Journal of Public Health Advance Access originally published online on December 21, 2007
Journal of Public Health 2008 30(1):8-13; doi:10.1093/pubmed/fdm083
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After ‘Unit 1421’: an exploratory study into female students' attitudes and behaviours towards binge drinking at Leeds University
Rhiannon Carpenter, Medical Student1
Adelle Fishlock, Medical Student1
Ann Mulroy, Medical Student1
Beth Oxley, Medical Student1
Kate Russell, Medical Student1
Claire Salter, Medical Student1
Nicole Williams, Medical Student1
Catherine Heffernan, Specialist Trainee in Public Health2,
1 University of Leeds Medical School, Leeds, UK
2 Department of Public Health, University of Oxford, Old Road, Headington, OX3 7LF, UK
Address correspondence to Catherine Heffernan, E-mail: hefferc{at}yahoo.com
Background Binge drinking has been highlighted as a growing problem in the UK, particularly amongst females aged 18–25 years. University of Leeds is situated within a population that has one of the highest reported statistics of binge drinking in the UK. In September 2006, the ‘Unit 1421’ campaign was launched at University of Leeds with the aim to promoted sensible drinking amongst students. The aim of this study is to explore female perspectives on binge drinking and on ‘Unit 1421’ campaign in the University of Leeds.
Methods Using a purposive sample, two focus groups were conducted with 12 female students aged 18–23 years within university grounds. Participants were recruited via email and poster advertisements on campus.
Results Four main themes emerged from the data: (i) lay perception of binge drinking; (ii) pressures of matching the drinking patterns of male peers; (iii) student rite of passage; (iv) evaluation of the ‘Unit 1421’ campaign.
Conclusion The social context of student life impacts greatly upon students' choices to binge drink. The norms, beliefs and morals governing student culture and the use of alcohol to assert identity should be considered when tailoring health promotion efforts to this target audience. Larger qualitative and ultimately quantitative studies are warranted to extrapolate and test the social pressures on drinking in this age group.
Keywords: alcohol, alcohol misuse, binge drinking, females, students
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Introduction |
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The prevalence of binge drinking amongst women in the UK has increased considerably in recent years.1 In 2003, 23% of 16–24-year-old women reported drinking more than 21 U a week, a rise from 14% in 1994.2 Over a quarter (27%) of the same age group report binge drinking at least once a week,3 defined by the government as drinking more than twice the recommended daily allowance in one session.4 Consequences of binge drinking include crime, loss of productivity in the workplace, domestic violence, increased emergency admissions, sexually transmitted infections and unwanted pregnancies and alcohol related health disorders and disease.5,6
In September 2006, the University of Leeds Student Union and Leeds North West Primary Care Trust (PCT) launched the ‘Unit 1421’ campaign to combat rising drinking rates amongst students by raising awareness of the dangers of binge drinking.7 Similar to the ‘Know your Limits’ campaign,8 the campaign uses a social marketing approach, which adapts marketing techniques to social issues.9 During ‘Freshers’ Week', flyers, bottles of water and wrist bands branded with ‘Unit 1421’ website address were distributed. These were accompanied by posters and advertisements in student newspapers. The campaign attempted to market responsible alcohol intake as being desirable. The target audience was 18–24-year students, which make up 21% of the Leeds North West PCT population.10 This population has the third highest estimated prevalence of binge drinking in England and is concentrated in the student populated areas of Headingley, University and Kirstall.2
The aim of this study is to explore female students' attitudes towards binge drinking. In spite of the rising prevalence, there is a dearth of public health literature on the social forces that prevent young women from binge drinking despite their knowledge of the outcomes. A secondary aim is to investigate the women's perceptions of the ‘Unit 1421’ campaign. To date the effects of the campaign are yet to be audited and its effectiveness as a health promotion intervention is unknown. Targeting an audience requires understanding their attitudes, knowledge and behaviour, therefore it is maintained that this study, though of a small scale nature, has much insight to offer.
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Method |
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Focus groups are an appropriate methodology when there is limited knowledge about people's perspectives11 and when exploring ‘context-embedded’ behaviour.12 Group dynamics can be used to stimulate the discussion and the interaction of participants produces deeper insight than interviews or questionnaires. Participants were recruited through an email sent to all university students and advertisements placed on student union notice boards around the campus. Lunch was provided as an incentive. The inclusion criteria were women aged between 18 and 25 years and who were students at the University of Leeds. Twenty-four women were recruited and 12 were attended the focus group sessions. The missing participants gave no reason for absence. Those who agreed to take part were aged 18–23 and were from a range of academic courses. Ethical approval was sought and approved by the medical school ethnics committee at the University.
Two focus groups were conducted in meeting rooms in the Students' Union and the Medical School. Both of these locations were accessible and familiar sites for participants, creating a comfortable and relaxed environment for open discussion. The focus groups lasted 2 h and were unstructured. The groups were facilitated by one of the female authors with a similar age and background to the participants. Two observers took detailed observation notes. Each session was tape-recorded and transcribed immediately afterwards. All participants informed about what was involved and signed a consent form, assuring confidentiality and anonymity.
Data analysis was thematic analysis, involving identification of key themes and categories across the participants. Themes were analysed by all researchers independently to ensure consistency. Results were validated by observer triangulation and by theory triangulation.13 Given the homogeneity of our focus groups, we make no claims for generalizability of our findings to the UK female student population.
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Results |
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Four main themes emerged from the data: (i) lay perception of binge drinking; (ii) pressures of matching the drinking patterns of male peers; (iii) student rite of passage; (iv) evaluation of the ‘Unit 1421’ campaign.
Lay perception of binge drinking
The majority of participants saw binge drinking as consuming copious amounts in one session. As Participant 8 said:
Binge drinking would be if you had about 10 drinks in one night, I guess that, to me, is binge drinking.
Others thought it depended on the number of nights you drank per week. There was a clear distancing of self from binge drinking. Participants associated binge drinking with the pattern of alcohol consumption held by others but not themselves:
You don't really think of it at all. You don't really think that you yourself binge drink. It's just sort of a problem I guess for like young people in Britain, but it's your lifestyle so you don't really question it too much.(Participant 7)
Participants felt binge drinking was engrained into their lifestyles. They demonstrated awareness of the serious medical and social consequences, but as Participant 6 said:
We are all sat here and we are all intelligent people, but we all still go out and get absolutely hammered, even though we know.
Only two participants knew their recommended weekly limit. Throughout the groups, the assertion was that people do not count units. They measure intake on whether they have a hangover the next day:
Suppose if you have a hangover you know you have drunk too much, you know you have punished your body, whereas I generally don't get hangovers, I rarely get hangovers so I don't think I've drunk too much.(Participant 12)
‘Keeping up with the lads’
It was widely felt that while males have always been perceived as heavy drinkers, females were definitely catching up. Many participants reasoned that girls are increasingly drinking with their male friends because they are expected to keep pace with them. During the non-participant observation, a competitive behaviour between the two sexes was evident in mixed groups. This can be linked to the rise of the ‘ladette’ culture and the convergence of female and male alcohol consumption.14 Mixed gender friendships are seemingly more common with females increasingly being seen as ‘drinking mates’:
I think it's the expectation that young lads will go out and get really drunk, whereas perhaps the expectation hasn't been that girls will go out with them, or you know, in groups of girls doing similar things. You get the piss taken out of you if you're not keeping up with the guys.(Participant 7)
Young et al.15 argue that this is not a result of gender equality but that female students try to match their male counterparts to make themselves more sexually attractive to the opposite sex and increase their social standing amongst both their male and female friends:
I've seen some of my friends when they are drunk flirting with these guys and saying ‘he keeps coming over and talking to me’, its like well if you left him alone for five minutes you'd probably be ok.(Participant 12)
The thing is that alcohol does increase testosterone in women so they probably are going to be more aggressive and have an increased libido and all the rest of it. I guess the shock is that a lot of girls are going out behaving in a way typically a drunken guy behaves, maybe that's what is shocking.
(Participant 10)
The perception that girls exhibit unattractive, undesirable and ‘unacceptable’ behaviour when drunk is similar to the findings of Parks et al.,16 where women who get drunk are more likely to be perceived as ‘loose’ or ‘easy’ by men. Participants admitted that there had been times when they had acted this way, and this made them feel embarrassed or ashamed:
You hear other peoples' perceptions like ‘I walked past someone and they were really drunk and it was shocking’ and you think, yeah that's probably been me a few times and that's quite embarrassing.(Participant 9)
Many stressed that binge drinking often leads to risk taking behaviour, such as walking home alone and this worried them:
I think it is a horrible realisation when you wake up in the morning and you don't know how you got in bed.(Participant 12)
Just thinking anything could have happened.
(Participant 11)
This was reiterated in the other focus group with Participant 5 saying:
I've seen lots of bad things. I've done lots of bad things... . a few times like you'll wake- up and be like ‘how on earth did I get here?’
Similar to Jack et al.,17 there was concern about how group drunken behaviours affect others:
I think you can, if you're not drunk, on the Otley Run you can be quite conscious of how you're perceived by other people because there's those, you have like, reports in the papers and stuff about how the pubs get really annoyed.(Participant 10)
The next day I think ‘oh my god what if my Dad saw me?’
(Participant 9)
Student rite of passage
Leeds student culture revolves around drinking. Pubs, clubs and house parties were forums for social interactions and networking, providing students with a means to create their own social capital. There is evidence that there is a perception that alcohol enhances social situations and makes them more enjoyable.18–20 A number of participants referred to people having more confidence when drinking and that this helped them to connect with peers:
Like I probably wouldn't talk to half the people I know or done half the stupid things I've done if I wasn't drunk...(Participant 7)
Drinking to meet people often starts in first year, when many students are trying to establish themselves within a new group of friends. The first year students in this study stated that they believed that getting drunk would help them to ‘fit in’:
You are out of your comfort zone. Your friends and family are back home. You will go out more because you have to in order to meet people and then because of that, you end up drinking.(Participant 2)
Despite the acknowledgement that binge drinking had a negative impact upon study and academic achievement, partaking in the ‘Otley Run’ was held in high regard. This is a pub-crawl stretching from Headingley to Leeds City Centre often done in fancy dress. It is a strong tradition in student culture. Other universities have similar rites of passage, for example, ‘The 14 stations’ at Trinity College Dublin and ‘Campus 14’ at Nottingham University:21
It's one of first things, like when you arrive at Leeds, everyone always says to you, ‘oh have you done an Otley Run yet?’ And it seems everyone, there's kind of, almost, it's not pressure but there's this expectation that you'll do an Otley Run at some point.(Participant 11)
It was evident that many of the participants associated the ‘Otley Run’ with a sense of identity. As Participant 8 said:
It makes you feel proud of Leeds. It's like something Leeds has that's different to everywhere else.
The participants identified a number of aspects of student culture that encourage binge drinking including cheap drinks promotions (such as ‘student nights’ or student privilege cards) and a belief that alcohol facilitates social interactions. Through non-participant observation students were seen asking about drink offers at the bar and ordering the cheapest drinks. Many participants pointed out that it was often cheaper to buy alcoholic drinks than soft drinks and that discount cards only discounted alcoholic drinks. Some establishments were said to be advertising ‘£10 all you can drink nights’. Participants maintained that students would still binge drink even if drinks became more expensive. As Participant 9 said:
It will take time for binge drinking to become socially unacceptable.
Both focus groups saw binge drinking as a phase while at university, which would decline or stop once they had graduated:
Sometimes it's just a phase isn't it? Like we are saying now in five years at Uni or whatever, you get past all that, and you don't binge drink as much.(Participant 1)
I think well I'm only doing it while I'm a student, when I start working I won't be able to do it because you just can't while I work I don't drink. It's like I'll be finishing in a few months I may as well enjoy it while I can, hopefully they will have worked out liver transplants by then.
(Participant 2)
Yeah... in first year I went out and got really, really hammered. But now, me and my mates just sit and have a few pints. [We] don't really go to clubs much ‘coz we all really feel we're getting on a bit now.
(Participant 1)
Evaluation of the ‘Unit 1421’ Campaign
There was limited awareness of the Unit 1421 campaign among participants. Very few had seen the materials and had little understanding of their purpose:
They look a bit like band posters, which I tend to ignore to be honest, like, they're always plastered everywhere and like, don't really grab my attention.(Participant 5)
Others felt the flyers were unclear, stating that they thought they were advertising a nightclub. Participants liked the idea of having a campaign targeted at students of Leeds as they could relate to it but they thought the medium was outdated:
I wouldn't wear the [wrist] bands; they're a bit out of date.(Participant 10)
There was also a disinterest in accessing an Internet site for more information:
They should not expect people to research it themselves.(Participant 9)
The groups maintained that increasing awareness about binge drinking on campus would require a more innovative approach than the usual flyer and poster. It seems that the bombardment of health messages on posters has caused students to become desensitized. Participants pointed out that many students do not look at the traditional campaign material because of the vast quantities of flyers and posters already targeting students, particularly in Freshers' Week. A preferred means to access health promotion information was ‘Facebook’, an Internet based blog site, which is widely used by a network of university students across the country. Since a lot of communication now takes place electronically, using ‘Facebook’ would help health promoters get their message quickly (and cheaply) to their target audience. Other suggestions included locating campaign material on public transport routes and ladies' toilets in clubs and bars.
Interestingly, participants maintained that campaigns were aimed at men rather than women. They reckoned that there should be female specific material reminding women about the dangers of binge drinking. A message could be included for men to check that women are okay if they are drunk. Like Jack et al.,18 some mentioned showing the devastating effects binge drinking has on people's families and friends as this made it a reality. They thought that this means may be more effective than the current shock tactics as ‘they're not new’.
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Discussion |
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Main findings
This exploration study suggests that lay definitions of binge drinking are variable and that women are indifferent to the harms. Women also felt pressured to match male drinking patterns, although they were self-conscious about other people's perceptions of drunk women. The biggest influence was the centralization of alcohol to student lifestyle. It is difficult for an individual to avoid binge drinking when the surrounding culture normalizes such behaviour.
What the study adds to the body of knowledge
By focusing on one of the UKs largest universities, the study was able to gain insight into the beliefs, attitudes and behaviours of young female drinkers. A recent study on female students' knowledge of recommended daily guidelines found that the UK sensible drinking message did not influence the drinking behaviours of newly matriculated female university students.22 This paper attempts to offer explanations for this behaviour. Social distancing was evident. Students were knowledgeable about the consequences of binge drinking but associated binge drinking as a problem affecting others but not them. There was nonchalance about binge drinking, particularly since the participants viewed it as simply a phase whilst at university. The influence of student culture on drinking behaviours is an important finding. Alcohol consumption is a social act and must be understood in its social context.23 The drinking culture may vary from university to university but it appears that it is an integral part of student life. It is a mean for students to network and form social capital. Another aspect is the pressure to drink on par with male counterparts. This finding is novel as there is a dearth of literature on male influences on the pattern of females' drinking behaviours.
Targeting binge drinking in this cohort will require health promotion efforts to modify social norms and cultural attitudes towards drinking in order to make it less acceptable for people to binge drink. This is not an entirely impossible task. For instance, the change in public attitudes and the incoming banning of smoking in public places has led to smoking becoming stigmatized.
Limitations of study
Since this study was undertaken as part of a degree course at University of Leeds, there were time and financial constraints. This meant that only two focus groups could be conducted. It is possible that the researchers have accessed individuals who are the most willing to partake in a focus group and to vocalize views on binge drinking. Peer led groups can also lead to a loss of objectivity. However, it is maintained that peer led discussions helped participants to share experiences.
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Conclusion |
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TOPIntroductionMethodResultsDiscussionConclusionReferences |
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The social context of student life impacts greatly upon students' choices to binge drink. The norms, beliefs and morals governing student culture and the use of alcohol to assert identity should be considered when tailoring health promotion efforts to this target audience. Larger qualitative and ultimately quantitative studies are warranted to extrapolate and test the social pressures on drinking in this age group.
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References |
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- Department of Health. Health Survey for England 2003. (2003) London: Department of Health.
- National Statistics Online. http://www.statistics.gov.uk (4 January 2007, date last accessed).
- Cabinet Office, Prime Ministers Strategy Unit. National Alcohol Harm Reduction Strategy for England (2004) London: Cabinet Office.
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- Jack S, Bouck M, Beyr C, et al. Marketing a hard to swallow message: Recommendations for the design of media campaigns to increase awareness about the risks of binge drinking. Can J Public Health (2005) 96:189–92.[Web of Science][Medline]
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