Introduction

Alcohol consumption is a public health problem, provoking substantial morbimortality worldwide. The World Health Organization (WHO 2018) estimates that three million deaths worldwide are due to harmful alcohol consumption each year, accounting for 5.3% of total deaths [1].

The legality of alcohol facilitates consumption among the young and makes it the most used drug in this population. Drinking at young ages is influenced by several factors, including parental and family consumption, demographic factors, media advertising, and the ease of acquiring alcoholic beverages.

A study conducted in 2017 indicates that adolescents are 4.4 times more likely to consume alcohol if they have a drinking parent, 4.6 times more if it is the sibling, and 10.4 times if their best friend drinks. In addition, alcohol is believed to alleviate sadness, instill courage, attenuate fear, or provoke joy, which may increase consumption among this group [2].

The intake of alcoholic beverages peaks between 20 and 24 years of age. At this period, young people frequently are at a professional training stage in university settings. The increase of alcohol intake in this age may bring low academic performance, mental health problems, physical deterioration, lower productivity, and school dropout. A study conducted in 2017 mentions that low self-esteem, rebelliousness, resistance to authority, affective distancing, inadequate handling of feelings, and poor parental supervision may lead college students to consume alcohol [3],[4],[5].

International studies conducted in 2014 and 2015 indicate that Spanish university students are more likely to consume alcohol sporadically and habitually. These works reveal that students consume alcohol two or three times a week (24%), with an intake of 5.6 (29.2%) or more than six alcoholic drinks (24.9%) on a single occasion, being higher in men than in women (14.6% and 13.9%; p < 0.001) [6],[7].

Similar research conducted in Cuba in 2015 indicates a drinking prevalence of 89% in males and 86% in females [8]. In Colombia, related findings mention drinking onset among university students at 14 years old, 20.5% of risky drinking patterns, and 14.9% of dependence [9].

In Mexico, the latest National Survey on Drug, Alcohol, and Tobacco Consumption (ENCODAT 2016-2017) indicates that drinking among 18 to 65 years increased from 72% to 77.1%. Moreover, alcohol consumption in the last year increased from 51.3% to 55.7%, and over last month increased from 22.2% to 35%. In addition, it reported beer as the most prevalent beverage (40.8%) [10].

Research conducted on nursing students in different Mexican universities between 2016 and 2017 indicates that 76.6% to 83.1% of students report drinking at least once in their lifetime, with an average of 3.9 to 5.3 alcoholic drinks on a single drinking occasion, with a predominant risky drinking patter [11],[12],[13]. In Veracruz, the state where this study was conducted, findings indicate 7.8% of risky and 17.4% of abusive drinking [14].

In all, alcohol consumption represents a health problem that affects young university students, who are considered a vulnerable population. Studying this problem is vital to developing effective intervention strategies to prevent drinking among future health caregivers. Therefore, this study aims to identify the prevalence of alcohol consumption among nursing students of a public institution in Minatitlán Veracruz, Mexico.

Methods

We conducted a descriptive cross-sectional study over a population of 416 nursing students from a public university in Minatitlán, Veracruz, Mexico. The sample size was calculated using the finite population formula and consisted of 201 students. The sample was increased by 30% for possible rejections, leaving a sample of 260 students, representing 62.5% of the total universe. Non-probabilistic sampling was used to select the participants.

The inclusion criteria involved studying in the nursing school between 2020 and 2021 and agreeing to participate in the research by signing the informed consent. Participants who did not answer the instruments completely were excluded.

An instrument composed of two sections was used to collect the information. The first section asked about personal data such as age, sex, family members with whom they live and their relationship with them, people close to them who consume alcohol, occasions where drinking occurs, age of drinking onset, and type of beverages consumed.

The second section identified alcohol consumption using the Alcohol Use Disorders Identification Test (AUDIT), an instrument developed by the WHO in 1988 [15] and validated in several countries, including Mexico, with reliability ranging from to 0.90 [16],[17],[18]. It consists of 10 items and evaluates alcohol consumption during the last year. The first three items refer to the amount and frequency of drinking, the following three explore potential dependence on alcohol, and the last four assess alcohol-related harm. It has a minimum value of zero and a maximum of 40 points, composed of zero to four Likert scale questions. The cut-off points are:

• Low-risk drinking: 1 to 7 points.
• Risky drinking: 8 to 16 points.
• Harmful drinking: 16 to 19 points.
• Dependent drinking: 20 to 40 points.

In this research, the test showed a Cronbach’s α reliability coefficient of 0.75.

The application of the instrument was carried out digitally through the Google Forms platform. Once the list of students was obtained, all received the electronic link to access the questionnaires through digital means. Only if students agreed to participate did they continue to answer the questionnaire. The instrument was accompanied by a video explaining the purpose of this study, the ethical aspects, and how they should answer questions. The delivery was anonymous. No incentives were offered to the participants, and only one contact was made with each student. Each questionnaire was reviewed, and only those with complete answers were selected to integrate the studied sample. The data were collected in October 2020.

The study was approved by the Ethics and Research Committee of the Nursing School of the Universidad Veracruzana Campus Minatitlán with protocol number CIEE-SM-176. The study was also authorized by the directors of the educational institution where the study was conducted. The research followed the Regulations of the General Health Law on Health Research, in Title Two, Chapters I and III of the standard provisions and articles 13, 14, 16, and 17 [19]. The international provisions on good practices in research on human subjects were also respected, adhering to the Declaration of Helsinki [20].

The SPSS version 22 statistical program was used for data analysis. Regarding descriptive statistics, frequencies and percentages for categorical variables and mean for numerical variables were used. The Chi-square test and the Pearson’s correlation coefficient were used to establish the relationship between alcohol consumption and students' family, social and academic environment.

Results

A total of 260 nursing students enrolled between 2020 and 2021 participated (Figure 1). We found that 74.6% were women with an average age of 20.4 years, 97.7% were single, 53.8% lived with both parents, and 29.2% had a very good relationship with their parents. Regarding drinking, 64.6% indicated that they had consumed alcohol at least once, the average age of onset was 16.3 years, and the preferred alcoholic beverage was beer (53.6%).

Regarding consumption in family and social contexts, friends (62.5%) and relatives (34.5%) were the leading providers of alcoholic beverages and the groups with whom they consumed the most (50.6% and 32.1%, respectively). The main reason for drinking alcohol was having a taste for drinking (73.2%) and curiosity (25%). Among drinking students, most reported having family members (58.3%) and friends (85.8%) who were consumers (Table 1).

Regarding alcohol consumption, according to the AUDIT measurement, 64.6% of nursing students have consumed alcoholic beverages in the last year. The majority (59.6%) consumed in a low-risk pattern, but a small group had risky (4.6%) and dependent (0.4%) consumption (Table 2).

The alcohol consumption was analyzed according to the semester to identify the school period of higher drinking. We found that risky consumption was more frequent among students in the most advanced semesters than at the beginning of their careers (Table 3).

Since the information was collected during the COVID-19 confinement, it was necessary to inquire about their activities in their free time. In this regard, Table 4 shows that the highest drinking was among students who indicated watching a series or movie or performing housework. However, when the Chisquare test was performed, no significant differences were observed between the pattern of consumption and leisure time activities (X2 = 25.970; p = 0.355).

There was an association between drinking patterns and age, current school semester, drinking at least once, and alcohol consumption by family and friends (p < 0.01) (Table 5). This finding indicates the close relationship between the initiation and maintenance of alcohol consumption and nursing students' social, family, and school context.

Figure 1.

Flow chart of the study participants.

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Table 1.

Data on alcohol consumption among drinking nursing students (n = 260).

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Table 2.

Prevalence of alcohol consumption among nursing students (n = 260).

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Table 3.

Drinking pattern by school semester among nursing students (n = 260).

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Table 4.

Drinking patterns in relation to leisure activities of nursing students (n = 260).

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Table 5.

Pearson correlation coefficient regarding drinking and family, social, and academic environment (n = 260).

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Discussion

This study evaluated 260 nursing students to identify the prevalence of alcohol consumption. The results show that 64.6% of students consume alcoholic beverages, which is lower than found in studies conducted on nursing students in Colombia (97.5%), Cuba (93%), and other Mexican cities such as Monterrey (83.1%), Oaxaca (76.6%), Puebla (92.5%) and Mexico City (95%) [4],[8],[11],[12],[13],[21].

The average age at drinking onset was 16.3 years, like other results in central and southern Mexico [11],[12],[13],[14]. However, the age is lower than reported by the National Survey on Drug, Alcohol, and Tobacco Consumption 2016-2017, which indicates the age at onset of 17.9 years [10].

In line with other studies on university students, we found that students prefer beer (53.6%) over other beverages, probably because of its low cost and availability near university centers [4],[21].

Regarding drinking patterns, low risk predominated (59.6%), similarly to other reports among national [9],[11],[13],[14] and international studies [7]. However, we found that risky and dependent drinking among nursing students is not neglectable, which aligns with other research conducted in similar populations [7],[8],[9],[11],[12],[13],[14]. This finding should alert us to the possible complications in students' health and academic training if this consumption pattern prevails over time.

We also found that students in more advanced semesters have a higher prevalence of risky drinking pattern than students in the first semesters of their careers. This data is consistent with a study conducted on Colombian university students. The authors found that students who completed five or more semesters consumed more alcohol than those in their first or second semester [22].

In our study, students' leisure time during confinement (due to the COVID-19 pandemic) was mainly used to watch series and movies. We found that these students were the ones who had the highest drinking prevalence and the highest prevalence of low-risk and risky drinking patterns. This finding is in line with a study in Cali, Colombia, where alcohol consumption was a main activity to be carried out during leisure time [23].

We also found a significant relationship between current drinking patterns and the social, family, and school contexts of nursing students (p < 0.01). A study affirms that both family and friends are generally the niches for initiation or maintenance of drinking [4]. Likewise, this finding supports what is proposed by the social learning theory, which states that the behaviors assumed by adolescents are the result of interaction with the surrounding environments [24].

Limitations

The non-probabilistic nature of our sampling, and the fact that only one university was included, limit our results' representativeness. This study also lacks explanatory capacity. However, these findings may contribute to understanding the health problem of alcohol consumption among nursing students.

Conclusions

This research characterized drinking among nursing students at a single university during confinement due to the COVID-19 pandemic. Although the prevailing drinking pattern corresponds to a low risk, some students have a risky pattern. It was also identified that social, family, and academic variables are linked to students' drinking patterns. These findings place young people at higher risk of increasing their drinking – aggravated by their complex life stage, the limited free time, and drinking within the family and friends – affecting their physical and mental health.

Our findings highlight the importance of designing and implementing intervention programs generated by institutions. These programs should monitor alcohol consumption throughout the undergraduate stage and support students to successfully transition as health professionals.

Notes

Contributor roles
LCR, MACO, LCHL, and DITB: contributed to the design and development of the project and the planning and writing of the original manuscript in all its sections.

Acknowledgments
e thank the undergraduate nursing students who agreed to participate in the research.

Competing interests
The authors have supplemented the ICMJE conflict of interest statement and declare that they have not received funding for this article; have no financial relationships with organizations that could have an interest in the published article within the last three years; and have no other relationships or activities that could influence the published article. The forms can be requested by contacting the corresponding author.

Funding
The authors declare that there were no external sources of financing.

Ethics 
The research had the approval of the Ethics and Research Committee of the Nursing Faculty of the Universidad Veracruzana Campus Minatitlán. It was authorized by the directors of the educational institution where the research was carried out.

Data access statement
The data used for the study are available upon request to the corresponding author.

The questionnaire used is available at: https://figshare.com/s/ 215fc7aad9e8bf27c98b DOI: 10.6084/m9.figshare.18863963.

Provenance and peer review
Not commissioned. Externally peer-reviewed by three reviewers, double-blind.

Language of submission
Spanish.