title: Heterogeneous dose-response and college student drinking: examining problem risks related to low drinking levels.
abstract: OBJECTIVE
  Previous research demonstrates that the number of problems related to each additional drink consumed on any drinking occasion, dose-response, varies non-linearly across average drinking quantities. We test predictions from a dynamic model of drinking behavior that locates this heterogeneity in drinkers' efforts to equilibrate between costs and benefits of use.
  
  
  METHODS
  Equations derived from the theoretical model are used to assess dose-response across drinking quantity subgroups using censored regressions.
  
  
  METHODS
  Fourteen California, USA, college campuses surveyed from 2003 to 2011.
  
  
  METHODS
  A total of 37 762 undergraduate college students 18 years of age and older.
  
  
  METHODS
  Drinking patterns, five physiological problems related to alcohol use (hangover, memory loss, medical treatment for overdose, nausea/vomiting, passing out) and student demographics.
  
  
  RESULTS
  The number of physiological problems related to each additional drink consumed was an inverse function of average drinking quantities (b = 0.2947, Z = 21.92, P<0.001), differed by drinker age (of-age drinker b = -0.1144, Z = -3.95, P < 0.001) and gender (male b = -0.3379, Z = -18.56, P<0.001) and, at the population level, drinking three drinks per occasion was associated with the greatest number of problems.
  
  
  CONCLUSIONS
  Among US college students, all drinkers exhibit greater risks for physiological problems related to alcohol use (hangover, memory loss, medical treatment for overdose, nausea/vomiting, passing out) when drinking greater amounts of alcohol, but heavier drinkers (those who consume more on average) exhibit fewer problems for each additional drink consumed (less dose-response) than light and moderate drinkers. Light and moderate drinkers exhibit greater dose-response, with three drinks per occasion associated with the greatest number of problems.
authors.affiliation: Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, CA, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Gruenewald
authors.affiliation: Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Mair
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D000067292:Alcohol Drinking in College; D000434:Alcoholic Beverages / Q000009:adverse effects / Q000706:statistics & numerical data; D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D017678:Sex Distribution; D013334:Students / Q000523:psychology / Q000706:statistics & numerical data; D000066608:Underage Drinking / Q000706:statistics & numerical data; D014495:Universities / Q000706:statistics & numerical data
keywords: Alcohol epidemiology; alcohol problems; college drinking; dose-response model; low dose effects; theoretical models