Abstract
The purpose of this study is to determine whether social support can moderate the relationship between acculturative stress and alcohol abuse among international college students. Cluster random sampling will be used to select the institutions from which the sample will be drawn, and stratified random sampling will be used to recruit male international students between the ages of 18 and 24 years, currently residing and studying in the state of California. Data will be collected using a demographic questionnaire, Alcohol Use Disorder Identification Test (AUDIT), Social Support Questionnaire (SSQ), and the Acculturative Stress Scale for International Students (ASSIS). Postal mail and internet-based research are feasible data collection methods because the population is dispersed and difficult to reach. Based on the characteristics of the variables analyzed in this study, the data will be analyzed using ANOVA and multiple linear regression. It is expected that this study will find a statistically significant relationship between acculturative stress and alcohol abuse, and it is also expected that social support will moderate that relationship.
CHAPTER 1: Introduction
Alcohol abuse is a common problem for college students world-wide. A national study of alcohol abuse and dependence in the United States (US) estimated the prevalence of alcohol abuse using a sample of more than 14,000 college students at 119 higher education institutions, and it was found that 31% of the students satisfied the DSM-IV criteria for an alcohol abuse diagnosis (Knight et al., 2002). In the United Kingdom (UK), a survey of 3,075 students from 10 universities showed that 15% of the students reported hazardous drinking while 28% reported binge drinking (Webb, Ashton, Kelly, & Kamali, 1996). A study in Australia found that 88% of the sample (n = 275 college students, age range 18-55 years) reported drinking alcohol, and approximately 40% of those participants were categorized as “at risk for harm” and in the “dependency range” (J. Davey, T. Davey, & Obst, 2002).
The consequences of alcohol abuse reflect on students’ personal lives, social interactions, and their academic achievements. It is estimated that around 25% of students who drink report blackouts and driving under the influence of alcohol, whereas 30% get into verbal or physical disputes (Perkins, 2002). Students who satisfy criteria for alcohol abuse or dependence are more likely to fail in their first year of college than students who did not report drinking problems (62.5% vs. 50%; Aertgeerts & Buntinx, 2002) Lack of drinking control also predicts alcohol abuse later in life, and blackouts are predictive of poor academic achievement because they often lead to the escalation of alcohol abuse during college (Read, Wardell, & Bachrach, 2013).
Although various psychological and social factors can influence the development of alcohol abuse in the general student population, such as mood disorders, peer pressure, age, or family history, international students are also required to cope with the stress associated with acculturation. Acculturation is the process of cultural change and intercultural interaction, and the perceived difficulties of various barriers that occur during the acculturation process are considered the causes of acculturative stress (Berry, 2006). Various negative effects of acculturative stress, such as deterioration of physical health, depression, and anxiety, have been identified in addition to alcohol and other drug abuse (Hovey & Magaña, 2002). Alcohol abuse is one of the indirect coping strategies students often use to alleviate negative emotions and stress, but drinking is an ineffective strategy because it does not resolve the issues students are trying to cope with and leads to reduced self-care, high-risk health behaviors, possible criminal behaviors, and low academic achievement (Carey & Correia, 1997).
Berry’s (2006) conceptual model of acculturative stress focuses mainly on explaining various conflicts (e.g.,, internal vs. external and integration vs. segregation) and their role in causing acculturative stress, but Berry (2006) also argued that acculturative stress is a complex construct and a better understanding of moderating and mediating variables is necessary to understand the relationship between acculturation and acculturative stress. Social support is possibly one of the moderating factors that can alleviate acculturative stress or moderate its relationship with negative outcomes because previous studies suggest that access to social support is a protective factor from stress and a suitable coping mechanism for stress management (Lin, Ye, & Ensel, 1999). It is also proposed that the size and quality of interpersonal relationships with family members, friends, and communities may improve both psychological and social functioning (Kawachi & Berkman, 2001).
Moderating strategies proved to be successful behavioral interventions for college students diagnosed with alcohol abuse (Scott-Sheldon, Carey, Elliott, Garey, & Carey, 2014). However, the exact role of social support as a protective factor from acculturative stress is unknown because most current research did not investigate whether social support has a direct relationship or whether it has moderating or mediating effects on acculturative stress and associated outcomes (Zhang & Goodson, 2011). Therefore, if social support is one of the moderating variables in the relationship between acculturative stress and alcohol abuse, it is highly likely that utilizing social support as a moderation strategy will prove as an effective intervention for international students who use alcohol to cope with acculturative stress. Consequently, reducing alcohol abuse will reduce the possibility of risks associated with excessive alcohol consumption, including both negative health-related and criminal behavior-related (e.g., physical abuse, sexual abuse, driving under the influence, and property crimes; National Institute on Alcohol Abuse and Alcoholism [NIAAA], 2013) consequences.
Problem Statement
It is known that international students may experience various psychological, social, and academic adjustment problems because of acculturation, but they remain an underserved group in the US because counseling services often lack cultural relevance to provide assistance to international students (Mori, 2000). Acculturation has been associated with a variety of behavioral issues, including alcohol abuse (Caetano & Clark, 2003). International students are apart from their family and friends, so their basic social network is unavailable, and they need to build a new social network in their new environment (Mori, 2000). Ensuring adequate social support is critical for reducing risks for alcohol abuse because high social support was identified as a protective factor against mental health issues and can facilitate the treatment of individuals diagnosed with alcohol abuse (Dobkin, Civita, Paraherakis, & Gill, 2002). However, the current body of literature rarely addresses alcohol abuse as one of the possible outcomes of acculturative stress in international students, and it is still not clear whether social support is directly related to acculturative stress or whether it can moderate its impact on negative health outcomes and detrimental coping strategies.
The purpose of this study is to analyze the relationship between acculturative stress and alcohol abuse in international male students and determine whether that relationship is moderated by social support. This study will aim to answer the following research questions:
RQ1: Is acculturative stress associated with alcohol abuse in male international students?
Sub-question 1: To what extent is acculturative stress associated with alcohol abuse?
Sub-question 2: What are the characteristics of the relationship between acculturative stress and alcohol abuse?
Sub-question 3: How are patterns of alcohol abuse different among students from different cultural backgrounds?
RQ2: To what extent does social support moderate the relationship between acculturative stress and alcohol abuse risks in male international students?
The following research hypotheses will be tested:
Alternative hypothesis (H1): There is a statistically significant positive correlation between acculturative stress and alcohol abuse in male international students.
Null hypothesis (H10): There is no statistically significant positive correlation between acculturative stress and alcohol abuse in male international students.
Alternative hypothesis (H2): High social support significantly decreases alcohol abuse risks by moderating the relationship between acculturative stress and alcohol abuse.
Null hypothesis (H20): High social support does not significantly decrease alcohol abuse risks and does not moderate the relationship between acculturative stress and alcohol abuse.
Significance of the Study
This study provides an opportunity to expand on the existing and scarce alcohol abuse research aimed at international students. It has been reported that international students start drinking or engage in excessive alcohol consumption usually after entering college because they want to manage acculturative stress or facilitate their social adjustment (Oshodin, 1982; Millar, 1999; Koyama, 2005). If a statistically significant correlation between acculturative stress and alcohol abuse is found, this study will also aim to determine whether social support can moderate that relationship.
It is known that moderating strategies are effective behavioral interventions in students diagnosed with alcohol abuse (Scott-Sheldon et al., 2014), but only the study by Lee, Koeske, and Sales (2004) investigated the role of social support as a moderator variable, and that study focused on Chinese students with mental health symptoms. Few previous studies aimed to investigate the issue of alcohol abuse in international students specifically (e.g., Koyama, 2005), whereas one study that aimed to assess the moderation effect of social support on domestic students was identified (Steptoe, Wardle, Pollard, Canaan, & Davies, 1996), so this will be the first study to assess the moderating effects of social support on the relationship between acculturative stress and alcohol abuse in international students.
In practice, this study can assist in creating policies and procedures aimed at improving both international student well-being on campuses and reduce alcohol-related crimes, such as violent behavior, property damage, or sexual abuse (Popovici, Homer, Fang, & French, 2012; NIAAA, 2013). For example, if there is a positive relationship between acculturative stress and alcohol abuse, which social support can moderate, it will be possible to propose utilizing social support as a preventive moderating strategy aimed at assisting international students experiencing difficulties with acculturation. The detrimental effects of losing a social support network because of relocation into a different country with a different cultural environment have already been documented, but social adjustment services are rarely provided to international students (Mori, 2000). However, alcohol abuse is not just a problem restricted to college campuses. It is related to some forms of criminal activity and addressing it could improve public safety, so the utilization of social support to prevent alcohol abuse among international students should be a collaborative effort from multiple institutions.
Most studies on alcohol abuse in the international student population focused on one specific cultural or ethnic group (e.g., Oshodin, 1982; Luczak, Wall, Shea, Byun & Carr; 2001). This study will focus on multiple ethnic groups to identify the ethnic groups at the highest risk for alcohol abuse. At the moment, the study by Schwartz et al. (2010) was the only study identified in the literature search that focused on health risk behaviors in international students and found that alcohol abuse was the most common coping strategy for acculturation-related issues among South and East Asian students. This study will also aim to determine which subgroup within the international student population is most likely to engage in alcohol abuse to determine which groups may need continuous assessment or counseling support. Policies and procedures for targeting specific subgroups can be effective because international students are a heterogeneous group. Understanding which specific subgroup is at the highest risk for acculturation-related alcohol abuse will enable the development of routine assessment strategies that consider the cognitive, affective, and behavioral specifics of the group that shows the highest risk for excessive alcohol consumption.
A proactive counseling approach on campuses can be used to prevent excessive alcohol consumption and alcohol-related offenses, but it is also expected that this study could potentially contribute to further development of police work related to processing students arrested for alcohol-related offenses. According to Hingson, Heeren, Zakocs, Kopstein, and Wechsler (2002), a survey of 6,930 college students between the ages of 18 and 24 years found that 1.4% of them were arrested for alcohol-related offenses, thus the projected number of alcohol-related arrests in the student population is 112,000 (95% CI = 89,871-134,132). It is highly likely that some or most of those students were not treated properly because the reported treatment rate was 1.2% for alcohol and drug treatment (projected prevalence 98,584; 95% CI = 71,067-126,101; Hingson et al., 2002).
Although international students are less likely to report experiencing the negative consequences of drinking than American students (OR = 0.62; 95% CI = 0.48-0.80; Turner, Perkins, & Bauerle, 2008), it is also possible that race can determine actions of police officers (e.g., Black drivers get searched more than White drivers; Moon & Corley, 2007). If social support is identified as a statistically significant moderator variable in this study, suitable procedures for processing students arrested for alcohol abuse will be recommended. Forensic psychologists have already developed training programs for police officers that focus on diversity training, inter-cultural or inter-racial communication, and dealing with intoxicated individuals (Steinheider, Wuestewald, & Bayerl, 2006; Watson, Morabito, Draine, & Ottati, 2008; Chopko, 2011), but it would also be beneficial to develop policies aimed at reducing repeat offending by mandating treatments focusing on social support for students who are arrested for offenses associated with alcohol abuse.
Operational Definitions
The variables of interest in this study are acculturative stress, social support, and alcohol abuse. Acculturative stress is the independent variable, and alcohol abuse is the dependent variable. Although acculturative stress can affect both international and first-generation students, this study focuses on the international student population. Social support is considered a moderator variable because it is expected that it alters the relationship between acculturative stress and alcohol abuse. If there is a statistically significant positive relationship between acculturative stress and alcohol abuse, it is expected that adequate social support reduces the risk for alcohol abuse.
Acculturation: The process of cultural and psychological changes caused by the interaction between cultures (Sam & Berry, 2010). Acculturation is a multidimensional construct that consists of behavioral (i.e., cultural practices – language and preferences), cognitive (i.e., values – individualistic vs. collectivistic cultural values), and affective (i.e., identification – the extent of attachment to a certain culture) domains (Chirkov, 2009; Rudmin, 2009).
Acculturative stress: The state individuals experience when they perceive the demands for cultural change greater than their capabilities (i.e., individual and social resources), and the stress causes individual and family dysfunctions until the acculturation process is complete (McCubbin & Patterson, 1983). Like acculturation, acculturative stress is a multidimensional construct, but the exact sources of stress are dependent on the specific situational factors and environments relevant to different populations. In the international student population, the most common sources of acculturative stress include: (1) language barriers, (2) educational barriers, (3) socio-cultural barriers, (4) discrimination, and (5) practical issues. As a quantitative measurement, Sandhu and Asrabadi (1994) defined the following six domains of acculturative stress: (1) Perceived discrimination, (2) Homesickness, (3) Perceived hate, (4) Fear, (5) Stress due to change, (6) Guilt, and (7) Miscellaneous (e.g., language barriers, practical issues, etc.). Although the domains are differentiated, Sandhu and Asrabadi (1994) recommend measuring the construct of acculturative stress as the total score.
Social support: The provision of material or psychological resources from multiple sources in the social support network that has a buffering effect on stress by facilitating problem-solving, minimizing the perception of problem importance, and promoting positive behavioral stress responses (Cohen & Wills, 1985). Researchers differentiate between various types of social support, such as perceived social support, different sources of social support, instrumental support, emotional support, and informational support (House & Kahn, 1985; Cohen, 2004; Zhang & Goodson, 2011). However, all types of social support measurement concepts and models were found to be associated with beneficial psychological effects (Zhang & Goodson, 2011). For the purpose of this study, perceived social support will be measured as a two-domain construct, consisting of the Network and Satisfaction domains (I. G. Sarason, Levine, Basham, & B. R. Sarason, 1983).
Alcohol abuse: According to the American Psychiatric Association (APA; 2013), alcohol abuse is a psychiatric diagnosis characterized by the excessive and recurring use of alcohol despite the negative consequences experienced, and it can be categorized as mild, moderate, or severe. According to the Tenth revision of the International Classification of Diseases (ICD-10), the six criteria for alcohol dependence diagnosis include: (1) a compulsion to consume alcohol, (2) impaired drinking control capacity, (3) the presence of withdrawal symptoms once alcohol use ceases, (4) evidence of increased alcohol tolerance, (5) preoccupation with alcohol, and (6) continued use despite the harm experienced (World Health Organization [WHO], 1993).
Binge drinking: A drinking pattern that increases blood alcohol concentration to 0.08 g/dL. As a general guideline for the measurement of binge drinking for research purposes, this happens within 2 hours after four drinks for females and after five drinks for males (NIAAA, n.d.).
First-generation student: The first member of the family to attend college. They are faced with several cultural adaptations challenges, and they tend to receive less social support and have higher drop-out rates than non-first-generation students (Stephens, Fryberg, Markus, Johnson, & Covarrubias, 2012). They undergo a similar acculturation processes as international students, but they need to be distinguished because their country of residence and the country in which they study are the same.
International student: A student with legal residence outside of the country in which the student is receiving higher education.
Limitations
This study will not consider the students’ personality traits, some social influences, or general mental health. Personality traits, such as high impulsivity (e.g., sensation-seeking and risk-taking) or low self-efficacy, have been associated with substance dependence (Ersche et al., 2012). Various mental health issues, such as mood disorders, are often comorbid with substance addiction and are sometimes identified as primary disorders in individuals with substance abuse issues (Chakroun, Johnson, & Swedsen, 2010). Social influences, such as socioeconomic status, peer pressure, and cultural background, are also reliable predictors of alcohol abuse (Li & Burmeister, 2010). Cultural background will be the only variable measured in this study that was established as a social predictor of alcohol abuse, so it is possible that personality traits, socioeconomic status, general mental health (e.g., depressive symptoms), and other predictors of alcohol abuse could be overlooked.
It is also highly likely that acculturative stress affects the development of alcohol abuse through indirect pathways. For example, it is mentioned that alcohol abuse has been associated with mood disorders. Acculturative stress could directly influence the development of mood disorders, which then possibly leads to alcohol abuse. Therefore, it is possible that a mood disorder or intense symptoms characteristic to mood disorders are potential mediator variables in the relationship between acculturative stress and alcohol abuse. The third variable considered in this study will be social support, thus the findings may be incomplete and require further elaboration.
This study will not investigate the causality in the relationship between alcohol abuse and acculturative stress because the cross-sectional nature of the data does not allow causal inferences. However, a cross-sectional study is the only feasible study given that various constructs, including social support and acculturative stress, cannot be observed directly, and the responses of the participants can be subject to various internal validity threats if measured over time, such as maturation or differential attrition.
It is also important to differentiate between students with F-1 and M-1 type visas. According to the U.S. Department of State (n.d.), an F-1 visa is required for international students attending academic institutions (e.g., colleges and universities) and an M-1 type visa is required for foreign citizens receiving education at non-academic institutions (e.g., vocational training). This study will focus on academic international students with F-1 visas, so it is possible that the findings could be generalized only to students with F-1 visas because of the differences in their reasons for visit, length of stay, type of educational institution, and legal statuses.
Delimitations
Given the quantitative nature of the study, the instruments used will present participants with multiple-choice items and a universal scoring system. Open-ended responses will not be allowed so that their results can be quantified, compared, and replicated. The questionnaire that will be used for measuring perceived social support allows the participants to list names of people they believe they can rely on for specific problems, but the scoring system is equal for all items, so the questionnaire scores can be scored and compared among participants (Sarason et al., 1983). Only validated instruments will be used to collect data to ensure that the constructs are appropriately measured and that they can be administered to cross-cultural groups without compromising the reliability of the results.
The number of international students in the US is high. In contrast to 1971, when 65,000 student visas were issued to foreign students, the number of international students in US colleges increased to 586,323 by 2003 (Hazen & Alberts, 2006). The US Department of Education (2011) estimated that there were more than 690,000 international students in the US higher education system. Given the large population size, it is not practical to choose a sample size relative to the entire population, and it is also important to consider the possibility of differences in environmental influences among participants from different states. Therefore, this study will draw the sample from within the state of California in order to ensure that the sample lives in a relatively homogeneous environment in terms of the domestic populations’ cultural values and behavioral habits.
Although a large sample size ensures that the sample represents the population adequately, a sample size that is too large can increase the possibility of Type I error because the predetermined alpha value for the desired significance level is consistent throughout the study whereas p-values are dependent on sample size (MacCallum, Widaman, Zhang, & Hong, 1999). Therefore, the sample size required to provide adequate power to the study will be determined using an a priori analysis, and that number will be increased by 25% to account for individuals who refuse to participate or drop out during the study.
The students’ demographic factors will be collected to identify potential confounding threats, such as religion. For example, some students may show high acculturative stress, but abstain from alcohol consumption because their religion prohibits alcohol consumption or has negative attitudes about it (Michalak, Trocki, & Bond, 2007), so they are more likely to develop other coping strategies. Therefore, this study will exclude participants from affiliated with religions that strictly prohibit alcohol consumption, such as Islam or Jainism.
Assumptions
Psychological constructs cannot be observed directly, so this study will have to rely on self-reported measurements. It is assumed that the participants will honestly answer the items in the questionnaires administered.
International students can come from many different countries and cultural backgrounds, so they will be categorized based on their ethnic group. Other studies (e.g., Yeh & Inose, 2003; Schwartz et al., 2010) used a similar strategy to ensure that the data is manageable. It is assumed that this categorization will not affect the reliability of the results because it is expected that general cultural values between similar cultures will be shared.
Organization of the Study
Chapter 1 has presented the introduction to the topic of alcohol abuse in the student population and the issues of acculturative stress and poor social support among international students. The problem being studied, significance of the study, research questions, hypotheses, operational definitions, limitations, delimitations, and the assumptions of the study were also discussed.
Chapter 2 presents the review of literature relevant to the issues of alcohol abuse, acculturative stress, and social support among international students. The literature review will support the necessity for this study by identifying the gaps in the relevant literature. Chapter 3 describes the proposed methodology of the study, which includes the targeted population, accessible population, sampling frame, exclusion criteria, and the sampling strategies used. The instruments used to measure demographic variables and the variables of interest are also discussed, as well as proposed data collection and data analysis procedures.
Chapter 4 will contain the results of the analyses and the main findings of the study. Based on the alternative hypotheses, it is expected that the analysis will show a statistically significant correlation between acculturative stress and alcohol abuse. It is also expected that social support will moderate that relationship and reduce the risk for excessive alcohol consumption. Chapter 5 will include a summary of the key findings, discussion of the results, a comparison of these findings with the previous literature, recommendations for future research, and recommendations for practice. It is considered that this study will add to the current body of knowledge on alcohol abuse among international students by investigating the moderating effects of social support.
CHAPTER 2: Review of Literature
This review of literature focuses on the issue of alcohol abuse in the student population and is divided into five sections: (1) alcohol abuse in the general student population, (2) acculturative stress in college students, (3) social support in college students, (4) impact of social support on alcohol abuse, and (5) gaps identified. The first section examines the problem of alcohol abuse in the general student population and focuses on the literature relevant to the prevalence and causes of alcohol abuse among international students. Within-group differences based on cultural values and sex are also examined.
The second section analyzes the impact of acculturative stress on the overall physical and mental functioning of international college students. The five main barriers to acculturation are also discussed as the potential causes of stress in international students. The third section focuses on research relevant to social support in college students. The impact of social support on the social adjustment, acculturative stress, and psychological health in international student is examined.
The fourth section specifically focuses on the impact of social support on alcohol abuse in the general population and domestic students because the literature search did not reveal studies pertinent to international students. However, this section of the literature review is important because it examines the sources that were used to develop the purpose of this study and research questions. The fifth section summarizes the gaps identified in the literature to justify the significance of this study, both in terms of professional and practical implications.
Alcohol Abuse in the General Student Population
Substance use, including alcohol and drugs, is common in the student population, but alcohol is the most commonly abused substance (Wechsler, Lee, Kuo, & Lee, 2000). It is estimated that 80% of college students consume alcohol, and 50% of those who consume alcohol abuse it through binge drinking (NIAAA, 2013). Compared to the estimated rate of illicit substance use of 22% among college students (Substance Abuse and Mental Health Services Administration, 2013), alcohol abuse is probably a more significant problem than drugs because it is both legal and perceived as socially acceptable in some social groups. Alcohol abuse in the student population is a serious issue that must not be neglected as it can have serious consequences. According to NIAAA (2013), possible outcomes of alcohol abuse include death (1,825 students per year), assault (over 690,000 cases per year), sexual abuse (over 97,000 cases per year), alcohol-related health problems (over 150,000 cases per year), and alcohol- or drug-related suicide attempts (estimated 1.2-1.5% of students per year).
Although alcohol abuse is a widespread issue among college students, they are less likely to receive treatment than peers who are not attending college (Blanco et al., 2008). Some potential barriers to seeking psychological treatment in the student population include time constraints, financial constraints, stigmatizing attitudes about mental disorders, and lack of emotional maturity or openness (Eisenberg, Downs, Golberstein, & Zivin, 2009). The study by Eisenberg, Golberstein, and Gollust (2007) also found that students from low socioeconomic backgrounds and international students were less likely to seek help regarding mental health issues than other students. International students in general are not willing to seek counseling on their own, and that is especially true for non-European students because they are not familiar with the concept of counseling (Zhang & Dixon, 2003). An alternative explanation is that counseling is perceived as weakness among some cultures (e.g., Asian students), so international students fail to seek help under the assumption that emotional control is a personal affair and seeking help is considered a personal failure (Wei et al., 2007). Therefore, a proactive approach to counseling that considers cultural differences is necessary to address alcohol abuse and related issues among international students.
The most commonly reported reasons for substance use in college students include experimentation, relaxation, and social or recreational reasons (Johnston & O'Malley, 1986). According to the theory of normative social behavior, the students’ normative beliefs determine their alcohol consumption, and the most common influences on their normative beliefs include injunctive norms, group identity, and outcome expectations (Rimal & Mollen, 2013). All of these factors are influenced by the beliefs or behaviors of majority of the students in general or within a specific group are alcohol users, and an individual develops positive expectancies (e.g., belief that alcohol will be beneficial for their social status). The study by Rimal and Mollen (2013) expands the theory of normative social behavior by introducing issue familiarity as the moderating variable, which means that students familiar with the issues associated with alcohol use were less likely to develop excessive alcohol consumption, despite the potential peer pressure or desire to conform to group norms.
The role of injunctive norms, group identity, and outcome expectations in determining alcohol use among international students in the US has been demonstrated by Millar (1999). The study consisted of 390 students, age range 23-46 years old, and 15% of the sample was comprised of international students. Among those international students, 83% reported alcohol use and 18% reported binge drinking. Although it was found that American students used alcohol (96%) and engaged in binge drinking (28%) more frequently than international students, which indicates that their drinking is more problematic than drinking among international students, it is important to note that most international students reported starting to drink after entering college to socialize with American students and alleviate stress. The reported source of stress was loneliness, which is associated with acculturative stress. Therefore, this study supports the assumption that identifying with domestic students and outcome expectations (e.g., better social status, alleviation of acculturative stress) are possible motivations for alcohol misuse among international students. However, the wide age range makes it difficult to determine whether the results would be consistent among different age groups.
The study by Koyama (2005) found that the motivations for drinking among international students were consistent with the motivations for drinking among non-international students. Both groups reported drinking alcohol because they wanted to conform to their social environment and enhance their need for pleasure or excitement, but few used alcohol as a coping strategy to deal with unpleasant feelings. Even though international students reported drinking more than non-international students, coping motives were not significantly associated with alcohol consumptions.
However, acculturative stress was found to be a significant predictor of binge drinking and excessive drinking (i.e., number of drinks within the past 30 days) among international students, and drinking problems were more prevalent in male students, even though there were no significant differences between males and females in terms of acculturative stress (Koyama, 2005). Although this study was one of the first studies to explore the relationship between acculturative stress and alcohol abuse specifically, a non-randomized sampling strategy was used. Therefore, it is not clear whether these results can be generalized, and using a non-probability sampling strategy could be a significant threat to internal validity (Leedy & Ormrod, 2010).
Findings in studies among the prevalence and reasons for alcohol use in international students are sometimes contradictory. Cultural differences are a potential explanation of these contradictions in levels of alcohol use among international students. For example, Nigerian students report high levels of alcohol use among males (80%) and females (75%), and 70% of Nigerian students reported drinking before coming to the US and entering college, so alcohol use is more likely associated with their traditional cultural belief that alcohol is a nutritional food substance (Oshodin, 1982). Instead of using alcohol to alleviate stress associated with acculturation and loneliness, 70% of Nigerian students reported aggravation, arguments, and disappointment as the main reasons for drinking excessively. It remains possible that adequate social support could have alleviated excessive drinking as a response to stress, but it is possible to suggest that excessive drinking was a coping mechanism for issues related to acculturative stress in Nigerian students.
The qualitative study by Bradley (2000) found that the emphasis on alcohol use in social settings can be detrimental to the social integration and result in the marginalization of international students coming from cultures that prohibit or disprove of alcohol use. Therefore, it is important to consider that international students from some regions or ethnic backgrounds will not engage in alcohol consumption for the purpose of socialization or stress alleviation, and may resort to other methods of coping with stress. Although this study was conducted in the UK, it is possible to suggest that the finding can be generalized because cultural norms are consistent depending on the student’s original location, and the investigations of international students’ reasons for alcohol use in US colleges also indicates that alcohol is an integral part of the student culture and contributes to socialization (Millar, 1999).
Sex was also investigated as a potential determinant of excessive alcohol intake as a response to stress, but the literature search found conflicting results. For example, Bradley (2000) reports that Asian females were more likely than males to criticize drinking habits of domestic students and avoid drinking alcohol themselves. In the Western culture, it was found that males are more likely than females to increase their alcohol consumption when faced with occupational stress or stressful life events in general (Cooper, Russell, Skinner, Frone, & Mudar, 1992; Crum, Muntaner, Eaton, & Anthony, 1995).
In contrast, Steptoe et al. (1996) did not find significant sex differences in terms of alcohol consumption among students during stressful situations. The study by J. Davey et al. (2002) found that there were no significant differences in alcohol consumption between males and females, and the authors believed that trend was consistent with national alcohol drinking trends in Australia (i.e., alcohol consumption among females is growing). The rates of alcohol consumption were equally high in the study by Oshodin (1982), but that can be explained by the Nigerian’s viewpoints of alcohol as a source of nutrients. Therefore, it is possible that turning to alcohol use during stressful situations is not always dependent on sex, and perhaps environmental influences (e.g., cultural heritage, social trends, and changing gender roles) are more likely to account for alcohol abuse differences than sex alone.
The study by Zamboanga, Raffaeli, and Horton (2006) on 126 Mexican American college students found that high ethnic identity was the primary reason for excessive alcohol consumption among males, but not among females. Although the authors concluded that the Latino culture is associated with excessive alcohol consumption, it is still not clear whether excessive alcohol consumption among Latino students is caused by their group identity or acculturative stress associated with the gap between their culture and the dominant college culture in the US.
Luczak et al. (2001) aimed to determine whether alcohol consumption in Chinese and Korean students can be explained by aldehyde dehydrogenase (ALDH2), a prevalent genotype in the Northeast Asian population, which is associated with a slow alcohol metabolism. However, it was found that alcohol abuse in the Korean sample was four times more prevalent than in the Chinese sample, despite the presence of ALDH2 genotype in both groups, so it is possible to suggest that differences between cultural norms are a significant predictor of alcohol use than physiological differences.
The role of coping strategies in determining alcohol abuse among international students must also be considered because the choice of coping strategies can vary among individuals from different cultural backgrounds. Cultures are broadly differentiated based on individualism and collectivism, and these two cultural perspectives are considered to be an important determinant of coping strategy choice when an individual is adapting to a new culture (Cross, 1995). According to Triandis, McCusker, and Hui (1990), individualistic cultures (e.g., European and American cultures) consider personal goals more important than family or group goals, and it is common and acceptable to engage in direct confrontations to solve problems or deal with stress. Other cultures (e.g., Latino and Asian cultures) are collectivistic and prioritize the goals and needs of families or groups over the needs and goals of an individual, so individuals from these groups are more likely to seek indirect coping strategies to address problems (Triandis et al., 1990). Based on these cultural differences, it is likely that international students from collectivistic cultures will more likely resort to alcohol abuse as an indirect coping strategy to deal with acculturative stress than students from individualistic cultures.
While alcohol abuse is one of the potential indirect coping strategies, the study by Schwartz et al. (2010) revealed various inconsistencies among groups with different ethnic or racial groups in terms of health risk behaviors. For example, acculturation was positively associated with alcohol use hazards in Black, South Asian, and East Asian participants whereas acculturation was positively associated with sexual risk-taking for Hispanic and East Asian participants. Although this study was conducted on first- and second-generation immigrants, it pointed out the necessity for considering the cultural background of the participants in research and practice because the international student population is heterogeneous. It also pointed out that it is possible that health risk behaviors, such as alcohol abuse, are not associated with acquiring a US identity in the process of acculturation. Instead, it is suggested that the loss of their own cultural identity contributes to the development of acculturation-related stress and health risk behaviors as coping strategies to deal with that stress.
However, indirect coping mechanisms can be effective in dealing with stress despite avoiding direct problem-solving because they are not necessarily detrimental to the physical or psychological health of international students. For example, Lin and Betz (2009) found that Chinese international students can practice self-compassion to reduce the effects of perceived acculturative stress. According to Ward, Bochner, and Furnham (2001), international students sometimes use humor as an indirect coping strategy to reduce the effects of acculturative stress, so that is another example of a positive indirect coping strategy. It is possible that individual factors or bonds with fellow international students can assist in stress alleviation and promote the development of healthier coping strategies that serve as protectors from acculturation stress.
Detrimental indirect coping strategies can occur among international students from all cultural and ethnic backgrounds, as demonstrated by Schwartz et al. (2010), but they also appear to be the most common among Asian international students. The study by Khawaja and Dempsey (2008) in Australia found that psychological stress was present in both international and domestic students, but international students from Asian countries were more likely to resort to dysfunctional coping strategies, such as substance abuse, alienation, denial, and other maladaptive behaviors. In the US, the study by Cheng, Leong, and Geist (1993) found that Asian international students were more likely to develop obsessive-compulsive behaviors than domestic students. In Canada, Chataway and Berry (1989) found that Asian international students were more likely to resort to maladaptive coping strategies, such as alcohol or drug abuse, than European international students.
These findings suggest that international students cannot be observed as a homogeneous group because within-group differences related to cultural norms determine their alcohol consumption attitudes, alcohol consumption habits, and choices of coping strategies. Even within specific continental ethnic groups, with-in group differences are apparent. For example, Lin and Betz (2009) reported positive coping strategies among Chinese students and Cheng et al. (1993) reported detrimental coping strategies among Asian students.
Despite the differences in cultural backgrounds within continental ethnic groups, current research often groups international students with ethnic minority students, so Sodowsky and Plake (1992) suggested that acculturative stress and problematic outcomes associated with it must be considered separately for minorities and international students because their levels of adaptation to the local culture, legal status, and reasons for staying in the US are significantly different. Ideally, within-group differences of international students should be considered, but an empirical study is rarely feasible given the large number of different ethnic groups of international students and the uneven distribution of international students in US colleges.
It is also possible to notice that most current studies found a significant correlation between alcohol abuse and certain ethnic groups, but few studies explored the reasons for alcohol abuse among international students. The majority of studies focused on investigating the general impact of acculturative stress and coping strategies on the international students’ mental health (e.g., Khawaja & Dempsey, 2008; Chataway & Berry, 1989). Most studies that investigated the reasons for alcohol abuse in international students were designed as surveys,
