Nurse Education Today 35 (2015) 132–137

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Nurse Education Today

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Self-assessment of alcohol consumption as a health-education strategy in

nursing students
Joseba Rabanales Sotos a,⁎, Ángel López Gonzalez a, Ignacio Párraga Martínez b, Monchi Campos Rosa c,
María J. Simarro Herraez d, Jesús López-Torres Hidalgo e
a
Albacete Faculty of Nursing, University of Castilla-La Mancha (Universidad de Castilla-La Mancha/UCLM), Spain
b
La Roda Health Centre (Albacete), Castilla-La Mancha Health Service (Servicio de Salud de Castilla-La Mancha/SESCAM), Spain
c
Albacete Integrated Healthcare Management (SESCAM), Spain
d
Villarrobledo-Albacete Integrated Healthcare Management (SESCAM), Spain
e
Albacete Faculty of Medicine (UCLM), Albacete Zone IV Health Centre (SESCAM), Spain

a r t i c l e i n f o s u m m a r y

Article history: Background: In the field of preventive activities, early identification of excessive alcohol consumption is essential.
Accepted 6 August 2014 The simplicity of existing instruments for detecting hazardous drinking makes for ready assimilation in univer-
sity students.
Keywords: Objective: To ascertain nursing students' level of knowledge about alcohol prevention activities and assess their
Hazardous drinker skills, acquired through self-assessment of their own alcohol consumption, in managing tools designed to detect
Alcohol consumption
hazardous drinkers.
Nursing student
Education
Design: Before and after intervention study.
Preventive activities Material and Methods: We assessed 1060 nursing students and ascertained their level of knowledge about exces-
sive alcohol consumption. Following an educational intervention in which students were taught to use the
recommended screening instruments in clinical practice through self-assessment of their own consumption
(Systematic Interview of Alcohol Consumption and Alcohol Use Disorders Inventory Test), we tested the skills
acquired in detecting hazardous drinkers and their knowledge of alcohol prevention activities.
Results: Initially, the concept of hazardous drinker was known by only 24.1% of students and the method of
quantifying alcohol consumption by only 3.1%. The prevalence of hazardous drinkers was 17.9% (95% CI: 15.5–
20.3). After the educational intervention, 95.8% of students stated that they understood the concept of hazardous
drinker and 92.5% stated that they understood how to quantify alcohol consumption, with these proportions
being significantly higher than those obtained at baseline (p b 0.001). When asked about the intervention's use-
fulness, 91.3% viewed it favourably.
Conclusion: By using a simple educational intervention, nursing students can improve their knowledge and skill
detection of hazardous drinkers and quantification of alcohol consumption. These concepts allow for students to
be satisfactorily introduced into the prevention activities during their university education. After assessing their
own consumption, a considerable proportion of students realise that they are indulging in excessive alcohol con-
sumption, which could in turn make for greater awareness of the problem among future health professionals.
© 2014 Elsevier Ltd. All rights reserved.

Introduction proportion of hazardous drinkers stands at 37.1% among Spanish uni-

Alcohol consumption is regarded as an important public health
problem world-wide, having been identified as the second largest
disease risk factor in Europe and the leading disease risk factor in the
Western Pacific and the Americas (WHO, 2011). In general, excessive
alcohol consumption is common among young adults in industrialised
countries, both in and outside Europe, and poses a problem of great
magnitude in this population. According to some previous studies, the
⁎ Corresponding author at: CalleHermanos Grimm 12, 02005 Albacete, Spain.
E-mail address: rabanalessotos@hotmail.com (J. Rabanales Sotos).
versity students (Caamaño-Isorna et al., 2008).
Prevention is a fundamental tool for reducing excessive alcohol
consumption. There are different hypotheses that might explain why
preventive activities targeting excessive alcohol consumption are not
present in the clinical and other spheres where healthy lifestyles should
be fostered, as is the case of university students (Salcedo et al., 2011).
The Association of American Medical Colleges (AAMC) indicates that
new graduates regard education in the fields of alcohol prevention
and screening as inadequate, and up to 22.8% of all new graduates
state that they do not feel sufficiently prepared in this respect (Stine
et al., 2000). It has also been said (Frost-Pineda et al., 2004) that the

http://dx.doi.org/10.1016/j.nedt.2014.08.004
0260-6917/© 2014 Elsevier Ltd. All rights reserved.
 J. Rabanales Sotos et al. / Nurse Education Today 35 (2015) 132–137 133

problem is not only the lack of time or interest on the part of health pro-
fessionals, but also the incomplete curricular education received on this
subject. It is suggested that educational requirements should be higher,
providing students with more information that would make them feel
competent in this area. Another recent study undertaken in the United
Kingdom (Holloway and Webster, 2013) underscores “the need for
a greater and more relevant focus of alcohol education” to nursing
students.
The literature shows that gaps have been identified in knowledge
about alcohol consumption at university (Boyd et al., 2005), that there
is no solid theoretical framework for its assessment (Devos-Comby
and Lange, 2008), and that this aspect has not been studied in all coun-
tries (Karam et al., 2007), all of which renders it advisable for research to
be targeted at singling out the aspects of most interest and protective
factors in the university environment, along with the most effective in-
terventions for reducing consumption (Velázquez et al., 2001).
Organisations such as the National Institute on Alcohol Abuse and
Alcoholism (NIAAA) and Centre for Addiction Research and Education
(CARE) have developed training programmes of an international nature
which seek to cater for physicians and nurses from different countries
(Murray and Fleming, 1996). These programmes focus health profes-
sionals' attention, not only on patients who are addicts, but also on
those who are at risk, a population that is more numerous and has the
possibility of responding to preventive actions. This model has shown
itself to be an effective strategy for enhancing health-staff skills in the
prevention and treatment of alcohol-related problems (Gaskin de
Urdaneta et al., 2002). In this regard, a number of academic authorities
and associations have also initiated efforts in recent years targeted at
improving student training in fields linked to substance prevention
and abuse.
In the sphere of health sciences, and specifically in the field of
preventive activities, it is of great importance to know how to identify
excessive alcohol consumption early and accurately, since this makes
it possible to intervene in the early stages of the problem. The simplicity
of existing instruments for detecting hazardous drinking makes for
ready assimilation in the initial stages of students' education, thereby
enabling them to be initiated into the tasks of prevention and ensuring
a higher state of alert with respect to risk behaviours, both their own
and of others. Students can acquire skills in the management of instru-
ments designed to identify hazardous drinkers, and also ascertain to
what extent their own alcohol-related habits approach what is regarded
as at-risk or hazardous drinking. Assessment of their own behaviour
allows students to perceive problematic alcohol consumption as some-
thing much closer to their own lives, and to form a more realistic view of
what is considered healthy and what is considered harmful. Such self-
assessment presumably makes students more sensitive when it comes
to detecting problematic alcohol-related behaviours, a very important
skill in those who are going to devote themselves to health care in the
future. Moreover, the experience of self-assessment could well facilitate
moderation in alcohol consumption, a trait that is very desirable for fu-
ture professionals who, in terms of healthy habits, should serve as a role
model for their patients.
Accordingly, the aim of this study was twofold: firstly, to ascertain
nursing students' level of knowledge about preventive activities
targeting excessive alcohol consumption; and secondly, to assess
their skills – acquired through self-assessment of their own alcohol con-
sumption – in managing tools designed to detect hazardous drinkers.
Material and Methods
We conducted a before–after intervention study among undergrad-
uate students enrolled in the nursing degree programme at the Univer-
sity of Castilla-La Mancha during the 2012/2013 academic year. The
criterion for inclusion was defined as follows: any person registered as
a student at any of the university's five nursing faculties in the above
academic year that consented to take part in the study. The sole exclu-
sion criterion was refusal to participate after being informed of the
study's designated objectives. Out of the total 1265 registered students
invited to participate, 1060 (83.8%) responded.
The intervention consisted of a one-hour-long teaching workshop
on alcohol prevention activities given to the participants by three
lecturers. To this end, the students were called together in groups of
20 to 25 and informed of the study's goals. To gather the information,
a pre-coded, self-administered, anonymous data-collection form was
designed. This training does not form part of the study plan of the nurs-
ing faculties where the study was undertaken. The study was approved
by the Clinical Research Ethics Committee of the Albacete University
Teaching Hospital (Spain).
We firstly assessed participants' prior knowledge of concepts relat-
ing to hazardous drinking, i.e., the concept of “hazardous drinker”, the
consumption limits defined as “hazardous”, the tools used for detection
purposes, and how to quantify alcohol consumption in standard drink
units (SDUs).
Following this, the participants were administered the instruments
routinely used for detection of hazardous drinking, specifically the
Alcohol Use Disorders Inventory Test (AUDIT) (Rubio et al., 1998) and
Systematic Alcohol Consumption Interview (Interrogatorio Sistematizado
de Consumos Alcohólicos/ISCA) (Gual et al., 2001).
The AUDIT is a self-administered questionnaire made up of 10
questions which assess events that have taken place in the preceding
year and make it possible to detect mild and moderate alcohol-related
problems, with the focus on hazardous consumption or alcohol abuse.
It is an internationally-used instrument for detecting non-severe
alcohol-related problems and has been previously validated in
Spain (Rubio et al., 1998). The ISCA, for its part, consists of three ques-
tions that address the quantity and frequency of alcohol consumption

Table 1
Level of knowledge about excessive alcohol consumption.

Characteristics Before the intervention After the intervention

Men Women Total Men Women Total

no. (%) no. (%) no. (%) no. (%) no. (%) no. (%)

Are you familiar with the concept of hazardous drinker?

Yes 53 (24.2) 202 (24.0) 255 (24.1) 210 (95.9) 806 (95.8) 1016 (95.8)
No 166 (75.8) 639 (76.0) 805 (75.9) 9 (4.1) 25 (3.0) 34 (3.2)
Not shown 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 10 (1.2) 10 (0.9)
Do you know the limits of what is regarded as hazardous alcohol consumption?
Yes 32 (14.6) 104 (12.4) 136 (12.8) 207 (94.5) 805 (95.7) 1012 (95.5)
No 187 (85.4) 736 (87.5) 923 (87.1) 12 (5.5) 29 (3.6) 41 (3.8)
Not shown 0 (0.0) 1 (0.1) 1 (0.1) 0 (0.0) 7 (0.7) 7 (0.7)
Do you know how to quantify alcohol consumption in SDUs?a
Yes 7 (3.2) 26 (3.1) 33 (3.1) 201 (91.8) 779 (92.6) 980 (92.5)
No 212 (96.8) 810 (96.3) 1022 (96.4) 16 (7.3) 51 (6.1) 67 (6.3)
Not shown 0 (0.0) 5 (0.5) 5 (0.5) 2 (0.9) 11 (1.3) 13 (1.2)
a
SDUS: standard drink units.
134 J. Rabanales Sotos et al. / Nurse Education Today 35 (2015) 132–137

(number of beers, wines and spirits), differentiating between workdays Table 2

and weekends/holidays, and enables weekly intakes deemed hazardous Distribution of answers to the Alcohol Use Disorders Inventory Test (AUDIT).

by the WHO (28 SDUs for men and 17 for women) to be quantified. Questions Number %
Once the participants had finished assessing their own alcohol How often do you have a “drink” containing alcohol?
consumption, they were taught how to interpret the instruments used Never 83 7.8
and given an explanation of the concepts linked to hazardous drinking Once or less than once per month 193 18.2
and its early detection. We used a dichotomous question to assess 2–4 times per month 522 49.2
2–3 times per week 235 22.2
their comprehension of the workshop content and a scale of 0 to 10 to
4 or more times per week 26 2.5
assess their comprehension of the completion, interpretation and Not shown 1 0.1
potential usefulness of both instruments. The workshop ended with a How many “alcoholic drinks” do you have on a typical day when
question-and-answer session in which doubts raised by the students you have been drinking?
were addressed by the lecturers. 0–2 377 35.6
3–4 373 35.2
Subsequently, the lecturers reviewed the participants' question- 5–6 227 21.4
naires to check whether equivalence in SDUs/week had been correctly 7–9 61 5.8
computed. 10 or more 21 2.0
Participants' answers were introduced into a database, processed Not shown 1 0.1
How often do you have six “drinks” or more on a single occasion
and analysed, using the IBM SPSS Statistics v.19 programme. We firstly
Never 459 43.3
described the characteristics of the participants, calculating the distribu- Less than once per month 337 31.8
tion of frequencies in the qualitative variables and the measures of Monthly 166 15.7
central trend and dispersion in the quantitative variables, along with Weekly 97 9.2
their 95% confidence intervals. Tests of comparison of proportions Daily or almost daily 0 0.0
Not shown 1 0.1
(chi-squared) were then performed, and the measurements taken
How often in the last year have you felt unable to stop drinking
before and after the educational intervention were compared using once you have begun?
the McNemar test and a significance level of 0.05. Never 897 84.6
Less than once per month 116 10.9
Monthly 29 2.7
Results
Weekly 14 1.3
Daily or almost daily 0 0.0
A total of 1060 students were analysed, with a mean age of 21.6 years Not shown 1 0.1
(SD: 4.6) and mostly female (79.3%). How often in the last year have you been unable to do what you
Table 1 shows students' knowledge of concepts relating to hazard- were normally expected to do due to drink?
Never 792 74.7
ous drinking pre- and post-intervention. The concept of hazardous
Less than once per month 226 21.3
drinker was known by only 24.1%, the consumption limits defined as Monthly 36 3.4
hazardous by only 12.8% and the way of quantifying alcohol consump- Weekly 3 0.3
tion by only 3.1%. When students were asked whether they knew of Daily or almost daily 0 0.0
Not shown 1 0.1
any instrument (questionnaire or scale) for detecting hazardous drink-
During the last year, how often have you needed a shot of alcohol
ing, only 6.5% answered affirmatively. in the morning, in order to be able to “get going” after a night of
After the participants had been administered the AUDIT and ISCA, heavy drinking?
along with the necessary instructions for their completion, they Never 1036 97.7
completed both instruments on the basis of their own consumption of Less than once per month 18 1.7
Monthly 3 0.3
and experience with alcohol. The responses obtained in the AUDIT are
Weekly 2 0.2
shown in Table 2. All the questions were answered by over 99% of Daily or almost daily 0 0.0
students and practically all (99.1%) calculated the total test score. Not shown 1 0.1
According to the respective cut-points used, 39.4% of men and 44.5% During the last year, how often have you felt guilt or remorse after
having been drinking?
of women indulged in hazardous drinking, with the difference not
Never 620 58.5
being statistically significant. The prevalence of hazardous alcohol con- Less than once per month 356 33.6
sumption for the sample as a whole was 43.4% (95% CI: 40.4–46.5). Monthly 65 6.1
The results of quantifying consumption by reference to the ISCA are Weekly 17 1.6
shown in Table 3. Of all the questions posed, the least answered – Daily or almost daily 1 0.1
Not shown 1 0.1
though even here with a 97.9% response rate – was the one that sought
During the last year, how often have you been unable to recall
to establish the frequency, in terms of days per week, of participants' what happened the previous night due to having been
consumption of alcoholic beverages. According to the results of this drinking?
questionnaire, 72.5% of subjects reported changing their drinking habits Never 639 60.3
on the weekend. Based on the hazardous-consumption limits for men Less than once per month 347 32.7
Monthly 62 5.8
and women, the prevalence of hazardous drinkers was 14.9% and Weekly 9 0.8
18.7% respectively, with this difference not proving statistically signifi- Daily or almost daily 0 0.0
cant. In the sample as a whole the prevalence of hazardous drinkers, ac- Not shown 3 0.3
cording to the alcohol consumption limits designated by the WHO, was Have you or any other person suffered any harm as a consequence
of the fact that you had been drinking?
17.9% (95% CI: 15.5–20.3).
No 936 88.3
Once participants had completed the self-assessment of their own Yes, but not in the last year 77 7.3
consumption, been shown how to interpret the two instruments and Yes, in the last year 45 4.2
been taught the concept of hazardous drinker, the limits deemed haz- Not shown 2 0.2
ardous and the equivalence of the number of alcoholic beverages in Has any relative, friend, doctor or health professional expressed
concern at your drinking or suggested that you stop drinking?
SDUs/week, 95.8% reported that they understood the concept of hazard- No 997 94.1
ous drinker, 95.5% that they understood the limits defined as hazardous Yes, but not in the last year 27 2.5
and 92.5% that they understood how to quantify consumption of alco- Yes, in the last year 34 3.2
holic beverages in SDUs/week (Table 1), with these proportions proving Not shown 2 0.2
 J. Rabanales Sotos et al. / Nurse Education Today 35 (2015) 132–137 135

Table 3 67.70%
Mean number of standard drink units per week among men and women, according to type
of alcohol beverage (Systematic Interview of Alcohol Consumption-Interrogatorio
Sistematizado de Consumos Alcohólicos/ISCA).

Questions

Mean 95% CI 7.70%

value
If you sometimes consume alcohol (wine, beer, etc.), 3.51
how many drinks do you have on the days that
you drink?
How often do you do so? (number of days per week) 1.37
Type of alcoholic beverage (SDUs/week)a
Beer 3.43
Wine 1.12
Spirits 6.55
All beverages 11.09
No.
Do you change your drinking habits on the weekend
(or on work days)?
Yes 769
No 286
Not shown 5 0.5
a
SDUS: standard drink units.
significantly higher than those obtained prior to the intervention
(p b 0.001) and indicating a great disparity with respect to the replies
obtained initially. Indeed, most of the students (97.0%) were seen to
have correctly calculated their own consumption in SDUs/week. This
percentage was not significantly different among students belonging
to different courses.
Using a scale of 0 to 10, the students rated their level of comprehen-
sion of how to complete and interpret the two questionnaires, and gave
their opinion about the potential usefulness of both (Fig. 1). The mean
score was above 8.0 for all items, except the one about the ease of
obtaining the ISCA score, for which a mean score of 7.5 was attained.
When it came to assessing the educational intervention's overall
usefulness (Fig. 2), 91.3% of participants expressed a favourable opinion
(with 67.7% rating the intervention as useful and 23.6% as very useful).
As regards their opinion about its applicability in clinical practice
(Fig. 3), 89.9% felt that the knowledge and skills acquired for detecting
hazardous drinkers were applicable in the clinical sphere. At the end
of the teaching workshop, the lecturers addressed doubts raised by
the students and noted their comments, which for the most part
highlighted their previous ignorance of the subject and the lack of train-
ing in these skills over the course of the regular syllabus.
1.00%
3.37–3.65
23.60%
Very useful Useful Of little or no use No reply
1.32–1.42
3.14–3.72 Fig. 2. Usefulness of the intervention.
0.97–1.26
6.12–6.98
10.43–11.75
Discussion
%
This study assessed nursing students' level of knowledge about
current preventive recommendations on alcohol consumption, geared
72.5 towards early detection of hazardous drinkers. Our results show that,
27.0 prior to the intervention, only a small proportion of students were fa-
miliar with the concept of hazardous drinker, the limits deemed hazard-
ous and, in particular, the quantification of alcohol consumption, which
reveals inadequate training of students in these matters during their
time at university.
By the same token, through self-assessment of their own consump-
tion, these students satisfactorily acquired skills in the management of
instruments frequently used in clinical practice for detection of hazard-
ous consumption or identification of the hazardous drinker by reference
to the WHO-designated limits, namely the AUDIT and ISCA respectively.
The need for such training and its subsequent assessment has previous-
ly been highlighted as a guideline for future research (VanKim et al.,
2010; Jonas et al., 2012). The simplicity of existing instruments for de-
tecting hazardous drinking makes for ready assimilation in the initial
stages of a university education: hence the fact that the majority of
the participants were able to answer the questionnaires appropriately.
The results indicate that it is easy to initiate students in the implemen-
tation of alcohol prevention activities, which could engender a higher
state of alert for future health professionals with respect to risk behav-
iours, both their own and of others.
Furthermore, the results reveal hazardous drinking in a high propor-
tion of students, with the prevalence obtained (17.9%) being compara-
ble to that reported by other studies conducted on university students
(11.9% to 37.1%), both in Spain and in other countries (Gerstenkorn
and Suwała, 2003; Caamaño-Isorna et al., 2008; Carvalho et al., 2008;
Leiva, 2009; Labbe and Maisto, 2011; Ji et al., 2012), to the extent that

10
8.40 8.59 8.46 8.31
9 8.01 8.17 8.07 8.23 8.24
8 7.51

7
6
5
4
3
2
1
0
Ease of completion Ease of interpreting Ease of obtaining Speed of scoring Overall usefulness
questions final scores

AUDIT ISCA

Fig. 1. Score denoting level of comprehension and interpretation of the ISCA (Interrogatorio Sistematizado de Consumos Alcohólicos/ Systematic Interview of Alcohol Consumption) and
AUDIT (Alcohol Use Disorders Inventory Test) on a scale of 0 to 10.
136 J. Rabanales Sotos et al. / Nurse Education Today 35 (2015) 132–137
89.90%
2.90%
6.30%
0.90%
Yes applicable Not applicable Do not know No reply
Fig. 3. Applicability to clinical practice.
it has come to be considered an important public health problem (Ham
and Hope, 2003; Karagülle et al., 2010; Diep et al., 2013). A previous
study (Carter et al., 2010), has shown that university students drink
more alcohol more frequently than do their non-university peers,
though other factors might intervene in such differences.
Different experiments have been conducted at universities to change
attitudes to alcohol consumption among students (Holloway and
Webster, 2013). On assessing the impact of an educational programme
about alcohol and other drugs on undergraduate nursing students in En-
gland, Rassool and Rawaf (2008a, 2008b) showed this to be significant.
Wilsher (2010) also drew up a health promotion strategy addressing al-
cohol consumption among second-year nursing students in Australia. In
the USA, Church and Babor (1995) and Hayes (2002) previously devel-
oped models designed to integrate substance abuse into nursing educa-
tion. Based on the Project NEADA (Nursing Education in Alcohol and
Drug Abuse), a study conducted in Colombia in 2005 developed an
alcohol and drug training programme for nurses, nursing students and
teachers (Vásquez and Pillon, 2005). Another instance of intervention
was that undertaken by Arthur (2001) in Hong Kong, where an early-
intervention educational programme was shown to have a significant
effect on students' knowledge of and attitudes to alcohol. Negrete
(1990) proposed a training model that would not be confined to acquir-
ing clinical knowledge and skills, but would also improve students' per-
sonal attitudes. In this regard, he also proposed helping students to
prevent them from rejecting self-imposed conditions, while at the same
time encouraging them to examine their own drinking habits and behav-
ioural patterns objectively, in order to ascertain how these might affect
their clinical judgement.
In general, both our study and other experiments undertaken in the
past show that satisfactory results are yielded when alcohol prevention
activities are addressed during the course of university education, and
their implementation in teaching programmes should therefore be gen-
eralised. This would help avoid the need for future health professionals
to acquire such knowledge and skills on entering the workforce, and at
the same time recognise the need for health professionals with exper-
tise in assessment, detection and brief alcohol-related interventions
(Holloway et al., 2007; Watson et al., 2010). Brief interventions of this
type in a primary-care setting lead to significant reductions in alcohol
consumption (Altisent et al., 1997; Córdoba et al., 1998, 2012) and dis-
play a good cost-effectiveness ratio (Bertholet et al., 2005).
Conclusion
In conclusion, a simple educational intervention enables nursing stu-
dents to broaden their knowledge and skills for detection of hazardous
drinkers and quantification of alcohol consumption, areas in which
there is currently insufficient curricular training. These concepts allow
for students to be satisfactorily introduced into the field of alcohol
prevention activities during the course of their university education.
Moreover, through assessment of their own consumption, a high pro-
portion of students come to realise that they are indulging in excessive
alcohol consumption, which could in turn make for greater awareness
of the problem among future health professionals.
Funding
No funding was requested for the undertaking of this study.
Acknowledgements
We would like to thank the deans and teaching staff of the Albacete,
Ciudad Real, Cuenca, Toledo and Talavera de la Reina Nursing Faculties
for their collaboration, as well as all the nursing degree students who
voluntarily participated in the study.
References
Altisent, R., Córdoba, R., Delgado, M.T., Pico, V., Melús, E., Aranguren, F., Alvira, U., Barberá,
C., Moran, J., Reixa, S., 1997. Estudio multicéntico para la prevención del alcoholismo
en atención primaria (EMPA). Med. Clin. 109, 121–124.
Arthur, D., 2001. The effects of the problem-based Alcohol Early-Intervention Education
Package on the knowledge and attitudes of students of nursing. J. Nurse Edu. 40
(2), 63–72.
Bertholet, N., Daeppen, J.B., Wietlisbach, V., Fleming, M., Burnand, B., 2005. Reduction of
alcohol consumption by brief alcohol intervention in primary care. Systematic review
and meta-analysis. Arch. Intern. Med. 165, 986–995.
Boyd, C.J., McCabe, S.E., Morales, M., 2005. College students' alcohol use: a critical review.
Annu. Rev. Nurs. Res. 23, 179–211.
Caamaño-Isorna, F., Corral, M., Parada, M., Cadaveira, F., 2008. Factors associated with
risky consumption and heavy episodic drinking among Spanish university students.
J. Stud. Alcohol Drugs 69, 308–312.
Carter, A.C., Brandon, K.O., Goldman, M.S., 2010. The college and noncollege experience: a
review of the factors that influence drinking behaviour in young adulthood. J. Stud.
Alcohol Drugs 71, 742–750.
Carvalho, K.A., Sant'Anna, M.J., Coates, V., Omar, H.A., 2008. Medical students: abuse of
psychoactive substances and sexuality aspects. Int. J. Adolesc. Med. Health 20,
321–328.
Church, O.M., Babor, T.F., 1995. Barriers and breakthroughs: substance abuse curricula in
nursing education. J. Nurs. Educ. 34 (6), 278–281.
Córdoba, R., Delgado, M.T., Pico, V., Altisent, R., Fores, D., Monreal, A., Frisas, O., López, D.V.,
1998. Effectiveness of brief intervention on nondependent alcohol drinkers (EBIAL): a
Spanish multicentre study. Fam. Pract. 15, 562–568.
Córdoba, R., Cabezas, C., Camarelles, F., Gómez, J., Díaz, D., López, A., Marqués, F., Muñoz, E.,
Navarro, B., Ramírez, J.I., 2012. Recomendaciones sobre estilos de vida. Aten. Primaria 44
(1), 16–22.
Devos-Comby, L., Lange, J.E., 2008. Standardized measures of alcohol-related problems: a
review of their use among college students. Psychol. Addict. Behav. 22, 349–361.
Diep, P.B., Knibbe, R.A., Giang, K.B., De Vries, N., 2013. Alcohol-related harm among uni-
versity students in Hanoi, Vietnam. Glob. Health Action 6, 1–10.
Frost-Pineda, K., Van Susteren, T., Gold, M.S., 2004. Are physicians and medical students
prepared to educate patients about alcohol consumption? J. Addict. Disord. 23, 1–13.
Gaskin de Urdaneta, A., Seale, J.P., Fleming, M., Murray, M., 2002. Primary care and alcohol
use disorders: evaluation of a faculty-development program in Venezuela. Pan Am. J.
Public Health 12, 79–85.
Gerstenkorn, A., Suwała, M., 2003. Alcohol use by future physicians — medical and social
problem. Wiad. Lek. 56, 402–406.
Gual, A., Contel, M., Segura, L., Riba, A., Colon, J., 2001. The ISCA (Systematic Interview of
Alcohol Consumption), a new instrument to detect risky drinking. Med. Clin. 117,
685–689.
Ham, L.S., Hope, D.A., 2003. College students and problematic drinking: a review of the
literature. Clin. Psychol. Rev. 23, 719–759.
Hayes, P.D., 2002. Substance abuse integration in nursing education: an innovative collab-
orative model. Subst. Abus. 23 (1), 67–79.
Holloway, A.S., Webster, B.J., 2013. Alcohol education and training in pre-registration
nursing: a national survey to determine curriculum content in the United Kingdom.
Nurse Educ. Today 33 (9), 992–997.
Holloway, A.S., Watson, H.E., Arthur, A.T., Starr, G., McFadyen, A.K., McIntosh, J., 2007. The
effect of brief interventions on alcohol consumption among heavy drinkers in a
general hospital setting. Addiction 102 (11), 1762–1770.
Ji, C.Y., Hu, P.J., Song, Y., 2012. The epidemiology of alcohol consumption and misuse
among Chinese college students. Alcohol Alcohol. 47, 464–472.
Jonas, D.E., Garbutt, J.C., Amick, H.R., Brown, J.M., Brownley, K.A., Council, C.L., Viera, A.J.,
Wilkins, T.M., Schawart, C.J., Richmond, E.M., Yeatts, J., Evans, T.S., Woos, S.D.,
Harris, R.P., 2012. Behavioral counseling after screening for alcohol misuse in primary
care: a systematic review and meta-analysis for the U.S. Preventive Services Task
Force. Ann. Intern. Med. 157, 645–654.
Karagülle, D., Donath, C., Grässel, E., Bleich, S., Hillemacher, T., 2010. Binge drinking in
adolescents and young adults. Fortschr. Neurol. Psychiatr. 78, 196–202.
Karam, E., Kypri, K., Salamoun, M., 2007. Alcohol use among college students: an interna-
tional perspective. Curr. Opin. Psychiatr. 20, 213–321.
Labbe, A.K., Maisto, S.A., 2011. Alcohol expectancy challenges for college students: a
narrative review. Clin. Psychol. Rev. 31, 673–683.
Leiva, V., 2009. Analysis of factors associated with the drug phenomenon in students of
second and fourth year of “Licenciatura en Enfermería”. Revista de Ciencias Sociales
123, 105–118.
 J. Rabanales Sotos et al. / Nurse Education Today 35 (2015) 132–137
Murray, M., Fleming, M., 1996. Prevention and treatment of alcohol-related problems: an
international medical education model. Acad. Med. 71, 1204–1210.
Negrete, J.C., 1990. The role of medical school in the prevention of alcohol-related
problems. Can. Med. Assoc. J. 143, 1048–1053.
Rassool, G.H., Rawaf, S., 2008a. Predictors of educational outcomes of undergraduate nurs-
ing students in alcohol and drug education. Nurse Educ. Today 28, 691–701.
Rassool, G.H., Rawaf, S., 2008b. Educational intervention for undergraduate nursing
students' confidence skills with alcohol and drug misusers. Nurse Educ. Today 28,
284–292.
Rubio, G., Bermejo, J., Caballero, M.C., Santodomingo, J., 1998. Validación de la prueba para
la identificación de trastornos por el uso de alcohol (AUDIT) en atención primaria.
Rev. Clin. Esp. 198, 11–14.
Salcedo, A., Palacios, X., Fernanda, A., 2011. Alcohol consumption in young college
students. Avances en Psicología Latinoamericana 29, 77–97.
Stine, C., Kohrs, F.P., Little, D.N., Kaprielian, V., Gatipon, B.B., Hap, C., 2000. Integrating
prevention education into the medical school curriculum: the role of department of
family medicine. Acad. Med. 75, 55–59.
137
VanKim, N.A., Laska, M.N., Ehlinger, E., Lust, K., Story, M., 2010. Understanding young
adult physical activity, alcohol and tobacco use in community colleges and 4-year
post-secondary institutions: a cross-sectional analysis of epidemiological surveillance
data. BMC Public Health 10, 208.
Vásquez, E.M., Pillon, S.C., 2005. La formación de enfermeras y el fenómeno de las drogas
en Colombia: conocimientos, actitudes y creencias. Rev Latino-am Enfermagen 13,
846–853.
Velázquez, C.E., Pasch, K.E., Laska, M.N., Lust, K., Story, M., Ehlinger, E.P., 2001. Differential
prevalence of alcohol use among 2-year and 4-year college students. Addict. Behav.
136, 1353–1356.
Watson, H., Munro, A., Wilson, M., Kerr, S., Godwin, J., 2010. The involvement of nurses
and midwives in screening and brief interventions for hazardous and harmful use
or alcohol and other psychoactive substances. World Health Organization, Geneva.
Wilsher, K.A., 2010. Overcoming mixed messages on alcohol consumption: a teaching
strategy. Nurse Educ. Pract. 10, 279–284.
Word Health Organization, 2011. Global Status Report on Alcohol and Health. WHO,
Geneva.