Binge drinking: a pattern associated with a risk of problems of alcohol use among university students 1

ABSTRACT Objective: to evaluate problems associated with alcohol use among university students who reported binge drinking in comparison to students who consumed alcohol without binging. Method: a cross-sectional study among university students (N=2,408) who accessed the website about alcohol use. Logistic and linear regression models were included in the statistical analyzes. Results: alcohol use in the last three months was reported by 89.2% of university students; 51.6% reported binge drinking. Compared to students who did not binge drink, university students who presented this pattern were more likely to report all evaluated problems, among them: black out (aOR: 5.4); having academic problems (aOR: 3.4); acting impulsively and having regrets (aOR: 2.9); getting involved in fights (aOR: 2.6); drinking and driving (aOR: 2.6) and accepting a ride with someone who had drunk alcohol (aOR: 1.8). Students who binged also had higher scores on the Alcohol Use Disorders Identification Test (b=4.6; p<0.001), more negative consequences (b=1.0; p<0.001) and a reduced perception of the negativity of the consequences (b=-0.5; p<0.01). Conclusion: binge drinking was associated with an increase in the chances of manifesting problems related to alcohol use. The conclusions of this study cannot be generalized for all of the Brazilian population.

Only invited students had access to the survey. A total of 2,596 individuals accessed the website and responded to the survey. The inclusion criteria for this study were: being between 18 and 30 years old and being enrolled in any Institution of Higher Education (Instituição de Ensino Superior -IES). Participants who did not meet these criteria were able to complete the questionnaires, however their data were disregarded from the analyses (N=167). As a way of ensuring the veracity of participants' responses, a question about the use of a fake drug was included (9) ; university students who responded positively to this question had their data excluded from the analyzes (N=21). The final sample evaluated in this study corresponded to 2,408 university students (N=2,408).

Instruments
The Alcohol Use Disorders Identification Test (AUDIT) (10) was used to evaluate the alcohol consumption, which was previously validated among university students (11) and for the Brazilian population (12) , and adapted to refer to the last three months. On the other hand, eight questions were used on the consequences of alcohol consumption, based on the scale Rutgers Alcohol Problem Index (RAPI) (13) , with questions regarding the behavior of drinking and driving, getting a ride with someone who had consumed alcohol, nausea or vomiting, impulsive behavior, and a question about the participant's assessment of how negative the consequences were.
Regarding the problems associated with alcohol use, answers to questions 4 to 10 of the AUDIT were used.

Ethical Considerations
This study was submitted and approved (

Statistical analyses
The participants were classified into three groups according to the profile of alcohol consumption in the previous three months: no alcohol consumption; alcohol consumption without binging (NB), and alcohol consumption with binge drinking (BD).
Chi-square and one-way ANOVA statistical tests were used. Linear and logistic regression models were used to compare groups of alcohol use with and without binging.
The primary outcomes evaluated were: total AUDIT score, total number of consequences associated with alcohol consumption, problems associated with alcohol consumption (AUDIT questions 4-8) and consequences of alcohol consumption. The secondary outcomes evaluated were: money spent on alcoholic beverages (R$), maximum number of drinks consumed per hour, and participant's perception regarding how negative the consequences are for it. All regression models were adjusted according to gender, age, income, type of institution, age at first alcohol consumption, and age at the first episode of intoxication.
A minimum level of 5% statistical significance was adopted.
The analyses were performed using Stata software v.12.0.

Results
More than half of the students were male (55.2%), residing in the South and Southeast Regions (54.2%), with monthly family income between 1 to 3 minimum wages (56.3%) and a mean age of 21.6 years (standard deviation -sd of 0.06). Approximately 85% of university students came from private institutions and had attended the university for 2.4 years on average (sd=0.02), while 54% of the students were from courses in the humanities area (Table 1). In addition, alcohol consumption frequency in the previous three months was 89.2%, and 51.6% of university students reported binge drinking.
Among students who consumed alcohol, the majority consumed between 1 and 4 drinks (65.6%). We also found that the frequency of women was higher in the NB group, while males were more frequent in the BD group (x 2 (2)=39.13; p<0.001). Students from the Midwest region reported less frequent use of alcohol, with or without patterns of binging (x 2 (4)=12.03; p=0.02), while students with a family income greater than 10 minimum wages were more prevalent in both the NB and BD groups (x 2 (8)=31.68; p<0.001).  (Table 2).
Rev. Latino-Am. Enfermagem 2017;25:e2925. The consequences and problems associated with alcohol consumption in the previous three months are presented in Table 3. All consequences and problems were more prevalent in the BD group. However, the same group evaluated the consequences as being less negative on average (F(1,2145)=6.40, p<0.01). Table 4 presents the logistic regression models comparing the participants from NB and BD groups, predicting the consequences and problems associated with alcohol use. For all evaluated outcomes, the models showed that university students in the BD group were more likely to report some of the consequences or problems associated with alcohol use. The linear regression models presented in Table   5 indicate that compared to the NB group, university students had an average score of 4.60 on the AUDIT; one more negative consequence; a maximum drink consumption around 0.65 more drinks per hour and an spent an average of R$29.68 more on beverages.
Although the BD group presented more negative consequences, this group showed a negative perception of the consequences of 0.45 points less on average than the NB group.

Discussion
The present study indicated that in the sample of Survey (43.7%) (3) . Data from North American studies indicate the prevalence of binging within the last two weeks (35%), showed no major changes since the early 1990s (14) . On the other hand, the direct comparison between the data of this work with those of other studies has limitations, since different methods of data collection were used, in addition to referring to frequency data with different temporal cut-outs. In addition, data collection in this study was carried out via the internet, while in the Survey it was carried out from the collective application of a printed questionnaire during class time. The use of the Internet for this type of procedure can attenuate the subjects' embarrassment regarding the use of drugs (15) , possibly reflecting in a higher frequency of alcohol use.
Another relevant aspect: during recruitment, participants were invited to access a survey to learn more about their current alcohol consumption habits. Thus, as previously mentioned, it is possible that this sample presents an underrepresentation of university students who do not consume alcoholic beverages.
The frequency of men was higher in the BD group, while women were more prevalent in the NB group. These data suggest that women do not seem to abstain from alcohol use, however, they binge drink less frequently than men. This data corroborates some findings that binge drinking among men is greater than among women (14,16) . The same data is similar to those of international studies indicating a higher prevalence of binging among men (17) . In this study, the North-Northeast Regions showed a higher frequency of alcohol use in the binge pattern, given the similarity observed in the National Survey (3) . The variable of family income of 10 or more minimum wages was associated with alcohol consumption with and without binging. An earlier study conducted among private high school students in São Paulo found a higher frequency of alcohol use, including binge drinking among higher socioeconomic classes (18) . with numerous other acute negative consequences (5) .
Although the college students in the BD group had more consequences associated with alcohol use, they evaluated the consequences as less negative. Southern Region, a characteristic of CIEE's own e-mail database due to the decentralization of some of the company's regional ones. Due to the characteristics of the invitation to access the website, there is also possibly an underrepresentation of university students who do not consume alcoholic beverages.

Conclusion
Among the study participants, we observed reports of binging alcohol consumption in a considerable portion of the sample. Compared to alcohol consumption without binging, the variable binge drinking was significantly associated with a greater chance of reporting several problems and negative consequences related to alcohol consumption. These results suggest a specific risk group for problems associated with alcohol use. In order to reduce the impact of the problems associated with this consumption, the information in this study should be considered in future public or institutional policies focused on Brazilian university students.