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Background: Alcohol use among college students is a major public health priority owing to its high prevalence and numerous negative outcomes. Most interventions targeting alcohol use among college students consider them as a homogenous entity. There is preliminary evidence from high-income countries that patterns of alcohol use differ across academic streams. This remains unstudied in India. Aims: To compare the prevalence and correlates of alcohol use among students enrolled in various collegiate educational streams (medical, nursing, engineering, arts and science, and others [law/fisheries]) in the state of Kerala, India. Settings and Design: This is a cross-sectional survey conducted among college students. Materials and Methods: 5784 students completed a self-administered questionnaire assessing alcohol use and its correlates in the psycho-social domains. Statiscal Analysis: Lifetime prevalence and severity of alcohol use was determined across examined academic streams. A multivariable logistic regression analysis was done separately for each course, to identify factors influencing alcohol use. Results: The lifetime prevalence of alcohol use varied between 10.6% among nursing students to 41.7% among students pursuing “other” stream (law/fisheries). Students pursuing medicine and nursing had a relatively lower proportion of hazardous users. Consistently across all academic streams, being male and using tobacco increased the risk, while those from the Muslim community had a lower risk of alcohol use. Other examined psychosocial correlates showed varying relationship across courses. Conclusion: The prevalence and psychosocial correlates of alcohol use vary among students pursuing various academic streams. This finding has public health importance as the incorporation of course level characteristics in intervention programs will improve effectiveness.

Objective To survey the prevalence of retrospectively recalled clinically significant symptoms of attention deficit hyperactivity disorder (ADHD) in childhood and determine the association of ADHD symptoms in childhood with current academic achievement and psychopathological outcomes among college students in the state of Kerala, India. Methods A self-administered questionnaire was distributed to 5784 students from 58 colleges selected by cluster random sampling. The Barkley Adult ADHD Rating Scale-IV was used for recollection of childhood ADHD symptoms; a total score of ≥60 (indicating the 99 percentile) was taken as the cut-off for clinically significant ADHD symptoms in childhood. The Alcohol, Smoking and Substance Involvement Screening Test was used to assess lifetime use of alcohol and tobacco. The Kessler Psychological Distress Scale was used to assess non-specific psychological distress. Lifetime suicidality and exposure to sexual abuse were assessed by asking relevant questions. Students who recalled having clinically significant ADHD symptoms in childhood were compared with those who did not. Results Of 5784 students, 639 (11.5%) did not complete the questionnaire. Of the remaining 5145 students, 1750 (34.8%) were men and 3395 (65.2%) were women, with a mean age of 19.4 years. 143 (2.8%) students reported clinically significant ADHD symptoms in childhood. Childhood ADHD symptoms were significantly more common in men and in those living in urban areas. In the bivariate analysis, those with clinically significant ADHD symptoms in childhood had significantly higher odds of poorer academic performance, alcohol use, tobacco use, psychological distress, suicidal thoughts, suicidal attempts, and contact and non-contact sexual abuse, after adjusting for sex and residence. Conclusions Clinical evaluation and appropriate management may be warranted for adults who retrospectively recall clinically significant ADHD symptoms in childhood.

Introduction and aims There is a paucity of studies on the harms experienced by college students from India due to others' drinking, despite their increased risk. We studied the prevalence and correlates of harm from others' drinking among college students in the state of Kerala, India. Design and methods A total of 5784 students from 58 colleges completed a self-administered questionnaire, which included the World Health Organization-Thai Health Harm to Others from Drinking Master Protocol and other structured instruments to assess correlates. The frequencies of various harms were determined and a mixed effect multivariable negative binomial regression model was used to identify the factors responsible for harms. Results Of the 4487 valid responses, 68.3% were females. The mean age of the sample was 19.5 years. Harm from others' drinking was reported by 68.7% of respondents. Among various harm domains, psychological harm was reported by 65.7%, physical by 15.2%, financial by 20.9%, and property harm by 5.0%. Strangers were the most common perpetrators. Being male and having a part-time job increased harms. Increasing age, urban residence, and staying in a hostel were correlated with psychological-but not physical-harm. Subjects who reported harm had higher odds of reporting alcohol use and psychological distress. 'Any harm' or psychological harm was associated with suicidal thoughts; only physical harm was correlated with suicidal attempts. Discussion and conclusions The high prevalence of harms from others' drinking and its negative correlates underscore the need for colleges to focus on second-hand effects in programs for tackling alcohol use.

Background: Studies of alcohol use among college students in India have reported a male preponderance, but a recent large study suggested that alcohol use is increasing in young females. This increase in use among the young females is of concern as they experience poorer outcomes and a higher risk for addiction. Hence, we aimed to examine the gender-specific correlates of alcohol use among college students in the district of Ernakulum, Kerala. Methods: From 58 colleges, 5,784 students completed a self-administered questionnaire that assessed use of alcohol, use of tobacco and illicit drugs, psychological distress, suicidality, symptoms of attention deficit hyperactivity disorder, and history of sexual abuse. Results: Of the questionnaires, 342 had incomplete responses and had to be discarded, and the rest (n = 5,442, 94.1%) were analyzed. lifetime alcohol use was reported by 39% males and 12.6% females. In the multivariable logistic regression analysis using a full model, male students using alcohol compared to male non-users were older, non-Muslim, had poor academic performance, and used other substances. Female users, compared to female non-users, were non-Muslim, had urban residence, used tobacco, and had higher psychological distress, higher suicidal thoughts, and higher lifetime exposure to sexual abuse. Conclusion: Gender-specific differences extend across sociodemographic and psychological domains. Incorporation of these may improve the effectiveness of public health strategies addressing alcohol use.

Background: Tobacco use is a major public health concern in India. Its use in young people is linked to increased severity, longer duration, and reduced efforts to seek treatment for tobacco use. A significant proportion of young people are enrolled in colleges, and early prevention during this period has better effectiveness. There is preliminary evidence that prevalence may vary across courses even among students of the same sociocultural background. Hence, we compared the prevalence and correlates of tobacco use among college students enrolled in five common streams of collegiate education (medical, nursing, engineering, arts/science and others, law/fisheries) in Kerala, India. Methods: 5784 college students from 58 colleges (medical, nursing, engineering, arts, and law and fisheries) selected by cluster random sampling in the district of Ernakulum, Kerala, completed a self-administered questionnaire incorporating standardized instruments. R software was used for analyses. Lifetime prevalence and severity of tobacco use were determined. Sociodemographic variables of tobacco users and nonusers enrolled in various courses were compared using chi-square test and two-way ANOVA. Furthermore, for each course, factors influencing tobacco use were identified using multivariable logistic regression analysis. Results: The mean age of the sample was 19.5 ± 1.9 years, with the majority being female (65.3%). Lifetime prevalence of tobacco use varied from 0.5% in nursing students, 4.2% in medical students, 8.2% in students of arts and science, 12.5% in engineering students, and 22.8% among other students (law/fisheries). Approximately two-thirds of all tobacco users across courses showed signs of nicotine dependence. Dependent users also showed variance with none in nursing, 2.6% among medicine, 1.6% among arts and science, 1.9% among engineering, and 6.3% among others. Male gender and alcohol use were consistently associated with tobacco use across courses, whereas other examined psychosocial correlates showed variance. Conclusions: To conclude, it appears that among college students, course-level characteristics may influence risk of tobacco use. This has public health importance as it suggests that interventions need to be tailored bearing this in mind. Future research needs to examine campus-level characteristics that may explain variance.

Context: There are scarce data on the prevalence of adult obsessive-compulsive disorder (OCD) in India. Aims: The aim was to study the point prevalence of OCD and subthreshold OCD and its psychosocial correlates among college students in the district of Ernakulam, Kerala, India. Settings and Design: A cross-sectional survey of 5784 students of the age range of 18–25 years from 58 colleges was conducted. Materials and Methods: Students were self-administered the OCD subsection of the Clinical Interview Schedule-Revised, the Composite International Diagnostic Interview for obsessive-compulsive symptoms (OCSs), and other relevant instruments to identify OCD, subthreshold OCD, and related clinical measures. Statistical Analysis: The point prevalence of OCD and subthreshold OCD was determined. Categorical variables were compared using Chi-square/Fisher's exact tests as necessary. Differences between means were compared using the ANOVA. Results: The point prevalence of OCD was 3.3% (males = 3.5%; females = 3.2%). 8.5% students (males = 9.9%; females = 7.7%) fulfilled criteria of subthreshold OCD. Taboo thoughts (67.1%) and mental rituals (57.4%) were the most common symptoms in OCD subjects. Compared to those without obsessive-compulsive symptoms (OCSs), those with OCD and subthreshold OCD were more likely to have lifetime tobacco and alcohol use, psychological distress, suicidality, sexual abuse, and higher attention-deficit/hyperactivity disorder symptom scores. Subjects with subthreshold OCD were comparable to those with OCD except that OCD subjects had higher psychological distress scores and academic failures. Conclusions: OCD and subthreshold OCD are not uncommon in the community, both being associated with significant comorbidity. Hence, it is imperative that both are identified and treated in the community because of associated morbidity.

Despite tobacco use among college students being a major health concern, data remain sparse from India. It is in this background that this study aimed to report the prevalence of tobacco use and its psychosocial correlates among college students in the State of Kerala, India.A total of 5784 students from 58 colleges from Ernakulam district, Kerala, selected by cluster random sampling and were provided with self-administered questionnaire. In addition to socio-demographic profile, the questionnaire incorporated alcohol, smoking, and substance involvement screening test (ASSIST, for assessing tobacco use and its severity, lifetime use of other substances); Kessler's scale (psychological distress) and Barkeley's scale (attention deficit hyperactivity disorder symptoms). Screening questions were used for assessing lifetime suicidality and sexual abuse.The lifetime prevalence of tobacco use was 8.6 per cent (21.5% males and 1.4% female). Among users, hazardous and dependent use defined using ASSIST scores was 63.3 and 2.9 per cent, respectively. Tobacco use was associated with older age, being male, urban residence, having a part-time job, use of alcohol and illicit drugs and academic failures.Although the prevalence of tobacco use in our study was relatively low, the proportionately higher rates of hazardous use and its association with the negative correlates suggest that more needs to be done to prevent its deleterious consequences.

This study describes the prevalence and correlates of alcohol use among college students in Ernakulam, Kerala State, India. A total of 5784 students from 58 colleges selected by stratified random sampling completed a questionnaire incorporating standardized instruments. The prevalence of lifetime alcohol use was 21.4% with a male predominance. Among users, low-risk, hazardous, and dependent use were 80.2%, 18.3% and 0.9% respectively. Initiation was mostly with friends (45.3%). Both low-risk and high-risk alcohol users (hazardous and dependent users), in comparison to abstainers, had higher odds of being older, non-Muslim, having a part-time job, using other substances, and exposure to sexual abuse. Students who reported low-risk use also had an urban background, more severe psychological distress and suicidal thoughts, while high-risk users had attention deficit hyperactivity disorder (ADHD) symptoms. Students who reported high-risk use compared to low-risk users had higher odds of having a part-time job, tobacco use, and ADHD symptoms. Alcohol use among college students is common, with both low- and high-risk drinking associated with significant morbidity. This study highlights the need to promote public health policies to target and prevent all patterns of alcohol use among young people.

Aims To study the prevalence and correlates of psychological distress among college students in Kerala, India. Material and methods 5784 students across 58 colleges were self-administered Kessler’s Psychological Distress Scale (K10) and other standardized instruments. Results The prevalence of psychological distress was 34.8% (Mild-17.3%; Moderate-9.2%; Severe-8.3%) with a female predominance. Students with psychological distress were more likely to report academic failures, substance use, suicidality, sexual abuse and symptoms of attention deficit hyperactivity disorder. Students with severe distress had higher morbidity. Conclusions Psychological distress is common among college students and its association with negative correlates suggests the need for early interventions.

Background In the Western world, a significant portion of college students have gambled. College gamblers have one of the highest rates of problem gambling. To date, there have been no studies on gambling participation or the rates of problem gambling in India. Aims This study evaluated the prevalence of gambling participation and problem gambling in college students in India. It also evaluated demographic and psychosocial correlates of gambling in that population. Method We surveyed 5784 college students from 58 colleges in the district of Ernakulam, Kerala, India, using cluster random sampling. Students completed questionnaires that addressed gambling, substance use, psychological distress, suicidality and attention-deficit hyperactivity disorder (ADHD). Results A total of 5580 completed questionnaires were returned, and while only 1090 (19.5%) college students reported having ever gambled, 415 (7.4%) reported problem gambling. Lotteries were the most popular form of gambling. Problem gamblers in comparison with non-gamblers were significantly more likely to be male, have a part-time job, greater academic failures, higher substance use, higher psychological distress scores, higher suicidality and higher ADHD symptom scores. In comparison with non-problem gamblers, problem gamblers were significantly more likely to have greater academic failures, higher psychological distress scores, higher suicidality and higher ADHD symptom scores. Conclusions This study, the first to look at the prevalence of gambling in India, found relatively low rates of gambling participation in college students but high rates of problem gambling among those who did gamble. Correlates of gambling were generally similar to those noted in other countries. Since 38% of college students who had gambled had a gambling problem, there is a need for immediate public health measures to raise awareness about gambling, and to prevent and treat problem gambling in this population. Declaration of interest S.G. was (until October 2014) a member of the UK Responsible Gambling Strategy Board, and authored the Royal College of Psychiatrists’ Faculty report FR/AP/01 Gambling: The Hidden Addiction – Future Trends in Addictions (2014). Copyright and usage © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.