University Student in Cameroon and its association with Psychological Status, Drinking Motives and Practices: A Cross- Sectional Study at the University of Dschang

High-Risk Alcohol Consumption among University Student in Cameroon and its association with Psychological Status, Drinking Motives and Practices: A Cross- Sectional Study at the University of Dschang | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article High-Risk Alcohol Consumption among University Student in Cameroon and its association with Psychological Status, Drinking Motives and Practices: A Cross- Sectional Study at the University of Dschang Laurie-Anne TEJIODONKENG KEUAGHO, Sylvain Raoul SIMENI NJONNOU, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7151859/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Context: Alcohol is the most widely consumed psychoactive and addictive substance in the world, contributing to increased global morbidity and mortality rates. High-risk alcohol consumption has become an increasingly significant public health problem in recent years, particularly among students. The aim of this study was to determine the prevalence of high-risk alcohol consumption and identify its determinants among students at the University of Dschang. Methods: A cross-sectional study was conducted on the main campus of the University of Dschang between January 2023 and May 2024. Students aged eighteen and over were selected using a two-stage cluster sampling, and data were collected using a self-administered electronic questionnaire. The primary outcomes of interest were alcohol consumption and high-risk alcohol consumption. Multilevel logistic regression investigated associations between these outcomes and key suspected predictors. Results: A total of 1,789 participants were enrolled in the study. The median age was 22 years (IQR: 20-24) and 916 (53.4%) were male. The prevalence of alcohol consumption was 67.9%, while the prevalence of high-risk alcohol consumption was 19.3%. Risk factors for alcohol consumption were Christianism (aOR 3.71 [95% CI 2.08-6.64]; p<0.001 ), living alone (aOR 6.97 [95% CI 4.23-11.5]; p<0.001 ), and depression (aOR 1.71 [95% CI 1.01-2.90]; p<0.05 ). Among alcohol consumers, factors such as depression (aOR 3.03 [95% CI 1.45-6.32]; p<0.001 ), and personal motives including enhancement(aOR 2.12 [95% CI 1.17-3.85]; p<0.005 ), conformity (aOR 1.91 [95% CI 1.19-3.06]; p<0.01 ) and coping (aOR 2.61 [95% CI 1.54-4.42]; p<0.001 ), were all positively associated with high-risk alcohol consumption. Conclusion: High-risk alcohol consumption is highly prevalent among the Cameroon's student population. Strategies to mitigate this trend should include promotion of behaviour change, prevention of psychological distress, and securing the living environment of students by restricting access to alcoholic beverages and encouraging parental responsibility. High-risk alcohol consumption Prevalence Determinants University of Dschang Psychological status Figures Figure 1 Figure 2 1. Background Alcohol is the most widely consumed psychoactive and addictive substance in the world. It is one of the primary contributors to global morbidity and mortality [ 1 ]. The health risks can be short-term, including intoxication and hazards, or long-term, mainly consisting of physical, social, and psychological disorders [ 2 ]. High-risk alcohol consumption refers to patterns of alcohol consumption that significantly increases the risk of negative consequences for both physical and mental health, necessitating attention and intervention of healthcare professionals; This includes consumption by individuals who should typically abstain from alcohol, such as children, pregnant women, or those with existing health conditions [ 3 – 5 ]. It is increasingly recognized that "whatever the quantity of alcohol being ingested, the risk to the health of the drinker is present from the first drop" [ 6 ]. High-risk alcohol consumption is a global public health problem, and one that has significantly increased in recent years [ 7 ]. Responsible for more than 200 health problems, it causes around 3.3 million deaths each year worldwide, representing 5.9% of all deaths (with a rate of up to 9% among young people aged 15 to 29) and the loss of 132.6 million disability-adjusted life years (DALYs) [ 8 ]. According to recent estimates, 283 million people aged 15 and over (i.e. 5.1% of the world's adult population) suffer from alcohol use disorders, and around 20.5% of all deaths among young people aged 20 to 39 years have been attributed to excessive alcohol consumption [ 9 ]. Many countries in sub-Saharan Africa have experienced rapid economic, social, and cultural transitions, which have contributed to a gradual increase in the level of alcohol consumption among drinkers since the beginning of the 21st century. Currently, alcohol consumption accounts for 5.1% of deaths in this region [ 10 – 12 ]. A notable example of this trend is seen in Central Africa, particularly in Cameroon, which was recognized in 2016 as the country with the highest rate of alcohol consumption; in that year, Cameroon exceeded 660 million litres of beer, representing almost four times its estimated consumption in the previous year. This results in a significant 7% prevalence of alcohol-related disorders in Cameroon, compared to the average of 3.7% in the African Region [ 13 ]. Alcohol consumption is particularly common among adolescents and young adults in Cameroon, with higher rates among students [ 14 ]. Despite Cameroon's legal regulations prohibiting the marketing of alcoholic beverages to minors and their advertisement in the vicinity of schools and universities, there has been a multiplication of drinking establishments around certain schools, with an increased promotion of alcoholic beverages [ 15 ]. Higher education presents students, mainly adolescents and young adults in their transition phase, with unique challenges leading some to use alcohol or other drugs [ 16 , 17 ]. Although much is known about rates of substance use among students worldwide, few representative studies have been conducted in Cameroon, with limited research into the factors explaining these rates. In Africa, the reported prevalence of alcohol consumption among higher education students varies from 2.6% in Sudan to 63.3% in Kenya [ 18 , 19 ]. The few studies carried out in Cameroon reveal a prevalence between 87.9% and 89.9% [ 20 , 21 ]. Potential factors predisposing students to alcohol consumption can be grouped into three main categories: socio-demographic and family factors, socio-psychological factors, and behavioral factors [ 22 ]. Some studies have shown that students subject to psychological distress or parental alcohol consumption increase their drinking frequency when exposed to the university environment [ 23 ]. Mental conditions such as stress, anxiety, and depression are important factors suspected of contributing to alcohol consumption and abuse among students [ 24 , 25 ]. Ranked among the top-performing universities in Central Africa, the University of Dschang attracts a variety of students with different backgrounds and socio-cultural characteristics [ 26 ]. In addition, the region has low temperatures, thought to contribute to higher alcohol consumption [ 27 ]. Since 2005, Cameroon has been working to strengthen its substance use prevention program [ 28 ]. Determining the rate of high-risk alcohol consumption and identifying the determining factors among students at the University of Dschang will help improve our knowledge of substance use disorders among students and provide policymakers with necessary evidence to better focus their efforts to combat this growing scourge. 2. Methods 2.1. Study design and setting We conducted a cross-sectional study that included an analytical case-control component. The study was carried out on the main campus of the University of Dschang, in the West Region of Cameroon, which has six faculties and two institutes. These are the Faculty of Letters and Social Sciences (FLSS), Faculty of Economics and Management Sciences (FEMS), Faculty of Law and Political Sciences (FLPS), Faculty of Sciences (FS), Faculty of Agronomy and Agricultural Sciences (FAAS), Faculty of Medicine and Pharmaceutical Science (FMPS), and the Fotso Victor’s University Institute of Technology (UIT) in Bandjoun and Institute of Fine Arts in Foumban (IFAF). In 2023, the institution had 19,971 students supervised by several research, teaching, and non-teaching staff. 2.2. Study period Data was collected from December 12, 2023, to March 12, 2024, for four months. 2.3. Participants 2.3.1. Selection criteria In this study, any student enrolled for the academic year 2023–2024 at the main campus of the University of Dschang, aged 18 or over, who agreed to participate in the study, and who owned a smartphone device, was included. We excluded those who had withdrawn consent to participate in the study or those who provided incomplete answers to the questionnaire regarding the main variables of interest. 2.3.2. Sample size determination The minimal required sample size was estimated based on Cochran's formula: N= 𝐙²×(𝟏-𝐏) 𝑬²; Where N = the sample size; Z = the confidence level desired for this study (for a 95% confidence level, z = 1.96); P = the estimated proportion of students who drink at risk (according to a recent study conducted in South Africa [ 7 ], p = 29.7%); E = the tolerated margin of error (which we set at 0.05 in this study). We therefore have: N= (1.96)2×0.297(1-0.297)/ (0.05) 2 N = 320.56 i.e. 321 participants. To take account of cluster sampling, we calculated the Design Effect: DE = 1 + r(m-1); Where r, the interclass correlation (based on prior studies [ 29 ], r = 0.020485); and m, the average size per cluster (m = 40). Thus obtaining: DE = 1 + 0.020485(40 − 1) = 1.799 For this design, we obtained N'= DE*N = 1.799×321 = 577.479 i.e. 577 participants. We also expected a non-response rate of 10%. Including it in the sample size calculation: 577 + 577×0.1 = 634.7 i.e. 635 . The final minimum sample size for the descriptive component was therefore 635 . 2.4. Data collection 2.4.1. Procedures After obtaining approval from the Vice-Chancellor of the University of Dschang and the Regional Human Health Ethics Committee, we carried out a random cluster sampling of our participants. First, we randomly selected three faculties (FMPS, FAAS, FEMS) out of the six on the main campus and five departments for each of these faculties. The first contact was made by telephone call to the department representatives to explain the study to them and request their assistance for the field visits. We then consecutively visited the rooms (clusters), each room corresponding to a single level of study within a specific program in each department, following their indicated availability. The visits generally happen during students' free time or breaks. Within each room, we surveyed the maximum number of students willing to participate in the study, within the limits of the allocated period. We continued this process in each faculty until the required number of students had been reached. Participants were asked to answer the questionnaire truthfully and honestly to reduce information bias. Priority was given to the health of the participants. Any participant with psychological distress or high-risk alcohol consumption detected during the interview was referred to the counselling unit on the main campus of the University of Dschang for ongoing support. All ethical issues concerning human research were strictly adhered to, and the information collected was used solely for research purposes. There was no risk to the participants in this study. The confidentiality of the participants was respected thanks to an anonymization technique that enabled a code to be assigned to each participant. The database containing the information was accessible only to the principal investigator, who was bound by professional secrecy. The results of the study were presented to the source population at a session organized at the University of Dschang, to which all participants were invited. 2.4.2. Measures The questionnaire included six sections, as follows: (note: the different instruments used in the questionnaire are described in greater details in an additional document [see Additional file 1]): a) Demographic and academic section It contains questions relating to sex, age, religion, living arrangement, marital status, monthly income, attended faculty, academic level, academic performance, parents' educational level and the level parental alcohol consumption assessed by the Children of Alcoholic Screening Test (CAST) [ 30 ] tool. CAST is a 30-item yes/no questionnaire used to identify individuals with alcoholic parents or relatives and understand the impact on their development. b) Alcohol Use Disorders Identification Test (AUDIT) AUDIT was used to screen and categorize students into abstainers, hazardous drinkers, harmful drinkers, and those with alcohol dependence. It is a self-administered, 10-item questionnaire using a 5-point Likert scale (0 = never to 4 = 4 + times per week) [ 31 ]. c) Depression, Anxiety and Stress Scale 21 (DASS-21) It is a 21-item questionnaire that assesses depression, anxiety, and stress through three subscales of 7 items each. Responses are rated on a 4-point Likert scale from 0 (does not apply at all) to 3 (applies most of the time) [ 32 ]. d) Practices related to alcohol consumption This section aimed to assess the types of alcoholic beverages consumed and how participants consume them, including their first drinking experience (age and place), preferred beverages, usual drinking settings and companions, use of other drugs, and their perception of alcohol. e) Drinking Motive Questionnaire- Revised-Short Form (DMQ-R-SF) The DMQ-R-SF, the most widely used tool to assess drinking motives in youth, includes 12 items rated on a 3-point scale (1 = never to 3 = almost always). It measures four motives: enhancement (seeking positive emotions), coping (managing negative emotions), social (enjoyment in social settings), and conformity (social pressure) [ 33 ]. 2.5. Cases and controls We formed three sets of cases and controls to examine the associations between our exposures and, first, alcohol consumption among students; second, high-risk alcohol consumption among students, and third, high-risk alcohol consumption among those who drink. In our first set, 455 cases were selected among participants who were alcohol consumers, i.e., who had consumed alcohol in the last twelve months (AUDIT score ≥ 1). Controls were selected among the abstinent participants (AUDIT score = 0). One control subject was selected for each case. In our second set, cases were participants who were high-risk alcohol consumers (AUDIT score > 7). Controls were selected among low-risk consumers and abstinent participants (AUDIT score [0–7]). Two control subjects were selected for each case. In our third set, cases were participants who were high-risk alcohol consumers (AUDIT score > 7). Controls were selected among low-risk alcohol-consuming participants (AUDIT score [ 1 – 7 ]). Two control subjects were selected for each case. For these three sets of controls, we selected using nearest neighbour matching by age (same strata by five years), sex (male or female), and cluster (58 clusters). None of the controls were matched to a case more than once. 2.6. Data management and analysis Submitted questionnaires were checked daily to ensure data completeness and accuracy. The generated database was saved on an external hard drive (to avoid data loss) and exported to Microsoft Excel (Office365®). All analyses were carried out using R statistical software (v4.3.2; R Core Team 2024). The analysis began by cleaning up the data and correcting any inconsistencies. Qualitative variables were summarized into frequencies and their proportions, while quantitative variables were presented as means (and standard deviation) or median (and interquartile range) where appropriate or categorized. The ‘survey’ package was used to take account of the clustering in the estimation of errors and confidence intervals. Chi-square tests for qualitative variables and Wald t-test (or Wilcoxon test if necessary) for quantitative variables were then used to compare the characteristics of cases and controls across our three case-control sets. The effects of factors associated with consumption, high-risk consumption, and high-risk consumption among consumers were identified using conditional logistic regression modelling, where all characteristics empirically linked to high-risk drinking and those that differed in comparisons showing p < 0.1 were included as adjustments in the respective models. For the first model, it included: religion, monthly income, mother's education, depression, anxiety, stress, parental consumption and living arrangement. For the second model: religion, monthly income, mother's education, depression, anxiety, stress, parental consumption and living arrangements. For the third model: monthly income, mother’s education, depression, anxiety, stress, parental consumption, living arrangement, usual place of consumption, the main source of alcoholic beverages, personal motive (such as enhancement, social, conformity, coping), age at the inaugural consumption, place of inaugural consumption, favourite type of drink, usual consumer’s company and perception of alcohol. A p < 0.05 was considered statistically significant. The results were presented in tables and bar charts to facilitate organization and understanding. 2.7. Operational definitions of terms and variables Alcohol: any kind of beverage obtained by distillation of wine, cider, fermented juice, or any fermented liquor derived from sugary or starchy substances or containing ethanol. Abstinent: any person who has not consumed alcohol for more than twelve months. Alcohol consumer: anyone who has consumed alcoholic beverages in the last twelve months. Low-risk alcohol consumption: estimated by an AUDIT score between 1 and 7. High-risk alcohol consumption: estimated by an AUDIT score strictly greater than 7. Binge drinking: This is the rapid and excessive consumption of more than 60 g (or 6 standard glasses) of alcohol over a short period of less than 2 hours. In this study, this mode of consumption is assessed by the second (annual binge drinking) and third (weekly binge drinking) items of the AUDIT instrument. The standard glass of alcohol: 10 grams of pure alcohol 3. Results Of the 19,971 students enrolled at the University for the year 2023-2024, we approached 1,900 (following our sampling technique). After excluding those under the age of 18 and those who did not have a smartphone device, we finally surveyed 1,789 people. However, 73 of these participants provided incomplete answers to the variables of interest, so we retained for further data analysis the 1716 who provided complete answers ( Figure 1 ). 3.1. Socio-demographic and academic characteristics Out of 1,716 students, (n=800; 46.6%) were male. The median age (IQR) was 22 (20 - 24) years. Most of the students were single (n=1,575; 91.8%). The predominant religion was Christianity (n=1,553; 90.5%). Approximately (n= 888; 51.7%) had a monthly income of less than 25,000 FCFA. According to the CAST test results, most of the students (n=1,651; 96.2%) had a history of parental alcoholism ( Table 1 ). Table 1: Socio-demographic characteristics of participants (N=1,716) Variables n (%) Age ]18;20] 540 (31.5) ]20;22] 435 (25.3) ]22;24] 370 (21.6) ]24;26] 195 (11.4) ≥26 176 (10.3) Matrimonial Status Single 1,575 (91.8) Married 72 (4.2) Cohabitation 62 (3.6) Divorced 4 (0.2) Widow (er) 3 (0.2) Religion Christianism 1,553 (90.5) Islam 70 (4.1) Atheism 40 (2.3) Animism 53 (3.1%) Environment of residence Urban 1,373 (80) Rural 343 (20) Monthly income < 25000 888 (51.7) [25000; 50000[ 629 (36.7) [50000; 75000[ 127 (7.4) ≥ 75000 72 (4.2) Parental alcohol consumption Non-alcoholic parent(s) 37 (2.2) Parent(s) with at-risk consumption) 28 (1.6) Alcoholic parent(s) 1,651 (96.2) The most represented faculty in our study population was the FEMS (n=748; 43.6%). A quarter of the students were third-year undergraduates (n=426; 24.8%). The mean (±SD) average annual academic grade was for the previous year was 12.6/20 (±1.31) ( Table 2 ). Table 2: Academic characteristics of participants (N=1,716) Variables n (%) Faculty FEMS 748 (43.6) FMPS 493 (28.7) FAAS 475 (27.7) Level of study Undergraduate 1 279 (16.3) Undergraduate 2 282 (16.4) Undergraduate 3 426 (24.8) Graduate 1 329 (19.2) Graduate 2 315 (18.4) PhD 4 85 (5.0) Living arrangement Living in a student estate 799 (46.6) Living with family 526 (30.7) Living alone 390 (22.7) Living in an orphanage 1 (0.1) Father’s education level University 867 (50.5) High school 610 (35.5) Primary level 184 (10.7) None 55 (3.2) Mother’s education level University 869 (50.6) High school 510 (29.7) Primary level 283 (16.5) None 54 (3.1) Abbreviations: FEMS= Faculty of Economics and Management Sciences; FMPS= Faculty of Medicine and Pharmaceutical Science; FAAS= Faculty of Agronomy and Agricultural Sciences; PhD= Doctor of Philosophy 3.2. Prevalence of high-risk alcohol consumption Regarding alcohol consumption, only (n=551; 32.1%) of the students reported that they did not consume alcohol, while (n=1,165; 67.9%) had consumed alcohol in the last twelve months. Among these consumers, (n=331; 28.4%) were classified as high-risk consumers (AUDIT score strictly over 7), which represents 19.3% of all the students ( Figure2 ). 3.3. Students' Psychological Status While the Median (IQR) of the students' DASS-21 total score was 14/21 (2-30) and those of the depression, anxiety and stress-specific scores were 4/7 (0-10), 4/7 (0-10), and 4/7 (0-12) respectively, we observed that up to 326 (19% ), 475 (27.7% ), and 144 (8.4% ) students respectively presented with scores compatible with moderate to severe states of depression, anxiety and stress ( Table 3 ). Table 3: Psychological distress (DASS-21) of participants (N=1,716) Variables n (%) Depression Normal 1,201 (70) Light 189 (11) Moderate – Extremely severe 326 (19) Anxiety Normal 1,123 (65.4) Light 118 (6.9) Moderate – Extremely severe 475 (27.7) Stress Normal 1,468 (85.5) Light 104 (6.1) Moderate – Extremely severe 144 (8.4) Abbreviations: DASS-21= Depression, Anxiety and Stress Scale-21 3.4. Practices related to alcohol consumption Students’ median (IQR) age at their first use of alcohol was 16 (14-18) years. The family home was both the most common place of first consumption (n=673; 57.8%) and the most common place of usual consumption (n=552; 47.4%). Nearly half (n=531; 45.6%) of the consumers preferred beer. Ceremonies were the main source of alcohol (n=341; 29.3%), and friends were the main drinking company (n=716; 61.5%). More than half of the students (n=754; 64.7%) have had a binge drinking episode in the previous twelve months, and (n=45; 3.9%) of these have had a weekly binge drinking episode. Moreover, nearly (n=40; 3.4%) of the students reported using other drugs. However, the most common perception of alcoholic beverages was that it was useless (n=324; 27.8%) ( Table 4 ). Table 4: Practices related to alcohol consumption of students (N=1,165) Variables n (%) Place of inaugural consumption Family home 673 (57.8) Celebration 381 (32.7) Other 111 (9.5) Usual place of consumption Home 552 (47.4) Snack 320 (27.5) Bars 214 (18.4) Other 79 (6.8) Preferred type of drink Beer 531 (45.6) Wine 340 (29.2) Other 150 (12.9) All type 144 (12.4) Company used to drink alcohol Friends 716 (61.5) Family 339 (29.1) Other 110 (9.5) Main source of alcoholic beverages During events 341 (29.3) Pocket money 327 (28.1) From my friends 238 (20.4) From my parents 167 (14.3) Other 92 (7.9) Annual Binge Drinking Yes 754 (64.7) No 411 (35.3) Weekly Binge drinking Yes 45 (3.9) No 1,120 (96.1) Consumption of other drugs Yes 40 (3.4) No 1,125 (96.6) Perception of alcohol Useless 324 (27.8) Toxic product 285 (24.5) Thirst-quenching drink 273 (23.4) Antidepressant 240 (20.6) Allow to Make new friends 43 (3.7) 3.5. Personal motives for alcohol consumption The overall median (IQR) score for all personal drinking motives was 17/36 (14-20). Students scored higher on social motives, with a median of 6/9 (4-6), followed by enhancement motives with 4/9 (3-5). Coping and conformity motives had the lowest median scores (IQR) i.e. 3/9 (3-4) ( Table 5 ). Table 5: Personal motives for consumption among drinking students (DMQ-R-SF 1 ) (N=1,165) Characteristic Median (IQR) Personal motives for consumption Median (Q1, Q3) 17.0 (14.0, 20.0) Enhancement Median (Q1, Q3) 4.00 (3.00, 5.00) Social Median (Q1, Q3) 6.00 (4.00, 6.00) Conformity Median (Q1, Q3) 3.00 (3.00, 4.00) Coping Median (Q1, Q3) 3.00 (3.00, 5.00) Abbreviations: DMQ-R-SF= Drinking Motive Questionnaire- Revised-Short Form; IQR= interquartile rate 3.6. Factors associated with alcohol consumption and high-risk alcohol consumption Within the student's sample, Christian religion increases the risk of alcohol consumption by about four times ( aOR 3.71 [ 95% CI 2.08-6.64]; p <0.001 ), while moderate to severe depression almost doubles it ( aOR 1.71 [ 95% CI 1.01-2.90]; p =0.047 ). Students who were living alone were about seven times more likely to consume alcohol ( aOR 6.97 [ 95% CI 4.23-11.5]; p <0.001 ). Among alcohol-consuming students, while anxiety and stress were not associated with high-risk alcohol consumption, those who were depressed were three times more likely to engage in high-risk consumption ( aOR 3.03 [ 95% CI 1.45-6.32]; p= 0.003 ). An inaugural consumption after 18 years old ( aOR 0.50 [ 95% CI 0.31-0.81]; p =0.004 ) had a significant protective effect against high-risk consumption as well as usual place of alcohol consumption at family home ( aOR 0.34 [ 95% CI 0.19-0.50]; p <0.001 ). Drinking alcohol for enhancement ( aOR 2.12 [ 95% CI 1.17-3.85]; p =0.014 ), conformity ( aOR 1.91 [ 95%CI 1.19-3.06]; p =0.007 ) and coping ( aOR 2.61 [ 95% CI 1.54-4.42]; p <0.001 ) motives also significantly increased the risk of high-risk consumption ( Table 6 ). Table 6: Factors associated with alcohol consumption and high-risk alcohol consumption (AUDIT) 4. Discussion Amidst rising concern about the spread of substance use among African youth, this study attempted to describe university students’ levels of alcohol consumption and holistically explain the drivers of such consumption. This is the first study with such a large university sample size in Cameroon that uses the AUDIT scale to assess students' drinking habits. The methodical sampling technique and the diversity of students at the University of Dschang further support the representativeness of our results. These could be used to inform nationwide policies to address the youth’s high-risk alcohol consumption problem. We found that 67.9% of students were alcohol consumers, and 19.3% had a high-risk consumption. This proportion of high-risk consumption among students was in line with data from other Sub-Saharan African countries, including Kenya in 2016 (15.5%), Botswana in 2018 (22.4%), and Nigeria in 2021 (14.5%) [34–36]. There is, now, solid evidence to suggest that the prevalence of high-risk consumption is higher in the student population than in the general population [7,37]. This is because adolescence is a period of Sturm und Drang (according to Sayer and Patton), which means storm and stress [38]. This storm and stress can potentially disrupt the health of adolescents, leading to maladaptive behaviour, including alcohol consumption. Another explanation is that drinking is a socially acceptable behaviour accompanying many events. However, this prevalence of high-risk alcohol consumption is far lower than the 40.4% found in deprived neighbourhoods of the city of Yaoundé in 2024 [39], implying that some adult urban populations in Cameroon are even more affected. A 2020 study in South Africa also found a 54.5% prevalence of high-risk alcohol consumption among students at the University of Johannesburg [7]. This difference could be explained by the difference in the tools used to assess alcohol consumption; the AUDIT-C tends to be less specific, but it is mainly a reminder of how, even in a similar population, cultural and social differences can influence consumption. This study showed that about one student in five suffers from moderate to extremely severe depression, and more than one student in four suffers from moderate to extremely severe anxiety. This result is close to the 30.6% prevalence of depression found by Ngasa et al. among students at four medical faculties in Cameroon in 2016 [40]. This contrast data from epidemiologic surveillance shows that the number of reported admissions for depressive syndromes has been decreasing since 2021 [25]. This proportion, however, exceeds global estimates. In its 2022 global mental health report, WHO indicates that approximately one person in eight suffers from psychological distress (anxiety disorders, depressive disorders and stress) [41]. In Cameroon in general, and among the student population in particular, mental health promotion is still neglected, causing insufficient population awareness, which translate to under-detection and under-notification of cases, social stigmatization, lack of suitable infrastructure, and shortages of qualified staff, all of which exacerbate disparities and difficulties in accessing mental health services. The University of Dschang, in its quest for academic excellence, could be encouraging the development of anxiety, stress and depression among students as a result of the pressure they are under to achieve better results. Regarding alcohol consumption-related practices, we found a median age of onset of alcohol consumption of 16 (IQR: 14-18) years. This early age is consistent with previous literature, such as student surveys revealing a mean (±SD) age of onset of alcohol consumption of 17.6 (±2.8) years in Tunisia [42], and 19.9 (±2.7) years in Ghana [43], could be explained by the extent of social pressure, parental influence as evidenced by the overwhelming 96.2% of alcoholic parents we found as per students reports and early exposure to alcohol drinks advertising across the media, which modify the perception of alcohol consumption and encourage young people to start drinking earlier. While more than half of students drank their first alcoholic beverage in their family house, fewer than 10% did so in a bar. This contrasts with results from Hormenu et al. in Ghana, where 28.6% of adolescents had drunk an alcoholic beverage for the first time in a bar [44]. In our context, this initial place of consumption could reflect by the social nature of drinking, with alcohol being expected at virtually every family reunion, celebration, or even simple visit, and alcoholic parents. Easy access to alcoholic beverages in the home and the lack of parental supervision could also be influencing factors. As evidenced in previous studies in Cameroon and Tunisia, respectively, reporting that 22.8 and 73.2 % of university students most commonly drank beer [21,42], we found that beer was the most preferred type of beverage among students. The increased affordability and accessibility of beer in our society could explain this inclination. You can find beer at every corner of our towns and even in the most remote areas of our rural communities. While other beverages like wine or liquor are more expensive and require a more elaborate consumption arrangement. Moreover, more than half of the students reported that their usual drinking companions were friends. Similar results were observed in Ghana [44]. This highlights students' perception of group drinking as a social tradition among youth, a way to relax after studying, and an opportunity to build camaraderie and strengthen bonds. Though they are mostly introduced to alcohol in a familial setting, it’s with their friends that youths usually foster the drinking habit. This also explains our finding of students scoring higher for social motives drinking than for any other motives. We also found that more than half of the students have had at least one episode of binge drinking in the last twelve months. This result is far higher than the 30% found in the United States in 2018 [45]. This difference could be explained by the time interval between the two studies. Recently, there has been increased socialization and normalization of risky practices among youths, including drunkenness. As regards weekly binge drinking, Henry et al. in Uganda found a prevalence of 4.5%, which is very close to the result of this study [46]. However, this result is lower than the 9.3% in Chad, 6.4% in Burkina Faso, and 5.4% in Namibia, but higher than the 2.8% in Zimbabwe and 2% in Ethiopia [47]. These rates of weekly binge drinking could be explained by the progressive acceptance and socialization of risky behaviours such as drunkenness in sub-Saharan Africa, in a background of lax regulation. Our findings showed a very low (3.4%) proportion of other drug use. This percentage is lower than those found by Zedini et al. (33.3%) and Metuge et al. (26.2%) [20,42]. This result could be explained by the fact that alcohol is often considered a gateway drug, and most often the first drug attempted by users, as it is most accessible and usually perceived as less dangerous. While those other substances are less socially accepted and even illicit. As a result, many student drinkers are not yet at the stage of using other substances. In general, many precursors have been associated with alcohol and other substance use disorders in adolescents and students, such as curiosity, the search for thrills, and the desire to integrate into new social groups. Another major reason for this low proportion could be student underreporting, as such substances are forbidden on campus. The first case-control analysis showed that moderate to extremely severe depression approximately doubles the risk of alcohol consumption. This effect even increases when comparing low-risk to high-risk consumers. On the other hand, moderate to extremely severe anxiety and stress appeared to play a protective role against alcohol consumption. When comparing abstainers and low-risk consumers to high-risk consumers, it emerged that moderate to extremely severe anxiety significantly increased the risk of high-risk consumption. Similar results were observed by Gemes et al. in Sweden in 2019, where non-drinkers had an increased risk of depression compared with light drinkers (≤7 drinks/week). In addition, high-risk drinking was associated with an increased risk of depression compared with low-risk drinking [48]. Furthermore, studies carried out by Henry et al. in Uganda in 2020 [46] and Blows et al. in South Africa in 2022 [35] showed that students who drank alcohol had higher depression and anxiety scores than non-drinkers. However, as in our results, Blows et al. found no significant association between the level of alcohol consumption and stress. Unlike other studies, gender, parental alcohol consumption, place of residence of the student and perception of alcoholic beverages were not associated with high-risk alcohol consumption [49]. We found that three out of the four measured drinking motives were significantly increasing the risks of high-risk drinking among alcohol-consuming students. While Coping motives refer to internally generated items related to the reduction of negative emotions, such as "to forget your worries", Enhancement refers to internally driven and linked to positive reinforcement, such as "drinking to have fun" or "to get drunk". Conformity motives, on the other hand, are externally generated reasons for drinking, such as "not wanting to feel left out of the group". The effect of both internal drinking motives were thus significant, with coping motives showing a slightly stronger association with high-risk drinking. Similar findings were reported by Caisa et al. (2016) and Nehlin et al. (2019) among Swedish psychiatric patients and students respectively [50] [51]. The later specifically reported that emotionally oriented motives (both enhancement and coping) were significantly associated with hazardous or harmful drinking. Linking it to the narrative that young people use alcohol as a means of emotional regulation and to facilitate social interactions [51]. Regarding external drinking motives, the conformity motive, i.e. drinking to avoid social rejection, was weakly associated with high-risk drinking, whereas social motives showed no significant association with high-risk drinking. Similar results were reported by Caisa et al. , who found that external drinking motives (social and conformity) were not as strongly related to alcohol use as internal motives (enhancement and coping) [50]. Conversely, Kuntsche et al. found that social motives were associated with hazardous and harmful drinking, whereas conformity motives had no association [33]. The cultural context may also influence drinking motives, as perceptions of alcohol's role in socialization and emotional coping vary across different cultural settings. While existing studies have explored how different drinking traditions shape young people's alcohol use behaviours, further research is needed to deepen our understanding of these cultural influences. [33]. We also found that the family home as a place of usual consumption was a protective factor against high-risk alcohol consumption, which contrasts with the findings of Ntone et al. in 2017 [21]. This result could be explained by the fact that those who drink at home are often under family supervision or in a more structured environment. Parents or relatives can supervise consumption, inculcate responsible habits and limit excesses. In line with Zedini et al ., we also found that the age of first alcohol consumption equal to or greater than eighteen years was negatively associated with high-risk drinking [42]. Among the factors that may explain why early alcohol consumption increases the risk of problem drinking are tolerance and the risk of dependence Another important factor is the social environment and peer pressure. Adolescents who delay their initiation to alcohol tend to frequent groups where risky behaviour is less prevalent, thereby reducing their exposure to social pressures to drink excessively. Finally, our results showed that the Christian religion triples the chances of drinking alcohol but is not associated with higher levels of consumption once you are a drinker. This could be explained by the fact that the Muslim religion prohibits alcohol consumption, whereas the Christian religion may, in certain contexts, encourage it. Indeed, the first miracle of Jesus recorded in the Bible is the transformation of water into wine, and wine is mentioned several times in the Scriptures. This study has a few limitations which should be considered when interpreting the findings. First, because of the cross-sectional nature of the study, we are not able to conclude that there is a causal link between high-risk alcohol consumption and risk factors. Second, Self-reported patterns of alcohol consumption, such as AUDIT, are often subject to recall and social desirability biases, leading to an underestimation of the prevalence of alcohol consumption. Even though we assisted the participants as they filled in the questionnaire, explaining the tools and defining key terms while reminding them of the confidentiality of their data, the prevalence of alcohol consumption and high-risk alcohol consumption may still be underestimated. Third, this study was conducted in a single university, which limits the inference of the results to the entire student population of Cameroon. Finally, the fact that students under the age of 18 were not selected could lead to a selection bias and limit the sample representativeness of the student population. 5. Conclusion This study reveals a high prevalence of high-risk alcohol consumption among Cameroon's student population. To address this, it is essential to implement targeting strategies that promote communication for behaviour change, prevention of psychological distress among students. Additionally, adopting integrated mental health and alcohol abuse policies and enhancing the living environment of students by restricting access to alcoholic beverages should help mitigate this consumption. Furthermore, there is a critical need to conduct further research to better describe and explain the mental health status and consumption habits of African students and assess potential factors. Strong evidence could be established by similar prospective multicentre studies, including students of all ages. This research is essential for strengthening initiatives to monitor and support students' mental health within higher education institutions and prevent substance use among youth. Abbreviations AOR: Adjusted Odds Ratio, AUDIT: Alcohol Use Disorders Identification Test, CAST: Children of Alcoholic Screening Test, CI: Confidence Interval, COR: Crude Odds Ratio, DALYs: Disability Adjusted Life Years, DASS: Depression, Anxiety and Stress Scale, DMQ-R-SF: Drinking Motive Questionnaire- Revised-Short Form, FAAS: Faculty of Agronomy and Agricultural Sciences, FEMS: Faculty of Economics and Management Sciences, FLSS: Faculty of Letters and Social Sciences, FLPS: Faculty of Law and Political Sciences, FMPS: Faculty of Medicine and Pharmaceutical Science, FS: Faculty of Sciences, IFAF: Institute of Fine Arts in Foumban, IQR: Interquartile Range, SD: Standard Deviation, UIT: University Institute of Technology. Declarations 6.1. Ethics approval and consent to participate We have obtained ethical approval from the Regional Human Health Ethics Committee with a reference number (994/10/2023/CE/CRESH-OU/VP). We have also requested institutional approval from the Vice-Chancellor of the University of Dschang (B26/04525//UDs/R/VR-RECOME/ED/D/DAAC/DRD/SR/JCS). Data collection began with an explanation of the study and its objectives to obtain participants’ free consent. Those who did not agree to participate were not coerced into it in any way, nor did they receive any kind of retribution. Respondents' rights to withdraw from the study, as well as confidentiality, were clearly explained to the students, after which those who were interested signed informed consent forms. All participants were treated with respect and equal care, regardless of age, gender, socio-economic status or affinity. The information gathered was used solely for research purposes. There was no risk to the participants in this study. The confidentiality of participants was respected through an anonymization technique that assigned a code to each participant. Participants' names were collected solely for the purpose of recontacting them if necessary, during data cleaning. The database containing this information was accessible only to the principal investigator, who is bound by professional secrecy. Priority was given to the participant's health. Any participant with psychological distress detected during the interview was counselled and referred to the support unit of the University of Dschang for further support. Moreover, after filling in the questionnaires, students were sensitized to key subjects such as substance abuse, mental health, and the support available. Students under the age of eighteen were not included due to an inability to obtain parental consent. 6.2. Consent for publication Not applicable. 6.3. Availability of data and materials The dataset used during the current study is available from the corresponding author upon reasonable request. 6.4. Competing interests The authors declare that they have no competing interests. 6.5. Funding This study did not receive any funding. 6.6. Author’s contribution : Conceptualization and methodology: LATK, SRSN, CMT, JGBA, SPC Project administration: LATK Data curation and formal analysis: LATK, DKG Manuscript writing: LATK, DKG Manuscript revision: LATK, JGBA, LFT, SRSN, CMT, SPC All authors read and approve the final version for publication. 6.7. Acknowledgements The team is most grateful to the various students who participated in the study, sparing their precious time to share their lives and give valuable input to our study. We acknowledge the important work of the team of surveyors who were not mentioned in the author's list, including Audrey Carline TANDAH NGOUEMETA , Eunice Audrey TEKALEU II KAKMENI , Armel Tilbaut TANON NGOUFO , Valicia Mariabel HOMB KEMEKONG , and Ali ADOUM for their contribution to the realization of this study. 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19:23:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7151859/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7151859/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89501742,"identity":"1c93a25a-f9da-4c41-973a-4bb9fefbf09f","added_by":"auto","created_at":"2025-08-20 16:13:54","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":38143,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eParticipants recruitment flow chart\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7151859/v1/901773bd1516bd94c12bf162.png"},{"id":89501740,"identity":"cd90d99c-a573-4d7e-89b5-afa835dc2808","added_by":"auto","created_at":"2025-08-20 16:13:54","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":52246,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAlcohol consumption by AUDIT risk categories among all students and alcohol-consuming students\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAUDIT, Alcohol Use Disorders Identification Test; Abstinence =AUDIT score at 0; Low-risk consumption =AUDIT score ‘1 and 7’; Hazardous consumption= AUDIT score ‘8 and 15’; Harmful consumption= AUDIT score ‘16 and 19’; Addiction= AUDIT score ≥ 20\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7151859/v1/193062f0462b80bbe730cab5.png"},{"id":108083737,"identity":"a3f2e226-0349-4e6d-b905-1540717720e4","added_by":"auto","created_at":"2026-04-29 08:12:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":540668,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7151859/v1/d91d7072-820d-4c33-aa10-57b3e2526bd1.pdf"},{"id":89501741,"identity":"18edc787-b961-492a-9fa8-05a8674180ef","added_by":"auto","created_at":"2025-08-20 16:13:54","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":30829,"visible":true,"origin":"","legend":"","description":"","filename":"Table6.docx","url":"https://assets-eu.researchsquare.com/files/rs-7151859/v1/902215c9008376982468d388.docx"},{"id":89502190,"identity":"9514bc29-e9de-41f8-9e2e-c117192ac7e4","added_by":"auto","created_at":"2025-08-20 16:21:55","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":26913,"visible":true,"origin":"","legend":"","description":"","filename":"AdditionalFile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7151859/v1/89f3c7c389a083a60cc5b64f.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"High-Risk Alcohol Consumption among University Student in Cameroon and its association with Psychological Status, Drinking Motives and Practices: A Cross- Sectional Study at the University of Dschang","fulltext":[{"header":"1. Background","content":"\u003cp\u003eAlcohol is the most widely consumed psychoactive and addictive substance in the world. It is one of the primary contributors to global morbidity and mortality [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The health risks can be short-term, including intoxication and hazards, or long-term, mainly consisting of physical, social, and psychological disorders [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. High-risk alcohol consumption refers to patterns of alcohol consumption that significantly increases the risk of negative consequences for both physical and mental health, necessitating attention and intervention of healthcare professionals; This includes consumption by individuals who should typically abstain from alcohol, such as children, pregnant women, or those with existing health conditions [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. It is increasingly recognized that \"whatever the quantity of alcohol being ingested, the risk to the health of the drinker is present from the first drop\" [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. High-risk alcohol consumption is a global public health problem, and one that has significantly increased in recent years [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Responsible for more than 200 health problems, it causes around 3.3\u0026nbsp;million deaths each year worldwide, representing 5.9% of all deaths (with a rate of up to 9% among young people aged 15 to 29) and the loss of 132.6\u0026nbsp;million disability-adjusted life years (DALYs) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. According to recent estimates, 283\u0026nbsp;million people aged 15 and over (i.e. 5.1% of the world's adult population) suffer from alcohol use disorders, and around 20.5% of all deaths among young people aged 20 to 39 years have been attributed to excessive alcohol consumption [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMany countries in sub-Saharan Africa have experienced rapid economic, social, and cultural transitions, which have contributed to a gradual increase in the level of alcohol consumption among drinkers since the beginning of the 21st century. Currently, alcohol consumption accounts for 5.1% of deaths in this region [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. A notable example of this trend is seen in Central Africa, particularly in Cameroon, which was recognized in 2016 as the country with the highest rate of alcohol consumption; in that year, Cameroon exceeded 660\u0026nbsp;million litres of beer, representing almost four times its estimated consumption in the previous year. This results in a significant 7% prevalence of alcohol-related disorders in Cameroon, compared to the average of 3.7% in the African Region [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Alcohol consumption is particularly common among adolescents and young adults in Cameroon, with higher rates among students [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Despite Cameroon's legal regulations prohibiting the marketing of alcoholic beverages to minors and their advertisement in the vicinity of schools and universities, there has been a multiplication of drinking establishments around certain schools, with an increased promotion of alcoholic beverages [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHigher education presents students, mainly adolescents and young adults in their transition phase, with unique challenges leading some to use alcohol or other drugs [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Although much is known about rates of substance use among students worldwide, few representative studies have been conducted in Cameroon, with limited research into the factors explaining these rates. In Africa, the reported prevalence of alcohol consumption among higher education students varies from 2.6% in Sudan to 63.3% in Kenya [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The few studies carried out in Cameroon reveal a prevalence between 87.9% and 89.9% [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Potential factors predisposing students to alcohol consumption can be grouped into three main categories: socio-demographic and family factors, socio-psychological factors, and behavioral factors [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Some studies have shown that students subject to psychological distress or parental alcohol consumption increase their drinking frequency when exposed to the university environment [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Mental conditions such as stress, anxiety, and depression are important factors suspected of contributing to alcohol consumption and abuse among students [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRanked among the top-performing universities in Central Africa, the University of Dschang attracts a variety of students with different backgrounds and socio-cultural characteristics [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In addition, the region has low temperatures, thought to contribute to higher alcohol consumption [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Since 2005, Cameroon has been working to strengthen its substance use prevention program [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Determining the rate of high-risk alcohol consumption and identifying the determining factors among students at the University of Dschang will help improve our knowledge of substance use disorders among students and provide policymakers with necessary evidence to better focus their efforts to combat this growing scourge.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003e2.1. Study design and setting\u003c/h2\u003e\n\u003cp\u003eWe conducted a cross-sectional study that included an analytical case-control component.\u003c/p\u003e\n\u003cp\u003eThe study was carried out on the main campus of the University of Dschang, in the West Region of Cameroon, which has six faculties and two institutes. These are the Faculty of Letters and Social Sciences (FLSS), Faculty of Economics and Management Sciences (FEMS), Faculty of Law and Political Sciences (FLPS), Faculty of Sciences (FS), Faculty of Agronomy and Agricultural Sciences (FAAS), Faculty of Medicine and Pharmaceutical Science (FMPS), and the Fotso Victor\u0026rsquo;s University Institute of Technology (UIT) in Bandjoun and Institute of Fine Arts in Foumban (IFAF). In 2023, the institution had 19,971 students supervised by several research, teaching, and non-teaching staff.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n\u003ch2\u003e2.2. Study period\u003c/h2\u003e\n\u003cp\u003eData was collected from December 12, 2023, to March 12, 2024, for four months.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n\u003ch2\u003e2.3. Participants\u003c/h2\u003e\n\u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\n\u003ch2\u003e2.3.1. Selection criteria\u003c/h2\u003e\n\u003cp\u003eIn this study, any student enrolled for the academic year 2023\u0026ndash;2024 at the main campus of the University of Dschang, aged 18 or over, who agreed to participate in the study, and who owned a smartphone device, was included. We excluded those who had withdrawn consent to participate in the study or those who provided incomplete answers to the questionnaire regarding the main variables of interest.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section3\"\u003e\n\u003ch2\u003e2.3.2. Sample size determination\u003c/h2\u003e\n\u003cp\u003eThe minimal required sample size was estimated based on Cochran's formula:\u003c/p\u003e\n\u003cp\u003eN= 𝐙\u0026sup2;\u0026times;(𝟏-𝐏) 𝑬\u0026sup2;; Where\u003c/p\u003e\n\u003cp\u003eN\u0026thinsp;=\u0026thinsp;the sample size;\u003c/p\u003e\n\u003cp\u003eZ\u0026thinsp;=\u0026thinsp;the confidence level desired for this study (for a 95% confidence level, z\u0026thinsp;=\u0026thinsp;1.96);\u003c/p\u003e\n\u003cp\u003eP\u0026thinsp;=\u0026thinsp;the estimated proportion of students who drink at risk (according to a recent study conducted in South Africa [\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e], p\u0026thinsp;=\u0026thinsp;29.7%);\u003c/p\u003e\n\u003cp\u003eE\u0026thinsp;=\u0026thinsp;the tolerated margin of error (which we set at 0.05 in this study).\u003c/p\u003e\n\u003cp\u003eWe therefore have:\u003c/p\u003e\n\u003cp\u003eN= (1.96)2\u0026times;0.297(1-0.297)/ (0.05)\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eN\u0026thinsp;=\u0026thinsp;320.56 i.e. \u003cstrong\u003e321\u003c/strong\u003e participants.\u003c/p\u003e\n\u003cp\u003eTo take account of cluster sampling, we calculated the Design Effect: DE\u0026thinsp;=\u0026thinsp;1\u0026thinsp;+\u0026thinsp;r(m-1); Where r, the interclass correlation (based on prior studies [\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e], r\u0026thinsp;=\u0026thinsp;0.020485); and m, the average size per cluster (m\u0026thinsp;=\u0026thinsp;40). Thus obtaining: DE\u0026thinsp;=\u0026thinsp;1\u0026thinsp;+\u0026thinsp;0.020485(40\u0026thinsp;\u0026minus;\u0026thinsp;1)\u0026thinsp;=\u0026thinsp;1.799\u003c/p\u003e\n\u003cp\u003eFor this design, we obtained N'= DE*N\u0026thinsp;=\u0026thinsp;1.799\u0026times;321\u0026thinsp;=\u0026thinsp;577.479 i.e. 577 participants.\u003c/p\u003e\n\u003cp\u003eWe also expected a non-response rate of 10%.\u003c/p\u003e\n\u003cp\u003eIncluding it in the sample size calculation: 577\u0026thinsp;+\u0026thinsp;577\u0026times;0.1\u0026thinsp;=\u0026thinsp;634.7 i.e. \u003cstrong\u003e635\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eThe final minimum sample size for the descriptive component was therefore \u003cstrong\u003e635\u003c/strong\u003e.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch2\u003e2.4. Data collection\u003c/h2\u003e\n\u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\n\u003ch2\u003e2.4.1. Procedures\u003c/h2\u003e\n\u003cp\u003eAfter obtaining approval from the Vice-Chancellor of the University of Dschang and the Regional Human Health Ethics Committee, we carried out a random cluster sampling of our participants. First, we randomly selected three faculties (FMPS, FAAS, FEMS) out of the six on the main campus and five departments for each of these faculties. The first contact was made by telephone call to the department representatives to explain the study to them and request their assistance for the field visits. We then consecutively visited the rooms (clusters), each room corresponding to a single level of study within a specific program in each department, following their indicated availability. The visits generally happen during students' free time or breaks. Within each room, we surveyed the maximum number of students willing to participate in the study, within the limits of the allocated period. We continued this process in each faculty until the required number of students had been reached. Participants were asked to answer the questionnaire truthfully and honestly to reduce information bias. Priority was given to the health of the participants.\u003c/p\u003e\n\u003cp\u003eAny participant with psychological distress or high-risk alcohol consumption detected during the interview was referred to the counselling unit on the main campus of the University of Dschang for ongoing support.\u003c/p\u003e\n\u003cp\u003eAll ethical issues concerning human research were strictly adhered to, and the information collected was used solely for research purposes. There was no risk to the participants in this study. The confidentiality of the participants was respected thanks to an anonymization technique that enabled a code to be assigned to each participant. The database containing the information was accessible only to the principal investigator, who was bound by professional secrecy. The results of the study were presented to the source population at a session organized at the University of Dschang, to which all participants were invited.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section3\"\u003e\n\u003ch2\u003e2.4.2. Measures\u003c/h2\u003e\n\u003cp\u003eThe questionnaire included six sections, as follows: (note: the different instruments used in the questionnaire are described in greater details in an additional document [see Additional file 1]):\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ea) Demographic and academic section\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIt contains questions relating to sex, age, religion, living arrangement, marital status, monthly income, attended faculty, academic level, academic performance, parents' educational level and the level parental alcohol consumption assessed by the Children of Alcoholic Screening Test (CAST) [\u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e] tool. CAST is a 30-item yes/no questionnaire used to identify individuals with alcoholic parents or relatives and understand the impact on their development.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eb) Alcohol Use Disorders Identification Test (AUDIT)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAUDIT was used to screen and categorize students into abstainers, hazardous drinkers, harmful drinkers, and those with alcohol dependence. It is a self-administered, 10-item questionnaire using a 5-point Likert scale (0\u0026thinsp;=\u0026thinsp;never to 4\u0026thinsp;=\u0026thinsp;4\u0026thinsp;+\u0026thinsp;times per week) [\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ec) Depression, Anxiety and Stress Scale 21 (DASS-21)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIt is a 21-item questionnaire that assesses depression, anxiety, and stress through three subscales of 7 items each. Responses are rated on a 4-point Likert scale from 0 (does not apply at all) to 3 (applies most of the time) [\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ed) Practices related to alcohol consumption\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis section aimed to assess the types of alcoholic beverages consumed and how participants consume them, including their first drinking experience (age and place), preferred beverages, usual drinking settings and companions, use of other drugs, and their perception of alcohol.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ee) Drinking Motive Questionnaire- Revised-Short Form (DMQ-R-SF)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe DMQ-R-SF, the most widely used tool to assess drinking motives in youth, includes 12 items rated on a 3-point scale (1\u0026thinsp;=\u0026thinsp;never to 3\u0026thinsp;=\u0026thinsp;almost always). It measures four motives: enhancement (seeking positive emotions), coping (managing negative emotions), social (enjoyment in social settings), and conformity (social pressure) [\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n\u003ch2\u003e2.5. Cases and controls\u003c/h2\u003e\n\u003cp\u003eWe formed three sets of cases and controls to examine the associations between our exposures and, first, alcohol consumption among students; second, high-risk alcohol consumption among students, and third, high-risk alcohol consumption among those who drink.\u003c/p\u003e\n\u003cp\u003eIn our first set, 455 cases were selected among participants who were alcohol consumers, i.e., who had consumed alcohol in the last twelve months (AUDIT score\u0026thinsp;\u0026ge;\u0026thinsp;1). Controls were selected among the abstinent participants (AUDIT score\u0026thinsp;=\u0026thinsp;0). One control subject was selected for each case.\u003c/p\u003e\n\u003cp\u003eIn our second set, cases were participants who were high-risk alcohol consumers (AUDIT score\u0026thinsp;\u0026gt;\u0026thinsp;7). Controls were selected among low-risk consumers and abstinent participants (AUDIT score [0\u0026ndash;7]). Two control subjects were selected for each case.\u003c/p\u003e\n\u003cp\u003eIn our third set, cases were participants who were high-risk alcohol consumers (AUDIT score\u0026thinsp;\u0026gt;\u0026thinsp;7). Controls were selected among low-risk alcohol-consuming participants (AUDIT score [\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e]). Two control subjects were selected for each case.\u003c/p\u003e\n\u003cp\u003eFor these three sets of controls, we selected using nearest neighbour matching by age (same strata by five years), sex (male or female), and cluster (58 clusters). None of the controls were matched to a case more than once.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n\u003ch2\u003e2.6. Data management and analysis\u003c/h2\u003e\n\u003cp\u003eSubmitted questionnaires were checked daily to ensure data completeness and accuracy. The generated database was saved on an external hard drive (to avoid data loss) and exported to Microsoft Excel (Office365\u0026reg;). All analyses were carried out using R statistical software (v4.3.2; R Core Team 2024).\u003c/p\u003e\n\u003cp\u003eThe analysis began by cleaning up the data and correcting any inconsistencies. Qualitative variables were summarized into frequencies and their proportions, while quantitative variables were presented as means (and standard deviation) or median (and interquartile range) where appropriate or categorized. The \u0026lsquo;survey\u0026rsquo; package was used to take account of the clustering in the estimation of errors and confidence intervals. Chi-square tests for qualitative variables and Wald t-test (or Wilcoxon test if necessary) for quantitative variables were then used to compare the characteristics of cases and controls across our three case-control sets.\u003c/p\u003e\n\u003cp\u003eThe effects of factors associated with consumption, high-risk consumption, and high-risk consumption among consumers were identified using conditional logistic regression modelling, where all characteristics empirically linked to high-risk drinking and those that differed in comparisons showing p\u0026thinsp;\u0026lt;\u0026thinsp;0.1 were included as adjustments in the respective models. For the first model, it included: religion, monthly income, mother's education, depression, anxiety, stress, parental consumption and living arrangement. For the second model: religion, monthly income, mother's education, depression, anxiety, stress, parental consumption and living arrangements. For the third model: monthly income, mother\u0026rsquo;s education, depression, anxiety, stress, parental consumption, living arrangement, usual place of consumption, the main source of alcoholic beverages, personal motive (such as enhancement, social, conformity, coping), age at the inaugural consumption, place of inaugural consumption, favourite type of drink, usual consumer\u0026rsquo;s company and perception of alcohol.\u003c/p\u003e\n\u003cp\u003eA p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. The results were presented in tables and bar charts to facilitate organization and understanding.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n\u003ch2\u003e2.7. Operational definitions of terms and variables\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eAlcohol:\u0026nbsp;\u003c/strong\u003eany kind of beverage obtained by distillation of wine, cider, fermented juice, or any fermented liquor derived from sugary or starchy substances or containing ethanol.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAbstinent:\u0026nbsp;\u003c/strong\u003eany person who has not consumed alcohol for more than twelve months.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAlcohol consumer:\u0026nbsp;\u003c/strong\u003eanyone who has consumed alcoholic beverages in the last twelve months.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLow-risk alcohol consumption:\u0026nbsp;\u003c/strong\u003eestimated by an AUDIT score between 1 and 7.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHigh-risk alcohol consumption:\u0026nbsp;\u003c/strong\u003eestimated by an AUDIT score strictly greater than 7.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBinge drinking:\u0026nbsp;\u003c/strong\u003eThis is the rapid and excessive consumption of more than 60 g (or 6 standard glasses) of alcohol over a short period of less than 2 hours. In this study, this mode of consumption is assessed by the second (annual binge drinking) and third (weekly binge drinking) items of the AUDIT instrument.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe standard glass of alcohol:\u0026nbsp;\u003c/strong\u003e10 grams of pure alcohol\u003c/p\u003e\n\u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eOf the 19,971 students enrolled at the University for the year 2023-2024, we approached 1,900 (following our sampling technique). After excluding those under the age of 18 and those who did not have a smartphone device, we finally surveyed 1,789 people. However, 73 of these participants provided incomplete answers to the variables of interest, so we retained for further data analysis the 1716 who provided complete answers (\u003cstrong\u003eFigure 1\u003c/strong\u003e).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e3.1. Socio-demographic and academic characteristics\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eOut of 1,716 students, (n=800; 46.6%) were male. The median age (IQR) was 22 (20 - 24) years. Most of the students were single (n=1,575; 91.8%). The predominant religion was Christianity (n=1,553; 90.5%). Approximately (n= 888; 51.7%) had a monthly income of less than 25,000 FCFA.\u0026nbsp;According to the CAST test results, most of the students (n=1,651; 96.2%) had a history of parental alcoholism\u0026nbsp;(\u003cstrong\u003eTable\u003c/strong\u003e \u003cstrong\u003e1\u003c/strong\u003e).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTable 1: Socio-demographic characteristics of participants (N=1,716)\u003c/strong\u003e\u003c/p\u003e\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"474\"\u003e \u003cthead\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Variables\u003c/strong\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u0026nbsp; ]18;20]\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e540 (31.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u0026nbsp; ]20;22]\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e435 (25.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u0026nbsp; ]22;24]\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e370 (21.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u0026nbsp; ]24;26]\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e195 (11.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u0026nbsp; \u0026ge;26\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e176 (10.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003eMatrimonial Status\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e1,575 (91.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e72 (4.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003eCohabitation\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e62 (3.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e4 (0.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003eWidow (er)\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e3 (0.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u0026nbsp;Christianism\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e1,553 (90.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u0026nbsp; Islam\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e70 (4.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u0026nbsp; Atheism\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e40 (2.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u0026nbsp; Animism\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e53 (3.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003eEnvironment of residence\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u0026nbsp; \u0026nbsp;Urban\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e1,373 (80)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u0026nbsp; \u0026nbsp;Rural\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e343 (20)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003eMonthly income\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u0026nbsp; \u0026lt; 25000\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e888 (51.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u0026nbsp; [25000; 50000[\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e629 (36.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u0026nbsp; [50000; 75000[\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e127 (7.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u0026nbsp; \u0026ge; 75000\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e72 (4.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003eParental alcohol consumption\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u0026nbsp; Non-alcoholic parent(s)\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e37 (2.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u0026nbsp; Parent(s) with at-risk consumption)\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e28 (1.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u0026nbsp; Alcoholic parent(s)\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e1,651 (96.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e\u003c/table\u003e\u003cp\u003eThe most represented faculty in our study population was the FEMS (n=748; 43.6%). A quarter of the students were third-year undergraduates (n=426; 24.8%). The mean (\u0026plusmn;SD) average annual academic grade was for the previous year was 12.6/20 (\u0026plusmn;1.31) (\u003cstrong\u003eTable 2\u003c/strong\u003e).\u0026nbsp;\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTable 2: Academic characteristics of participants (N=1,716)\u003c/strong\u003e\u003c/p\u003e\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"474\"\u003e \u003cthead\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Variables\u003c/strong\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003eFaculty\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u0026nbsp; \u0026nbsp;FEMS\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e748 (43.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u0026nbsp; \u0026nbsp;FMPS\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e493 (28.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u0026nbsp; \u0026nbsp;FAAS\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e475 (27.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003eLevel of study\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u0026nbsp;Undergraduate 1\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e279 (16.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u0026nbsp;Undergraduate 2\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e282 (16.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u0026nbsp;Undergraduate 3\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e426 (24.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u0026nbsp;Graduate 1\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e329 (19.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u0026nbsp;Graduate 2\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e315 (18.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u0026nbsp;PhD\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e85 (5.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003eLiving arrangement\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003eLiving in a student estate\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e799 (46.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003eLiving with family\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e526 (30.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003eLiving alone\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e390 (22.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003eLiving in an orphanage\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e1 (0.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003eFather\u0026rsquo;s education level\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u0026nbsp;University\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e867 (50.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u0026nbsp;High school\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e610 (35.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u0026nbsp;Primary level\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e184 (10.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u0026nbsp;None\u0026nbsp;\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e55 (3.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003eMother\u0026rsquo;s education level\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u0026nbsp;University\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e869 (50.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u0026nbsp;High school\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e510 (29.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u0026nbsp;Primary level\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e283 (16.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u0026nbsp;None\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e54 (3.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e\u003c/table\u003e\u003cp\u003eAbbreviations: FEMS= Faculty of Economics and Management Sciences; FMPS= Faculty of Medicine and Pharmaceutical Science; FAAS= Faculty of Agronomy and Agricultural Sciences;\u0026nbsp;PhD= Doctor of Philosophy\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e3.2. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ePrevalence of high-risk alcohol consumption\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eRegarding alcohol consumption, only (n=551; 32.1%) of the students reported that they did not consume alcohol, while (n=1,165; 67.9%) had consumed alcohol in the last twelve months. Among these consumers, (n=331; 28.4%) were classified as high-risk consumers (AUDIT score strictly over 7), which represents 19.3% of all the students (\u003cstrong\u003eFigure2\u003c/strong\u003e).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e3.3.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eStudents\u0026apos; Psychological Status\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eWhile the Median (IQR) of the students\u0026apos; DASS-21 total score was 14/21 (2-30) and those of the depression, anxiety and stress-specific scores were 4/7 (0-10), 4/7 (0-10), and 4/7 (0-12) respectively, we observed that up to 326 (19% ), 475 (27.7% ), and 144 (8.4% ) students respectively presented with scores compatible with moderate to severe states of depression, anxiety and stress (\u003cstrong\u003eTable 3\u003c/strong\u003e).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTable 3: Psychological distress (DASS-21) of participants (N=1,716)\u003c/strong\u003e\u003c/p\u003e\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"474\"\u003e \u003cthead\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e1,201 (70)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eLight\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e189 (11)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003e\u0026nbsp;Moderate \u0026ndash; Extremely severe\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e326 (19)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e1,123 (65.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eLight\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e118 (6.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eModerate \u0026ndash; Extremely severe\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e475 (27.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eStress\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003e\u0026nbsp;Normal\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e1,468 (85.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003e\u0026nbsp;Light\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e104 (6.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003e\u0026nbsp;Moderate \u0026ndash; Extremely severe\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e144 (8.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e\u003c/table\u003e\u003cp\u003eAbbreviations: DASS-21= Depression, Anxiety and Stress Scale-21\u0026nbsp;\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e3.4.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ePractices related to alcohol consumption\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eStudents\u0026rsquo; median (IQR) age at their first use of alcohol was 16 (14-18) years. The family home was both the most common place of first consumption (n=673; 57.8%) and the most common place of usual consumption (n=552; 47.4%). Nearly half (n=531; 45.6%) of the consumers preferred beer. Ceremonies were the main source of alcohol (n=341; 29.3%), and friends were the main drinking company (n=716; 61.5%). More than half of the students (n=754; 64.7%) have had a binge drinking episode in the previous twelve months, and (n=45; 3.9%) of these have had a weekly binge drinking episode. Moreover, nearly (n=40; 3.4%) of the students reported using other drugs. However, the most common perception of alcoholic beverages was that it was useless (n=324; 27.8%) (\u003cstrong\u003eTable 4\u003c/strong\u003e).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTable 4: Practices related to alcohol consumption of students (N=1,165)\u003c/strong\u003e\u003c/p\u003e\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"474\"\u003e \u003cthead\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003ePlace of inaugural consumption\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eFamily home\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e673 (57.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eCelebration\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e381 (32.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e111 (9.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eUsual place of consumption\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eHome\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e552 (47.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eSnack\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e320 (27.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eBars\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e214 (18.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e79 (6.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003ePreferred type of drink\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eBeer\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e531 (45.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eWine\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e340 (29.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e150 (12.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eAll type\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e144 (12.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eCompany used to drink alcohol\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eFriends\u0026nbsp;\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e716 (61.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eFamily\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e339 (29.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e110 (9.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eMain source of alcoholic beverages\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eDuring events\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e341 (29.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003ePocket money\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e327 (28.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eFrom my friends\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e238 (20.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eFrom my parents\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e167 (14.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e92 (7.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eAnnual Binge Drinking\u0026nbsp;\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e754 (64.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e411 (35.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eWeekly Binge drinking\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e45 (3.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e1,120 (96.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eConsumption of other drugs\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e40 (3.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e1,125 (96.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003ePerception of alcohol\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eUseless\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e324 (27.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eToxic product\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e285 (24.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eThirst-quenching drink\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e273 (23.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eAntidepressant\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e240 (20.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eAllow to Make new friends\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e43 (3.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e\u003c/table\u003e\u003cp\u003e\u003cstrong\u003e3.5.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ePersonal motives for alcohol consumption\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThe overall median (IQR) score for all personal drinking motives was 17/36 (14-20). Students scored higher on social motives, with a median of 6/9 (4-6), followed by enhancement motives with 4/9 (3-5). Coping and conformity motives had the lowest median scores (IQR) i.e. 3/9 (3-4) (\u003cstrong\u003eTable 5\u003c/strong\u003e).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTable 5: Personal motives for consumption among drinking students (DMQ-R-SF\u003c/strong\u003e\u003csup\u003e1\u003c/sup\u003e\u003cstrong\u003e) (N=1,165)\u003c/strong\u003e\u003c/p\u003e\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"474\"\u003e \u003cthead\u003e \u003ctr\u003e \u003ctd\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003ePersonal motives for consumption\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eMedian (Q1, Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e17.0 (14.0, 20.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eEnhancement\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eMedian (Q1, Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e4.00 (3.00, 5.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eSocial\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eMedian (Q1, Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e6.00 (4.00, 6.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eConformity\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eMedian (Q1, Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e3.00 (3.00, 4.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eCoping\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd valign=\"top\"\u003e \u003cp\u003eMedian (Q1, Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd\u003e \u003cp\u003e3.00 (3.00, 5.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e\u003c/table\u003e\u003cp\u003eAbbreviations: DMQ-R-SF=\u0026nbsp;Drinking Motive Questionnaire- Revised-Short Form;\u0026nbsp;IQR= interquartile rate\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e3.6.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eFactors associated with alcohol consumption and high-risk alcohol consumption\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eWithin the student\u0026apos;s sample, Christian religion increases the risk of alcohol consumption by about four times (\u003cstrong\u003eaOR 3.71\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e[\u003c/strong\u003e\u003cstrong\u003e95% CI 2.08-6.64];\u003c/strong\u003e \u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e\u0026lt;0.001\u003c/em\u003e\u003c/strong\u003e), while moderate to severe depression almost doubles it (\u003cstrong\u003eaOR 1.71\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e[\u003c/strong\u003e\u003cstrong\u003e95% CI 1.01-2.90];\u003c/strong\u003e \u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e=0.047\u003c/em\u003e\u003c/strong\u003e).\u0026nbsp;Students who were living alone were about seven times more likely to consume alcohol (\u003cstrong\u003eaOR 6.97\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e[\u003c/strong\u003e\u003cstrong\u003e95% CI 4.23-11.5];\u003c/strong\u003e \u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e\u0026lt;0.001\u003c/em\u003e\u003c/strong\u003e).\u003c/p\u003e\u003cp\u003eAmong alcohol-consuming students, while anxiety and stress were not associated with high-risk alcohol consumption, those who were depressed were three times more likely to engage in high-risk consumption (\u003cstrong\u003eaOR 3.03\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e[\u003c/strong\u003e\u003cstrong\u003e95% CI 1.45-6.32];\u003c/strong\u003e \u003cstrong\u003e\u003cem\u003ep=\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e0.003\u003c/em\u003e\u003c/strong\u003e). An inaugural consumption after 18 years old (\u003cstrong\u003eaOR 0.50\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e[\u003c/strong\u003e\u003cstrong\u003e95% CI 0.31-0.81];\u003c/strong\u003e \u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e=0.004\u003c/em\u003e\u003c/strong\u003e)\u0026nbsp;had a significant protective effect against high-risk consumption as well as usual place of alcohol consumption at family home (\u003cstrong\u003eaOR 0.34\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e[\u003c/strong\u003e\u003cstrong\u003e95% CI 0.19-0.50];\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003ep \u0026lt;0.001\u003c/em\u003e\u003c/strong\u003e).\u003c/p\u003e\u003cp\u003eDrinking alcohol for enhancement (\u003cstrong\u003eaOR 2.12\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e[\u003c/strong\u003e\u003cstrong\u003e95% CI 1.17-3.85];\u003c/strong\u003e \u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e=0.014\u003c/em\u003e\u003c/strong\u003e), conformity (\u003cstrong\u003eaOR 1.91\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e[\u003c/strong\u003e\u003cstrong\u003e95%CI 1.19-3.06];\u003c/strong\u003e \u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e=0.007\u003c/em\u003e\u003c/strong\u003e)\u0026nbsp;and coping (\u003cstrong\u003eaOR 2.61\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e[\u003c/strong\u003e\u003cstrong\u003e95% CI 1.54-4.42];\u003c/strong\u003e \u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e\u0026lt;0.001\u003c/em\u003e\u003c/strong\u003e)\u0026nbsp;motives also significantly increased the risk of high-risk consumption (\u003cstrong\u003eTable 6\u003c/strong\u003e).\u0026nbsp;\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTable 6:\u0026nbsp;\u003c/strong\u003eFactors associated with alcohol consumption and high-risk alcohol consumption (AUDIT)\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eAmidst rising concern about the spread of substance use among African youth, this study attempted to describe university students\u0026rsquo; levels of alcohol consumption and holistically explain the drivers of such consumption. This is the first study with such a large university sample size in Cameroon that uses the AUDIT scale to assess students' drinking habits. The methodical sampling technique and the diversity of students at the University of Dschang further support the representativeness of our results. These could be used to inform nationwide policies to address the youth\u0026rsquo;s high-risk alcohol consumption problem.\u003c/p\u003e\n\u003cp\u003eWe found that 67.9% of students were alcohol consumers, and 19.3% had a high-risk consumption. This proportion of high-risk consumption among students was in line with data from other Sub-Saharan African countries, including Kenya in 2016 (15.5%), Botswana in 2018 (22.4%), and Nigeria in 2021 (14.5%) [34\u0026ndash;36]. There is, now, solid evidence to suggest that the prevalence of high-risk consumption is higher in the student population than in the general population [7,37]. This is because adolescence is a period of Sturm und Drang (according to Sayer and Patton), which means storm and stress [38]. This storm and stress can potentially disrupt the health of adolescents, leading to maladaptive behaviour, including alcohol consumption. Another explanation is that drinking is a socially acceptable behaviour accompanying many events. However, this prevalence of high-risk alcohol consumption is far lower than the 40.4% found in deprived neighbourhoods of the city of Yaound\u0026eacute; in 2024 [39], implying that some adult urban populations in Cameroon are even more affected. A 2020 study in South Africa also found a 54.5% prevalence of high-risk alcohol consumption among students at the University of Johannesburg [7]. This difference could be explained by the difference in the tools used to assess alcohol consumption; the AUDIT-C tends to be less specific, but it is mainly a reminder of how, even in a similar population, cultural and social differences can influence consumption.\u003c/p\u003e\n\u003cp\u003eThis study showed that about one student in five suffers from moderate to extremely severe depression, and more than one student in four suffers from moderate to extremely severe anxiety. This result is close to the 30.6% prevalence of depression found by Ngasa et \u003cem\u003eal.\u003c/em\u003e among students at four medical faculties in Cameroon in 2016 [40]. This contrast data from epidemiologic surveillance shows that the number of reported admissions for depressive syndromes has been decreasing since 2021 [25]. This proportion, however, exceeds global estimates. In its 2022 global mental health report, WHO indicates that approximately one person in eight suffers from psychological distress (anxiety disorders, depressive disorders and stress) [41]. In Cameroon in general, and among the student population in particular, mental health promotion is still neglected, causing insufficient population awareness, which translate to under-detection and under-notification of cases, social stigmatization, lack of suitable infrastructure, and shortages of qualified staff, all of which exacerbate disparities and difficulties in accessing mental health services. The University of Dschang, in its quest for academic excellence, could be encouraging the development of anxiety, stress and depression among students as a result of the pressure they are under to achieve better results.\u003c/p\u003e\n\u003cp\u003eRegarding alcohol consumption-related practices, we found a median age of onset of alcohol consumption of 16 (IQR: 14-18) years. This early age is consistent with previous literature, such as student surveys revealing a mean (\u0026plusmn;SD) age of onset of alcohol consumption of 17.6 (\u0026plusmn;2.8) years in Tunisia [42], and 19.9 (\u0026plusmn;2.7) years in Ghana [43], could be explained by the extent of social pressure, parental influence as evidenced by the overwhelming 96.2% of alcoholic parents we found as per students reports and early exposure to alcohol drinks advertising across the media, which modify the perception of alcohol consumption and encourage young people to start drinking earlier. While more than half of students drank their first alcoholic beverage in their family house, fewer than 10% did so in a bar. This contrasts with results from Hormenu et \u003cem\u003eal.\u003c/em\u003e in Ghana, where 28.6% of adolescents had drunk an alcoholic beverage for the first time in a bar [44]. In our context, this initial place of consumption could reflect by the social nature of drinking, with alcohol being expected at virtually every family reunion, celebration, or even simple visit, and alcoholic parents. Easy access to alcoholic beverages in the home and the lack of parental supervision could also be influencing factors.\u003c/p\u003e\n\u003cp\u003eAs evidenced in previous studies in Cameroon and Tunisia, respectively, reporting that 22.8 and 73.2 % of university students most commonly drank beer [21,42], we found that beer was the most preferred type of beverage among students. The increased affordability and accessibility of beer in our society could explain this inclination. You can find beer at every corner of our towns and even in the most remote areas of our rural communities. While other beverages like wine or liquor are more expensive and require a more elaborate consumption arrangement. Moreover, more than half of the students reported that their usual drinking companions were friends. Similar results were observed in Ghana [44]. This highlights students' perception of group drinking as a social tradition among youth, a way to relax after studying, and an opportunity to build camaraderie and strengthen bonds. Though they are mostly introduced to alcohol in a familial setting, it\u0026rsquo;s with their friends that youths usually foster the drinking habit. This also explains our finding of students scoring higher for social motives drinking than for any other motives.\u003c/p\u003e\n\u003cp\u003eWe also found that more than half of the students have had at least one episode of binge drinking in the last twelve months. This result is far higher than the 30% found in the United States in 2018 [45]. This difference could be explained by the time interval between the two studies. Recently, there has been increased socialization and normalization of risky practices among youths, including drunkenness. As regards weekly binge drinking, Henry et \u003cem\u003eal.\u003c/em\u003e in Uganda found a prevalence of 4.5%, which is very close to the result of this study [46]. However, this result is lower than the 9.3% in Chad, 6.4% in Burkina Faso, and 5.4% in Namibia, but higher than the 2.8% in Zimbabwe and 2% in Ethiopia [47]. These rates of weekly binge drinking could be explained by the progressive acceptance and socialization of risky behaviours such as drunkenness in sub-Saharan Africa, in a background of lax regulation.\u003c/p\u003e\n\u003cp\u003eOur findings showed a very low (3.4%) proportion of other drug use. This percentage is lower than those found by Zedini et \u003cem\u003eal.\u003c/em\u003e (33.3%) and Metuge et \u003cem\u003eal.\u003c/em\u003e (26.2%) [20,42]. This result could be explained by the fact that alcohol is often considered a gateway drug, and most often the first drug attempted by users, as it is most accessible and usually perceived as less dangerous. While those other substances are less socially accepted and even illicit. As a result, many student drinkers are not yet at the stage of using other substances. In general, many precursors have been associated with alcohol and other substance use disorders in adolescents and students, such as curiosity, the search for thrills, and the desire to integrate into new social groups. Another major reason for this low proportion could be student underreporting, as such substances are forbidden on campus.\u003c/p\u003e\n\u003cp\u003eThe first case-control analysis showed that moderate to extremely severe depression approximately doubles the risk of alcohol consumption. This effect even increases when comparing low-risk to high-risk consumers. On the other hand, moderate to extremely severe anxiety and stress appeared to play a protective role against alcohol consumption. When comparing abstainers and low-risk consumers to high-risk consumers, it emerged that moderate to extremely severe anxiety significantly increased the risk of high-risk consumption. Similar results were observed by Gemes et \u003cem\u003eal.\u003c/em\u003e in Sweden in 2019, where non-drinkers had an increased risk of depression compared with light drinkers (\u0026le;7 drinks/week). In addition, high-risk drinking was associated with an increased risk of depression compared with low-risk drinking [48]. Furthermore, studies carried out by Henry et \u003cem\u003eal.\u003c/em\u003e in Uganda in 2020 [46] and Blows et \u003cem\u003eal.\u003c/em\u003e in South Africa in 2022 [35] showed that students who drank alcohol had higher depression and anxiety scores than non-drinkers. However, as in our results, Blows et \u003cem\u003eal.\u003c/em\u003e found no significant association between the level of alcohol consumption and stress.\u003c/p\u003e\n\u003cp\u003eUnlike other studies, gender, parental alcohol consumption, place of residence of the student and perception of alcoholic beverages were not associated with high-risk alcohol consumption [49].\u003c/p\u003e\n\u003cp\u003eWe found that three out of the four measured drinking motives were significantly increasing the risks of high-risk drinking among alcohol-consuming students. While Coping motives refer to internally generated items related to the reduction of negative emotions, such as \"to forget your worries\", Enhancement refers to internally driven and linked to positive reinforcement, such as \"drinking to have fun\" or \"to get drunk\". Conformity motives, on the other hand, are externally generated reasons for drinking, such as \"not wanting to feel left out of the group\". The effect of both internal drinking motives were thus significant, with coping motives showing a slightly stronger association with high-risk drinking. Similar findings were reported by Caisa et \u003cem\u003eal.\u003c/em\u003e (2016) and Nehlin et \u003cem\u003eal.\u003c/em\u003e (2019) among Swedish psychiatric patients and students respectively [50] [51]. The later specifically reported that emotionally oriented motives (both enhancement and coping) were significantly associated with hazardous or harmful drinking. Linking it to the narrative that young people use alcohol as a means of emotional regulation and to facilitate social interactions [51]. Regarding external drinking motives, the conformity motive, i.e. drinking to avoid social rejection, was weakly associated with high-risk drinking, whereas social motives showed no significant association with high-risk drinking. Similar results were reported by Caisa et \u003cem\u003eal.\u003c/em\u003e, who found that external drinking motives (social and conformity) were not as strongly related to alcohol use as internal motives (enhancement and coping) [50]. Conversely, Kuntsche et \u003cem\u003eal.\u003c/em\u003e found that social motives were associated with hazardous and harmful drinking, whereas conformity motives had no association [33]. The cultural context may also influence drinking motives, as perceptions of alcohol's role in socialization and emotional coping vary across different cultural settings. While existing studies have explored how different drinking traditions shape young people's alcohol use behaviours, further research is needed to deepen our understanding of these cultural influences. [33].\u003c/p\u003e\n\u003cp\u003eWe also found that the family home as a place of usual consumption was a protective factor against high-risk alcohol consumption, which contrasts with the findings of Ntone et \u003cem\u003eal.\u003c/em\u003e in 2017 [21]. This result could be explained by the fact that those who drink at home are often under family supervision or in a more structured environment. Parents or relatives can supervise consumption, inculcate responsible habits and limit excesses. In line with Zedini et \u003cem\u003eal\u003c/em\u003e., we also found that the age of first alcohol consumption equal to or greater than eighteen years was negatively associated with high-risk drinking [42]. Among the factors that may explain why early alcohol consumption increases the risk of problem drinking are tolerance and the risk of dependence Another important factor is the social environment and peer pressure. Adolescents who delay their initiation to alcohol tend to frequent groups where risky behaviour is less prevalent, thereby reducing their exposure to social pressures to drink excessively.\u003c/p\u003e\n\u003cp\u003eFinally, our results showed that the Christian religion triples the chances of drinking alcohol but is not associated with higher levels of consumption once you are a drinker. This could be explained by the fact that the Muslim religion prohibits alcohol consumption, whereas the Christian religion may, in certain contexts, encourage it. Indeed, the first miracle of Jesus recorded in the Bible is the transformation of water into wine, and wine is mentioned several times in the Scriptures.\u003c/p\u003e\n\u003cp\u003eThis study has a few limitations which should be considered when interpreting the findings. First, because of the cross-sectional nature of the study, we are not able to conclude that there is a causal link between high-risk alcohol consumption and risk factors. Second, Self-reported patterns of alcohol consumption, such as AUDIT, are often subject to recall and social desirability biases, leading to an underestimation of the prevalence of alcohol consumption. Even though we assisted the participants as they filled in the questionnaire, explaining the tools and defining key terms while reminding them of the confidentiality of their data, the prevalence of alcohol consumption and high-risk alcohol consumption may still be underestimated. Third, this study was conducted in a single university, which limits the inference of the results to the entire student population of Cameroon. Finally, the fact that students under the age of 18 were not selected could lead to a selection bias and limit the sample representativeness of the student population.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThis study reveals a high prevalence of high-risk alcohol consumption among Cameroon's student population. To address this, it is essential to implement targeting strategies that promote communication for behaviour change, prevention of psychological distress among students. Additionally, adopting integrated mental health and alcohol abuse policies and enhancing the living environment of students by restricting access to alcoholic beverages should help mitigate this consumption.\u003c/p\u003e\n\u003cp\u003eFurthermore, there is a critical need to conduct further research to better describe and explain the mental health status and consumption habits of African students and assess potential factors. Strong evidence could be established by similar prospective multicentre studies, including students of all ages. This research is essential for strengthening initiatives to monitor and support students' mental health within higher education institutions and prevent substance use among youth.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAOR: Adjusted Odds Ratio,\u003c/p\u003e\n\u003cp\u003eAUDIT: Alcohol Use Disorders Identification Test,\u003c/p\u003e\n\u003cp\u003eCAST: Children of Alcoholic Screening Test,\u003c/p\u003e\n\u003cp\u003eCI: Confidence Interval,\u003c/p\u003e\n\u003cp\u003eCOR: Crude Odds Ratio,\u003c/p\u003e\n\u003cp\u003eDALYs: Disability Adjusted Life Years,\u003c/p\u003e\n\u003cp\u003eDASS: Depression, Anxiety and Stress Scale,\u003c/p\u003e\n\u003cp\u003eDMQ-R-SF: Drinking Motive Questionnaire- Revised-Short Form,\u003c/p\u003e\n\u003cp\u003eFAAS: Faculty of Agronomy and Agricultural Sciences,\u003c/p\u003e\n\u003cp\u003eFEMS: Faculty of Economics and Management Sciences,\u003c/p\u003e\n\u003cp\u003eFLSS: Faculty of Letters and Social Sciences,\u003c/p\u003e\n\u003cp\u003eFLPS: Faculty of Law and Political Sciences,\u003c/p\u003e\n\u003cp\u003eFMPS: Faculty of Medicine and Pharmaceutical Science,\u003c/p\u003e\n\u003cp\u003eFS: Faculty of Sciences,\u003c/p\u003e\n\u003cp\u003eIFAF: Institute of Fine Arts in Foumban,\u003c/p\u003e\n\u003cp\u003eIQR: Interquartile Range, SD: Standard Deviation,\u003c/p\u003e\n\u003cp\u003eUIT: University Institute of Technology.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e6.1. Ethics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe have obtained ethical approval from the Regional Human Health Ethics Committee with a reference number (994/10/2023/CE/CRESH-OU/VP). We have also requested institutional approval from the Vice-Chancellor of the University of Dschang (B26/04525//UDs/R/VR-RECOME/ED/D/DAAC/DRD/SR/JCS).\u003c/p\u003e\n\u003cp\u003eData collection began with an explanation of the study and its objectives to obtain participants\u0026rsquo; free consent. Those who did not agree to participate were not coerced into it in any way, nor did they receive any kind of retribution. Respondents' rights to withdraw from the study, as well as confidentiality, were clearly explained to the students, after which those who were interested signed informed consent forms.\u003c/p\u003e\n\u003cp\u003eAll participants were treated with respect and equal care, regardless of age, gender, socio-economic status or affinity. The information gathered was used solely for research purposes. There was no risk to the participants in this study. The confidentiality of participants was respected through an anonymization technique that assigned a code to each participant. Participants' names were collected solely for the purpose of recontacting them if necessary, during data cleaning. The database containing this information was accessible only to the principal investigator, who is bound by professional secrecy. Priority was given to the participant's health. Any participant with psychological distress detected during the interview was counselled and referred to the support unit of the University of Dschang for further support. Moreover, after filling in the questionnaires, students were sensitized to key subjects such as substance abuse, mental health, and the support available. Students under the age of eighteen were not included due to an inability to obtain parental consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6.2. Consent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6.3. Availability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset used during the current study is available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6.4. Competing interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6.5. Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not receive any funding.\u003c/p\u003e\n\u003cp\u003e6.6. \u003cstrong\u003eAuthor\u0026rsquo;s contribution\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eConceptualization and methodology: LATK, SRSN, CMT, JGBA, SPC\u003c/p\u003e\n\u003cp\u003eProject administration: LATK\u003c/p\u003e\n\u003cp\u003eData curation and formal analysis: LATK, DKG\u003c/p\u003e\n\u003cp\u003eManuscript writing: LATK, DKG\u003c/p\u003e\n\u003cp\u003eManuscript revision: LATK, JGBA, LFT, SRSN, CMT, SPC\u003c/p\u003e\n\u003cp\u003eAll authors read and approve the final version for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6.7. Acknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe team is most grateful to the various students who participated in the study, sparing their precious time to share their lives and give valuable input to our study. We acknowledge the important work of the team of surveyors who were not mentioned in the author's list, including \u003cem\u003eAudrey Carline TANDAH NGOUEMETA\u003c/em\u003e, \u003cem\u003eEunice Audrey TEKALEU II KAKMENI\u003c/em\u003e, \u003cem\u003eArmel Tilbaut TANON NGOUFO\u003c/em\u003e, \u003cem\u003eValicia Mariabel HOMB KEMEKONG\u003c/em\u003e, and \u003cem\u003eAli ADOUM\u003c/em\u003e for their contribution to the realization of this study. We also extend our heartfelt gratitude to \u003cem\u003eProf. Gloria ASHUNTANTANG\u003c/em\u003e as well as \u003cem\u003eProf. Mathurin KOWO\u003c/em\u003e for thoroughly proofreading this work.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSalameh P, Rachidi S, Al-Hajje A, Awada S, Chouaib K, Saleh N et al. Consommation de substances psychoactives des \u0026eacute;tudiants universitaires libanais: pr\u0026eacute;valence et facteurs associ\u0026eacute;s. 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Drug and Alcohol Review https://onlinelibrary.\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ewiley.com/doi/10.1111/dar.12421\u003c/span\u003e\u003cspan address=\"http://wiley.com/doi/10.1111/dar.12421\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 3 Feb 2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNehlin C, \u0026Ouml;ster C. Measuring drinking motives in undergraduates: an exploration of the Drinking Motives Questionnaire-Revised in Swedish students. Subst Abuse Treat Prev Policy. 2019;14(1):49.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Table 6","content":"\u003cp\u003eTable 6 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"High-risk alcohol consumption, Prevalence, Determinants, University of Dschang, Psychological status","lastPublishedDoi":"10.21203/rs.3.rs-7151859/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7151859/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eContext: \u003c/strong\u003eAlcohol is the most widely consumed psychoactive and addictive substance in the world, contributing to increased global morbidity and mortality rates. High-risk alcohol consumption has become an increasingly significant public health problem in recent years, particularly among students.\u003cstrong\u003e \u003c/strong\u003eThe aim of this study was to determine the prevalence of high-risk alcohol consumption and identify its determinants among students at the University of Dschang.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA cross-sectional study was conducted on the main campus of the University of Dschang between January 2023 and May 2024. Students aged eighteen and over were selected using a two-stage cluster sampling, and data were collected using a self-administered electronic questionnaire. The primary outcomes of interest were alcohol consumption and high-risk alcohol consumption. Multilevel logistic regression investigated associations between these outcomes and key suspected predictors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e A total of 1,789 participants were enrolled in the study. The median age was 22 years (IQR: 20-24) and 916 (53.4%) were male. The prevalence of alcohol consumption was 67.9%, while the prevalence of high-risk alcohol consumption was 19.3%. Risk factors for alcohol consumption were Christianism (aOR 3.71 [95% CI 2.08-6.64]; \u003cem\u003ep\u0026lt;0.001\u003c/em\u003e), living alone (aOR 6.97 [95% CI 4.23-11.5]; \u003cem\u003ep\u0026lt;0.001\u003c/em\u003e), and depression (aOR 1.71 [95% CI 1.01-2.90]; \u003cem\u003ep\u0026lt;0.05\u003c/em\u003e). Among alcohol consumers, factors such as depression (aOR \u003cem\u003e3.03\u003c/em\u003e [95% CI 1.45-6.32]; \u003cem\u003ep\u0026lt;0.001\u003c/em\u003e), and personal motives including enhancement(aOR 2.12 [95% CI 1.17-3.85]; \u003cem\u003ep\u0026lt;0.005\u003c/em\u003e), conformity (aOR 1.91 [95% CI 1.19-3.06]; \u003cem\u003ep\u0026lt;0.01\u003c/em\u003e) and coping (aOR 2.61 [95% CI 1.54-4.42]; \u003cem\u003ep\u0026lt;0.001\u003c/em\u003e), were all positively associated with high-risk alcohol consumption.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eHigh-risk alcohol consumption is highly prevalent among the Cameroon's student population. Strategies to mitigate this trend should include promotion of behaviour change, prevention of psychological distress, and securing the living environment of students by restricting access to alcoholic beverages and encouraging parental responsibility.\u003c/p\u003e","manuscriptTitle":"High-Risk Alcohol Consumption among University Student in Cameroon and its association with Psychological Status, Drinking Motives and Practices: A Cross- Sectional Study at the University of Dschang","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-20 16:13:50","doi":"10.21203/rs.3.rs-7151859/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6b0c3e63-95e2-4ddd-a43a-cbd0c35b6a71","owner":[],"postedDate":"August 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-29T08:11:20+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-20 16:13:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7151859","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7151859","identity":"rs-7151859","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}