- Email: [email protected]
Participation in sports and alcohol consumption among French adolescents
Addictive Behaviors 29 (2004) 941 – 946
Short communication
Participation in sports and alcohol consumption among French adolescents Fabrice O. Lorentea,*, Marc Souvilleb,1, Jean Griffetb,2, Laurent Gre´lota,3 a
Department of Physiology, Faculty of Sport Sciences Marseille, University of the Mediterranean, UPRES EA 3285, and IFR 107 Marey, 163 avenue de Luminy, case 910 Marseille, France b Department of Psycho-sociology, Faculty of Sport Sciences Marseille, University of the Mediterranean, UPRES EA 3294, and IFR 107 Marey, 163 avenue de Luminy, case 910 Marseille, France
Abstract Using an anonymous self-report questionnaire (N = 816 participants), we examined the relation between participation in sports and alcohol consumption and identified the risk factors associated with alcohol consumption among French high-school students. Univariate analysis showed that sport involvement was related to higher alcohol use ( P < .05). Participants who participated in group sports drank significantly more than those who participated as individuals ( P < .01). Multivariate analysis underlined factors associated with alcohol consumption, but these varied considerably according to the level of alcohol consumption. Three factors were associated with weekly and daily alcohol use: male gender, daily cigarette use, and perception of poor health. D 2004 Elsevier Ltd. All rights reserved. Keywords: Alcohol use; Adolescents; Physical activity; Risk factor
1. Introduction Alcohol, tobacco, and marijuana appear to be the most widely abused substances by children and adolescents (Bruner & Fishman, 1998). A study on 10,870 French adolescents (Arvers & * Corresponding author. Tel.: +33-4-91-82-83-72; fax: +33-4-91-82-83-75. E-mail addresses: [email protected] (F.O. Lorente), [email protected] (M. Souville), [email protected] (J. Griffet), [email protected] (L. Gre´lot). 1 Tel.: +4-91-17-04-35; fax: +4-91-17-22-89. 2 Tel.: +4-91-17-04-75; fax: +4-91-17-22-89. 3 Tel.: +33-4-91-82-83-69; fax: +33-4-91-82-83-73. 0306-4603/$ – see front matter D 2004 Elsevier Ltd. All rights reserved. doi:10.1016/j.addbeh.2004.02.039
942
F.O. Lorente et al. / Addictive Behaviors 29 (2004) 941–946
Choquet, 1999) shows that 4.3% of males between the ages of 18 and 21 years old drink wine daily, 4.2% drink beer, and 1% drink hard liquor; 8.2% drink wine at least twice a week, 23.9% beer, and 11.5% hard liquor. Choquet and Hassler (1997) described a U-shaped curve relating participation in sports to alcohol use: Athletes drank less alcohol than those who performed no physical activity, and those who played sports intensively drank more than those who practiced sports in moderation. Peretti-Watel, Beck, and Legleye (2002) showed that the U-shaped curve relating the intensity of physical activity and licit and illicit drug use is not constant; it depends on the substance, its level of use, gender, age, registration in a club, and type of sport. We propose here to study the nature of the relations between alcohol use among adolescents and their participation in sports, including the context, type, and number of training sessions.
2. Methods 2.1. Participants and procedure The self-report questionnaire was administered anonymously to a sample of 816 students from 20 public high schools in southeastern France. This sample is representative of the parental population according to sex (46.2% of boys vs. 45.9% for the parental population), age (mean age = 18.3 F 1.2 years), geographic area, and parental profession. The survey was undertaken during the spring of 2001. The population sample was selected on a quota basis. The framework included a definition of the number of participants to be questioned within each geographic area and the student’s scholastic orientation (technical vs. academic). In each geographic area, a predetermined number of schools was selected. For each school, we questioned students in a set number of classes according to the scholastic orientation of the students. The teenagers approached were free to decline to participate (response rate 90.7%; 816 of 900). 2.2. Data analysis Statistical analysis was performed using the SPSS software, Version 10.1. Relations between variables were first analysed using the Pearson’s Chi-square Test. To control for confounding factors, we then used four logistic regressions to study the factors associated with alcohol use (no use, use during the last 15 days, use during the last week, and daily use).
3. Results 3.1. Frequency of alcohol consumption Table 1 indicates that 70.1% of the students drank at least once per 15 days, and 38.5% drank at least once per week. Females were more likely to report no alcohol use ( P < .001), and males were more likely to report drinking at least once per week ( P < .001).
F.O. Lorente et al. / Addictive Behaviors 29 (2004) 941–946
943
Table 1 Self-reported frequency of alcohol use (N = 816) Alcohol use
All [%] (N = 816)
Boys [%] (n = 377)
Girls [%] (n = 439)
P value
Daily use One to four times per week One to two times per 15 days Never
2.4 36.1 31.6 29.9
4.2 42.2 30 23.6
0.5 30 33.3 36.2
< .001 < .001 NS < .001
NS = v2 > .05.
3.2. Participation in sports and alcohol consumption Statistical analysis (Table 2) shows that athletes were more likely to report alcohol use ( P < .05). Participants who practiced only in a formal context, as a member of a club or association ( P < .05), who practiced at the regional level ( P < .01), and who reported a Table 2 Pearson v2 for sport participation and the use of alcohol (N = 816) Drink alcohol at least once per 15 days [%] (n) Sport involvement Yes (n = 621) No (n = 195)
70.4 (437)* 60.0 (117)
Context of sporting practice Formal only (club, association; n = 122) Informal only (free sport; n = 275) Both formal and informal (n = 224)
81.1 (99)* 65.1 (179) 75.9 (170)
Level of practice in this sport Departmental (n = 90) Regional (n = 126) National (n = 40) International (n = 3)
72.2 (65) 80.2 (101)** 72.5 (29) Ø
Frequency of practice per week 1 to 2 times (n = 356) 3 to 5 times (n = 230) 6 to 10 times (n = 27) more than 10 times (n = 8) Team sports (n = 233)c Individual sports (n = 388)
67.4 76.1 66.7 62.5 84.1 61.8
(240) (175)* (18) (5) (196)** (240)
Ø = not calculated. c Team sports: soccer (n = 128), basketball (n = 37), volleyball (n = 29), ice hockey (n = 2), handball (n = 22), American football (n = 2), and rugby (n = 13). *P < .05. **P < .01.
944
F.O. Lorente et al. / Addictive Behaviors 29 (2004) 941–946
frequency of practice between three to five times per week ( P < .05), were more likely to report alcohol consumption. 3.3. Predictors of alcohol consumption among French high-school students Daily alcohol users were mostly male from rural areas, who lived in a foster home, whose head of family was a company manager, whose studies were in the technical, as opposed to
Table 3 Four logistic regression models for demographic, sport, and substance-use variables entered as predictors of alcohol use (N = 816) Frequency of alcohol ingestion
Regression 1
Regression 2
Regression 3
Regression 4
Never (n = 243)
One to two times per 15 days (n = 259)
One to four times per week (n = 295)
Daily (n = 19)
1.000 1.681*** 1.705* 1.258** 0.729 0.868 0.768 0.836 0.978
1.000 1.672** 1.216 1.342 0.754 1.055 1.050 1.579* 0.833
1.543** 1.000 0.793 0.625 1.517 0.937 0.521 0.665* 1.305
12.700*** 1.000 1.314 0.136* 6.972** 3.804* 8.474* 0.450 9.078**
0.784 0.428** 1.420* 1.600*
0.859 1.184 0.941 1.639
1.211* 0.978 1.198 0.625
0.986 1.734 1.354 0.365*
1.295
1.027
0.692
0.246*
Perception of well-being Very satisfactory Not satisfactory at all
1.244* 0.647
1.607 1.263
0.914 1.984*
0.278* 12.547**
Smoke cigarettes daily
0.205***
0.818
1.362*
7.405*
Demographics Male Female Nonremedial student Academic scholastic orientation Technical scholastic orientation Head of family’s profession: CP a Live in a foster home Urban areab Rural areac Sport Practice only in informal context Practice only in formal context Practice both in formal and informal Level of practice: national and international Practice between 6 to 10 times per week
a
CP: company manager. Area of Marseille, Aix-en-Provence, Vitrolles, Marignane, and Martigues. c Area of Gap, Briancßon, Digne, and Embrun. *P < .05. **P < .01. ***P < .001. b
F.O. Lorente et al. / Addictive Behaviors 29 (2004) 941–946
945
the academic, stream, who felt they were in relatively poor health, and who smoked cigarettes daily (Table 3). Individuals who never used alcohol tended to be female, nonremedial students, in the academic stream, who participated in sports, both formally and informally, who participated at a national or international level, and who felt they were in very good health.
4. Discussion The results of the univariate analysis indicate that group sports are those in which alcohol use was prevalent. These results corroborate those of Peretti-Watel et al. (2002), who indicated that regular participation in team sports is positively correlated with repeated alcohol use by both sexes. More generally, and even in the presence of differences between participants and nonparticipants in their use of alcohol (because participants are significantly more likely to drink), the relations between involvement in sports and alcohol consumption appear to be more complex, with certain nuances being associated with certain sports. For example, alcohol consumption seems to depend on numerous characteristics associated with the sporting activity, for example, the type of sport practiced, the context, competitive or noncompetitive sport, the level, and the number of training sessions. The results are consistent with those of Wechsler, Davenport, Dowdall, Grossman, and Zanakos (1997), who showed that students participating in sports drank more often than nonparticipants did. In contrast with the results of Challier, Chau, Pre´dine, Choquet, and Legras (2000), our results do not reveal greater alcohol consumption among French adolescents who participated in intensive extracurricular sporting activities when compared with those who participated in moderate activity. The results of the multivariate analyses indicate that factors associated with alcohol consumption varied according to the level of alcohol consumption. Not surprisingly, and consistent with the results of earlier studies (Grunbaum, Tortolero, Weller, & Gingiss, 2000; Sussman, McCuller, & Dent, 2002), male gender was a variable strongly associated with weekly or daily alcohol use among adolescents. Other sociodemographic characteristics (scholastic orientation, parental profession, and area of residence) played an important role in alcohol consumption. Surprisingly, the type of sport was not a variable predictive of alcohol use and abuse among French adolescents. However, participating in sports at a national or international level and training more than six times weekly were associated with reduced daily alcohol consumption. In contrast, perception of poor health was strongly associated with weekly and daily alcohol consumption. The limitations of this study include the lack of qualitative data permitting us to study the importance attributed by those participating in sports to their activities and the absence of a detailed classification of sport activities that takes into account both the sociological and biological aspects of the activity. In addition, our study did not examine the participants’ attitudes to substance abuse, and we did not identify the type of alcohol consumed. To have a preventive action program adapted to substance abuse, future evaluations need to characterize more completely young teenagers who participate in sports and use multiple drugs.
946
F.O. Lorente et al. / Addictive Behaviors 29 (2004) 941–946
Acknowledgements We thank the ‘‘Conseil Ge´ne´ral 13’’ and A.S.O. (Socie´te´ du Tour de France) for their financial support, the Rectorat de l’Acade´mie d’Aix-Marseille for authorising the access to the public high schools, and Dr Steve Iscoe for his helpful advises on the manuscript.
References Arvers, P., & Choquet, M. (1999). Regional variations in alcohol use among young people in France. Epidemiological approach to alcohol use and abuse by adolescents and conscripts. Drug and Alcohol Dependence, 56, 145 – 155. Bruner, A. B., & Fishman, M. (1998). Adolescents and illicit drug use. JAMA, 280, 597 – 598. Challier, B., Chau, N., Pre´dine, R., Choquet, M., & Legras, B. (2000). Associations of family environment and individual factors with tobacco, alcohol and illicit drug use in adolescents. European Journal of Epidemiology, 16, 33 – 42. Choquet, M., & Hassler, C. (1997). Sports and alcohol consumption during adolescence. Alcoologie, 19, 21 – 27. Grunbaum, J. A., Tortolero, S., Weller, N., & Gingiss, P. (2000). Cultural, social, and intrapersonal factors associated with substance use among alternative high school students. Addictive Behaviors, 25, 145 – 151. Peretti-Watel, P., Beck, F., & Legleye, S. (2002). Beyond the U-curve: The relationship between sport and alcohol, cigarette and cannabis use in adolescents. Addiction, 97, 707 – 716. Sussman, S., McCuller, W. J., & Dent, C. W. (2002). The associations of social self-control, personality disorders, and demographics with drug use among high-risk youth. Addictive Behaviors, 27, 1 – 8. Wechsler, H., Davenport, A. E., Dowdall, G. W., Grossman, S. J., & Zanakos, S. I. (1997). Binge drinking, tobacco, and illicit drug use and involvement in college athletics. A survey of students at 140 American colleges. Journal of American College Health, 45, 195 – 200.
Short communication
Participation in sports and alcohol consumption among French adolescents Fabrice O. Lorentea,*, Marc Souvilleb,1, Jean Griffetb,2, Laurent Gre´lota,3 a
Department of Physiology, Faculty of Sport Sciences Marseille, University of the Mediterranean, UPRES EA 3285, and IFR 107 Marey, 163 avenue de Luminy, case 910 Marseille, France b Department of Psycho-sociology, Faculty of Sport Sciences Marseille, University of the Mediterranean, UPRES EA 3294, and IFR 107 Marey, 163 avenue de Luminy, case 910 Marseille, France
Abstract Using an anonymous self-report questionnaire (N = 816 participants), we examined the relation between participation in sports and alcohol consumption and identified the risk factors associated with alcohol consumption among French high-school students. Univariate analysis showed that sport involvement was related to higher alcohol use ( P < .05). Participants who participated in group sports drank significantly more than those who participated as individuals ( P < .01). Multivariate analysis underlined factors associated with alcohol consumption, but these varied considerably according to the level of alcohol consumption. Three factors were associated with weekly and daily alcohol use: male gender, daily cigarette use, and perception of poor health. D 2004 Elsevier Ltd. All rights reserved. Keywords: Alcohol use; Adolescents; Physical activity; Risk factor
1. Introduction Alcohol, tobacco, and marijuana appear to be the most widely abused substances by children and adolescents (Bruner & Fishman, 1998). A study on 10,870 French adolescents (Arvers & * Corresponding author. Tel.: +33-4-91-82-83-72; fax: +33-4-91-82-83-75. E-mail addresses: [email protected] (F.O. Lorente), [email protected] (M. Souville), [email protected] (J. Griffet), [email protected] (L. Gre´lot). 1 Tel.: +4-91-17-04-35; fax: +4-91-17-22-89. 2 Tel.: +4-91-17-04-75; fax: +4-91-17-22-89. 3 Tel.: +33-4-91-82-83-69; fax: +33-4-91-82-83-73. 0306-4603/$ – see front matter D 2004 Elsevier Ltd. All rights reserved. doi:10.1016/j.addbeh.2004.02.039
942
F.O. Lorente et al. / Addictive Behaviors 29 (2004) 941–946
Choquet, 1999) shows that 4.3% of males between the ages of 18 and 21 years old drink wine daily, 4.2% drink beer, and 1% drink hard liquor; 8.2% drink wine at least twice a week, 23.9% beer, and 11.5% hard liquor. Choquet and Hassler (1997) described a U-shaped curve relating participation in sports to alcohol use: Athletes drank less alcohol than those who performed no physical activity, and those who played sports intensively drank more than those who practiced sports in moderation. Peretti-Watel, Beck, and Legleye (2002) showed that the U-shaped curve relating the intensity of physical activity and licit and illicit drug use is not constant; it depends on the substance, its level of use, gender, age, registration in a club, and type of sport. We propose here to study the nature of the relations between alcohol use among adolescents and their participation in sports, including the context, type, and number of training sessions.
2. Methods 2.1. Participants and procedure The self-report questionnaire was administered anonymously to a sample of 816 students from 20 public high schools in southeastern France. This sample is representative of the parental population according to sex (46.2% of boys vs. 45.9% for the parental population), age (mean age = 18.3 F 1.2 years), geographic area, and parental profession. The survey was undertaken during the spring of 2001. The population sample was selected on a quota basis. The framework included a definition of the number of participants to be questioned within each geographic area and the student’s scholastic orientation (technical vs. academic). In each geographic area, a predetermined number of schools was selected. For each school, we questioned students in a set number of classes according to the scholastic orientation of the students. The teenagers approached were free to decline to participate (response rate 90.7%; 816 of 900). 2.2. Data analysis Statistical analysis was performed using the SPSS software, Version 10.1. Relations between variables were first analysed using the Pearson’s Chi-square Test. To control for confounding factors, we then used four logistic regressions to study the factors associated with alcohol use (no use, use during the last 15 days, use during the last week, and daily use).
3. Results 3.1. Frequency of alcohol consumption Table 1 indicates that 70.1% of the students drank at least once per 15 days, and 38.5% drank at least once per week. Females were more likely to report no alcohol use ( P < .001), and males were more likely to report drinking at least once per week ( P < .001).
F.O. Lorente et al. / Addictive Behaviors 29 (2004) 941–946
943
Table 1 Self-reported frequency of alcohol use (N = 816) Alcohol use
All [%] (N = 816)
Boys [%] (n = 377)
Girls [%] (n = 439)
P value
Daily use One to four times per week One to two times per 15 days Never
2.4 36.1 31.6 29.9
4.2 42.2 30 23.6
0.5 30 33.3 36.2
< .001 < .001 NS < .001
NS = v2 > .05.
3.2. Participation in sports and alcohol consumption Statistical analysis (Table 2) shows that athletes were more likely to report alcohol use ( P < .05). Participants who practiced only in a formal context, as a member of a club or association ( P < .05), who practiced at the regional level ( P < .01), and who reported a Table 2 Pearson v2 for sport participation and the use of alcohol (N = 816) Drink alcohol at least once per 15 days [%] (n) Sport involvement Yes (n = 621) No (n = 195)
70.4 (437)* 60.0 (117)
Context of sporting practice Formal only (club, association; n = 122) Informal only (free sport; n = 275) Both formal and informal (n = 224)
81.1 (99)* 65.1 (179) 75.9 (170)
Level of practice in this sport Departmental (n = 90) Regional (n = 126) National (n = 40) International (n = 3)
72.2 (65) 80.2 (101)** 72.5 (29) Ø
Frequency of practice per week 1 to 2 times (n = 356) 3 to 5 times (n = 230) 6 to 10 times (n = 27) more than 10 times (n = 8) Team sports (n = 233)c Individual sports (n = 388)
67.4 76.1 66.7 62.5 84.1 61.8
(240) (175)* (18) (5) (196)** (240)
Ø = not calculated. c Team sports: soccer (n = 128), basketball (n = 37), volleyball (n = 29), ice hockey (n = 2), handball (n = 22), American football (n = 2), and rugby (n = 13). *P < .05. **P < .01.
944
F.O. Lorente et al. / Addictive Behaviors 29 (2004) 941–946
frequency of practice between three to five times per week ( P < .05), were more likely to report alcohol consumption. 3.3. Predictors of alcohol consumption among French high-school students Daily alcohol users were mostly male from rural areas, who lived in a foster home, whose head of family was a company manager, whose studies were in the technical, as opposed to
Table 3 Four logistic regression models for demographic, sport, and substance-use variables entered as predictors of alcohol use (N = 816) Frequency of alcohol ingestion
Regression 1
Regression 2
Regression 3
Regression 4
Never (n = 243)
One to two times per 15 days (n = 259)
One to four times per week (n = 295)
Daily (n = 19)
1.000 1.681*** 1.705* 1.258** 0.729 0.868 0.768 0.836 0.978
1.000 1.672** 1.216 1.342 0.754 1.055 1.050 1.579* 0.833
1.543** 1.000 0.793 0.625 1.517 0.937 0.521 0.665* 1.305
12.700*** 1.000 1.314 0.136* 6.972** 3.804* 8.474* 0.450 9.078**
0.784 0.428** 1.420* 1.600*
0.859 1.184 0.941 1.639
1.211* 0.978 1.198 0.625
0.986 1.734 1.354 0.365*
1.295
1.027
0.692
0.246*
Perception of well-being Very satisfactory Not satisfactory at all
1.244* 0.647
1.607 1.263
0.914 1.984*
0.278* 12.547**
Smoke cigarettes daily
0.205***
0.818
1.362*
7.405*
Demographics Male Female Nonremedial student Academic scholastic orientation Technical scholastic orientation Head of family’s profession: CP a Live in a foster home Urban areab Rural areac Sport Practice only in informal context Practice only in formal context Practice both in formal and informal Level of practice: national and international Practice between 6 to 10 times per week
a
CP: company manager. Area of Marseille, Aix-en-Provence, Vitrolles, Marignane, and Martigues. c Area of Gap, Briancßon, Digne, and Embrun. *P < .05. **P < .01. ***P < .001. b
F.O. Lorente et al. / Addictive Behaviors 29 (2004) 941–946
945
the academic, stream, who felt they were in relatively poor health, and who smoked cigarettes daily (Table 3). Individuals who never used alcohol tended to be female, nonremedial students, in the academic stream, who participated in sports, both formally and informally, who participated at a national or international level, and who felt they were in very good health.
4. Discussion The results of the univariate analysis indicate that group sports are those in which alcohol use was prevalent. These results corroborate those of Peretti-Watel et al. (2002), who indicated that regular participation in team sports is positively correlated with repeated alcohol use by both sexes. More generally, and even in the presence of differences between participants and nonparticipants in their use of alcohol (because participants are significantly more likely to drink), the relations between involvement in sports and alcohol consumption appear to be more complex, with certain nuances being associated with certain sports. For example, alcohol consumption seems to depend on numerous characteristics associated with the sporting activity, for example, the type of sport practiced, the context, competitive or noncompetitive sport, the level, and the number of training sessions. The results are consistent with those of Wechsler, Davenport, Dowdall, Grossman, and Zanakos (1997), who showed that students participating in sports drank more often than nonparticipants did. In contrast with the results of Challier, Chau, Pre´dine, Choquet, and Legras (2000), our results do not reveal greater alcohol consumption among French adolescents who participated in intensive extracurricular sporting activities when compared with those who participated in moderate activity. The results of the multivariate analyses indicate that factors associated with alcohol consumption varied according to the level of alcohol consumption. Not surprisingly, and consistent with the results of earlier studies (Grunbaum, Tortolero, Weller, & Gingiss, 2000; Sussman, McCuller, & Dent, 2002), male gender was a variable strongly associated with weekly or daily alcohol use among adolescents. Other sociodemographic characteristics (scholastic orientation, parental profession, and area of residence) played an important role in alcohol consumption. Surprisingly, the type of sport was not a variable predictive of alcohol use and abuse among French adolescents. However, participating in sports at a national or international level and training more than six times weekly were associated with reduced daily alcohol consumption. In contrast, perception of poor health was strongly associated with weekly and daily alcohol consumption. The limitations of this study include the lack of qualitative data permitting us to study the importance attributed by those participating in sports to their activities and the absence of a detailed classification of sport activities that takes into account both the sociological and biological aspects of the activity. In addition, our study did not examine the participants’ attitudes to substance abuse, and we did not identify the type of alcohol consumed. To have a preventive action program adapted to substance abuse, future evaluations need to characterize more completely young teenagers who participate in sports and use multiple drugs.
946
F.O. Lorente et al. / Addictive Behaviors 29 (2004) 941–946
Acknowledgements We thank the ‘‘Conseil Ge´ne´ral 13’’ and A.S.O. (Socie´te´ du Tour de France) for their financial support, the Rectorat de l’Acade´mie d’Aix-Marseille for authorising the access to the public high schools, and Dr Steve Iscoe for his helpful advises on the manuscript.
References Arvers, P., & Choquet, M. (1999). Regional variations in alcohol use among young people in France. Epidemiological approach to alcohol use and abuse by adolescents and conscripts. Drug and Alcohol Dependence, 56, 145 – 155. Bruner, A. B., & Fishman, M. (1998). Adolescents and illicit drug use. JAMA, 280, 597 – 598. Challier, B., Chau, N., Pre´dine, R., Choquet, M., & Legras, B. (2000). Associations of family environment and individual factors with tobacco, alcohol and illicit drug use in adolescents. European Journal of Epidemiology, 16, 33 – 42. Choquet, M., & Hassler, C. (1997). Sports and alcohol consumption during adolescence. Alcoologie, 19, 21 – 27. Grunbaum, J. A., Tortolero, S., Weller, N., & Gingiss, P. (2000). Cultural, social, and intrapersonal factors associated with substance use among alternative high school students. Addictive Behaviors, 25, 145 – 151. Peretti-Watel, P., Beck, F., & Legleye, S. (2002). Beyond the U-curve: The relationship between sport and alcohol, cigarette and cannabis use in adolescents. Addiction, 97, 707 – 716. Sussman, S., McCuller, W. J., & Dent, C. W. (2002). The associations of social self-control, personality disorders, and demographics with drug use among high-risk youth. Addictive Behaviors, 27, 1 – 8. Wechsler, H., Davenport, A. E., Dowdall, G. W., Grossman, S. J., & Zanakos, S. I. (1997). Binge drinking, tobacco, and illicit drug use and involvement in college athletics. A survey of students at 140 American colleges. Journal of American College Health, 45, 195 – 200.