COLLEGIATE ATHLETES’ KNOWLEDGE OF THE EFFECTS OF ALCOHOL CONSUMPTION ON ATHLETIC PERFORMANCE A THESIS Submitted to the Faculty of the School of Graduate Studies and Research of California University of Pennsylvania in partial fulfillment of the requirements for the degree of Master of Science by Joanna M. Murray Research Advisor, Dr. Robert Kane California, Pennsylvania 2011 ii iii ACKNOWLEDGEMENTS I would like to take this opportunity to mention some very special people in my life to whom I owe my deepest gratitude. First, I need to thank my family. You all are the most amazing support system I could have ever asked for. Without your continuous love and encouragement this year would not have been possible. Next, I would like to take this opportunity to thank the number of people who helped me in the completion of my thesis. I never would have been able to complete such a challenging task without these knowledgeable people behind me. First, I would like to thank my Chair, Dr. Bob Kane, my committee members, Mr. Adam Annaccone and Dr. Bruce Barnhart, and the rest of the CalU staff for all your help and guidance. Now, I need to thank my roommates and those that share my MG status, Kathryn Annunziata, Jacqueline Coyne, and Kristin Defenbaugh for sharing so many wonderful memories with me. I never would have survived this year without you girls. I am so excited to see where the next steps in our lives take all of us, but I am so sad our year together is over. iv Next, I owe a special thank you to my amazing fiancé, Shane Fendlay. After four long years of being apart from each other, this part of our journey is over. You have been the most amazing support system through this whole experience. I cannot begin to thank you for listening to me talk about my days at Trinity, or complain about class or my thesis. You have been everything I could have asked for and I cannot wait to begin our life together! Lastly, I need to mention my best friends from home and bridesmaids-to-be. Shannon, Emily, Caasi, and Liz, all I need to say to you all is… I’m finally coming back to Bowie! v TABLE OF CONTENTS Page SIGNATURE PAGE . . . . . . . . . . . . . . . . ii AKNOWLEDGEMENTS . . . . . . . . . . . . . . . . iii TABLE OF CONTENTS LIST OF TABLES . . . . . . . . . . . . . . . v . . . . . . . . . . . . . . . . viii LIST OF FIGURES . . . . . . . . . . . . . . . . ix INTRODUCTION METHODS . . . . . . . . . . . . . . . . . 1 . . . . . . . . . . . . . . . . . . . 6 Research Design Subjects . . . . . . . . . . . . . . . 6 . . . . . . . . . . . . . . . . . . 7 Preliminary Research . . . . . . . . . . . . . 7 Instruments . . . . . . . . . . . . . . . . . 8 Procedures . . . . . . . . . . . . . . . . . 9 Hypotheses . . . . . . . . . . . . . . . . . 11 Data Analysis RESULTS . . . . . . . . . . . . . . . . 12 . . . . . . . . . . . . . . . . . . . 13 Demographic Data . . . . . . . . . . . . . . . 13 Hypothesis Testing . . . . . . . . . . . . . . 16 Additional Findings . . . . . . . . . . . . . . 19 DISCUSSION . . . . . . . . . . . . . . . . . . 29 Discussion of Results . . . . . . . . . . . . . 29 Conclusions . . . . . . . . . . . . . . . . . 34 vi Recommendations . . . . . . . . . . . . . . . 35 Policy Recommendations . . . . . . . . . . . . . 35 REFERENCES . . . . . . . . . . . . . . . . . . 37 APPENDICES . . . . . . . . . . . . . . . . . . 40 APPENDIX A: Review of Literature Introduction . . . . . . . . . 41 . . . . . . . . . . . . . . . . 42 Athletes vs. Non-athletes Drinking Habits . . . . . . . . . . . 43 . . . . . . . . . . . . . . . 45 Alcohol’s Effect on Performance . . . . . . . 48 Athlete’s Knowledge of Alcohol’s Effect on Performance . . . . . . . . . . . . . . . . . 52 Summary . . . . . . . . . . . . . . . . . . 54 APPENDIX B: The Problem . . . . . . . . . . . . . 55 Statement of Problem . . . . . . . . . . . . 56 Definition of Terms . . . . . . . . . . . . . . 57 Basic Assumptions . . . . . . . . . . . . . . . 57 Limitations of the Study . . . . . . . . . . . . 58 Significance of the Study . . . . . . . . . . . 58 APPENDIX C: Additional Methods . . . . . . . . . . 60 Knowledge about Alcohol Questionnaire (C1) . . . . 61 IRB: California University of Pennsylvania (C2) . . . 65 Cover Letter (C3) . . . . . . . . . . . . . . . 76 Coaches Informational Letter (C4) REFERENCES . . . . . . . . 79 . . . . . . . . . . . . . . . . . 81 vii ABSTRACT . . . . . . . . . . . . . . . . . . 84 viii LIST OF TABLES Table Page 1 Frequency Table of Sport 13 2 Frequency Table of Year in College 14 3 Frequency Table of Sports 14 4 Frequency Table of Age 15 5 t-Test between Gender & Total Score 16 6 t-Test between Type of Sport & Total Score 17 7 One way ANOVA between Total Score & Frequency of Alcohol Consumption 8 18 Mean Scores for Frequency of Alcohol Consumption 19 9 t-Test between NCAA Divisions & Total Score 20 10 t-Test between student athlete’s Hangover Practice and Game Status 11 and Total Score 21 t-Test between Age and Total Score 22 ix LIST OF FIGURES Figure Page 1 Drinking Habits Question 1 23 2 Drinking Habits Question 3 24 3 Drinking Habits Question 5 24 4 Drinking Habits Question 6 25 5 Drinking Habits Question 7 26 6 Drinking Habits Question 8 26 7 Drinking Habits Question 9 27 1 INTRODUCTION For many young adults, going to college is their first time living on their own without parental supervision. After leaving home, there is a newfound sense of freedom and college students are introduced to a new social environment where it is common to experiment with alcohol. It is even more common for alcohol consumption to take place if the student participates in athletics. In spite of all the negative consequences associated with alcohol, there is evidence that alcohol is a prominent factor in the lifestyles of many athletes at all levels of competition.1 The idea that athletes consume alcohol more frequently and more often to the stage of intoxication than do nonathletes is well documented.2 There are a number of reasons why athletes are considered an at risk population for alcohol consumption. Wilson et al2 examined if there was a difference in the reasons behind alcohol consumption between female and male athletes. The results indicated that the female athletes included in this study reported using alcohol more commonly as a coping mechanism (e.g. using alcohol to feel better or “to get through the problem”) rather than a social 2 facilitator. The male athletes included in this study reported using alcohol most commonly as a way to “get high” and for social reasons. Other research indicates that the challenges associated with being a student-athlete put them at higher risk for having problem drinking characteristics. These challenges can include dealing with multiple role demands and the high expectations of coaches as well as professors and balancing time between school work, practices, competitions, and social lives.3 The relationship between alcohol and athletes has been long standing. Researchers have suggested that alcohol is widely used because it continues to be a social facilitator. The experience of a new environment, such as college, allows students to look to their social groups to determine what attitudes and behaviors are expected and appropriate. Ford examined alcohol use between athletes and non-athletes and generalized that athletes are in a “peer intensive” state, in which, they tend to only socialize with their teammates or other people associated with athletics. Therefore, if consuming alcohol at team functions and weekend parties is the norm athletes will be influenced to participate in drinking alcohol or risk being labeled as anti-social.4 3 There are a number of negative effects alcohol can have on the body and on athletic performance. Athletes may not fully understand how consuming alcohol will affect their ability to perform on the court or field. El-Sayed et al states alcohol use is directly related to the number of injuries sustained in sporting events and appears to have detrimental effects on performance capacity5. Most people know and understand the acute effects of alcohol include a variety of psychomotor defects such as impaired balance, reaction time, and coordination. However, there are also a variety of effects alcohol can have for extended periods of time. Alcohol impairs muscular work capacity which in turn, results in decreased over performance levels such as slower running and cycling speeds. Alcohol will also increase the onset of fatigue during high intensity exercise and impair temperature regulation during exercise.6 Glucose is an extremely important source of energy during exercise that is synthesized in the liver and when there is even low amounts of alcohol being digested in the liver it can seriously impair glucose production during prolonged moderate intensity exercise.7 Most athletes understand that the body needs to recover after exercise; however, are unsure of the proper physiological needs to recover properly. Rehydrating after 4 practice or competition is extremely important as it allows for maximal recovery, thus preparing the body for the next exercise session. Alcohol, due to its diuretic effect, delays the recovery process by promoting urine loss and keeping the body in a dehydrated state.1 Also, not only is the risk of sustaining an injury increased while consuming alcohol but the ability of a trauma-related immune response is hindered. Even a single occasion of moderate to heavy drinking will negatively affect the body’s immune system response abilities such as the attenuation of inflammatory cell functions.8 There is much attention on the use of steroids and performance enhancing drugs in the sporting world but the most frequently consumed and least talked about drug in athletics is alcohol. Therefore, it is important for athletes to understand all the effects alcohol can have on their body, performance, and life. Some schools have recognized this importance and have implemented a requirement for an alcohol education course during their high school education or during their freshman year in college. This is one example of how to help address alcohol related problems associated with colleges but it does not target student-athletes. It would be beneficial for athletic departments to provide a course for student- 5 athletes that addresses alcohol education. This education, for both students and coaches is the cornerstone in combating this problem.9 6 METHODS The primary purpose of this study was to examine the amount of knowledge collegiate athletes have in regards to the effects of alcohol consumption on athletic performance. This section includes the procedures used to carry out the purpose of this research study and it includes: research design, subjects, pilot testing, instruments, procedures, hypotheses, and data analysis. Research Design The research design for this study was descriptive. The dependent variable in this study was knowledge of the effects alcohol consumption will have on athletic performance. The independent variables were gender and the type of team (i.e. individual sports members and team sports members). The strengths of this study were that athletes from more than one NCAA division were included and the instrument used was a reliable questionnaire approved by a panel of experts. A limitation of this study was that only athletes from a limited geographical region were surveyed. 7 Subjects The subjects that were used are athletes from California University of Pennsylvania, Penn State Fayette – the Eberly Campus, Penn State Greater Allegheny, Washington and Jefferson College, and Frostburg State University. The reliable questionnaire was distributed to all NCAA athletes enrolled at the participating institutions. Preliminary Research Questions were developed by the researcher based on preliminary research of the topic. The questionnaire was reviewed by a panel of experts that included Dr. Robert Kane, Dr. Bruce Barnhart, and Mr. Adam Annaccone, before it was distributed. This panel could be considered experts in the field of Athletic Training because they have over 5 years of experience working as professionals and they have knowledge on the subject matter beyond the scope of the average population. Upon review the panel of experts believed the knowledge question type should be a true and false format instead of on a Likert Scale. 8 Instruments The Alcohol Knowledge Questionnaire (Appendix C1) examined athlete’s drinking habits and their knowledge of the effects consuming alcohol has on athletic performance. This questionnaire had three sections: demographics, drinking habits, and knowledge. Within the demographics section, questions about gender, sport, school, age, and year in school were answered. The drinking habits section required athletes to establish how often they drank, how often they get drunk, what types of drinks they consume, and with whom they usually drink. Questions regarding whether or not alcohol has ever affected their academics, athletic performance, personal life, or professional responsibilities were also examined. For the section on knowledge, the purpose was to determine whether or not athletes understood the effects alcohol consumption can have on athletic performance. The athletes were asked if the statements made on the subject matter were true or false. 9 Procedure The researcher applied for approval by the Institutional Review Board at California University of Pennsylvania (Appendix C2). After having the questionnaire reviewed by a panel of experts and upon approval by the IRB, the researcher distributed the questionnaire by way of www.surveymonkey.com. The Athletic Director at each institution was contacted and a different protocol for contacting the student athletes was created by them and followed by the researcher. The Athletic Director at California University of Pennsylvania provided the researcher with a list of email addresses for all student athletes enrolled at California University of Pennsylvania. The researcher sent a cover letter (Appendix C3) that contained the link for the survey in order for the subjects to understand the purpose of the study and to administer instructions for participation. The athletes were instructed to complete the survey honestly and without assistance from any outside sources. A follow up email was sent one week after the initial email in order to encourage the athletes to participate in the study. The Athletic Director at Frostburg State University asked that the researcher send the necessary information to 10 the head coach of each Varsity sport and allow them to forward the cover letter to their athletes. The researcher emailed each coach an informational letter (Appendix C4) explaining the purpose of the study and requesting their assistance in contacting their teams. A follow up email was sent one week after the initial email in order to ask the coaches to forward the information again to encourage participation. The Athletic Director at Penn State Fayette – Eberly Campus instructed the researcher to obtain the roster of each sport from the athletics website and then utilize the people finder search engine on www.psu.edu to find the email address for each student athlete. The researcher sent a cover letter that obtained the link for the survey in order for the subjects to understand the purpose of the study and to administer instructions for participation. The athletes were instructed to complete the survey honestly and without assistance from any outside sources. A follow up email was sent one week after the initial email in order to encourage the athletes to participate in the study. The Athletic Director at Penn State Greater Allegheny did not provide the researcher with the email addresses of the student athletes so the researched contacted the head coach of each sport and sent them an informational letter 11 explaining the purpose of the study and requesting their assistance in contacting their teams. A follow up email was sent one week after the initial email in order to ask the coaches to forward the information again to encourage participation. The Athletic Director at Washington and Jefferson College requested that the researcher send him the information to be forwarded to the student athletes so he could contact the participants himself. The researcher forwarded him the cover letter with the information explaining the purpose of the study and the link to access the questionnaire. Hypotheses The following hypotheses were made based upon the literature reviewed and the insights of the researcher. 1. There will be a difference in knowledge about alcohol’s effect on performance scores when comparing males and females. 2. There will be a difference between the scores on Knowledge About Alcohol Questionnaire in members of 12 individual sports teams and members of team sports teams. 3. Knowledge about Alcohol scores will vary significantly based on how frequently the participant consumes alcohol. Data Analysis To test the stated hypotheses, the significance level was set at .05 to determine the acceptability of the results. For hypotheses 1 and 2 an independent T test was used to compare two different sets of score. The difference in scores between men and women was compared for hypothesis 1 and the scores between team sports and individual sports for hypothesis 2. To determine if there were any variances between consumption rates and scores on the knowledge survey for hypothesis 3, an ANOVA test was used. All the data was be compiled and assessed by way of PASW statistics 18. 13 RESULTS Demographic Data The sample consisted of student athletes enrolled at five collegiate institutions. The sample included 200 athletes, 88 males and 112 females. Table 1 reports where the student athletes were enrolled in college. Washington and Jefferson College (W&J) had the highest response rate (56) and Penn State Fayette – Eberly Campus (PSU-Fayette) and Penn State Greater Allegheny (PSU Greater All) both had the lowest response rate (4). California University of Pennsylvania (CalU) and Frostburg State University (Frostburg State) had moderate response rates. Table 1. Frequency Table of School of Participants School Frequency Percentage CalU Frostburg State PSU-Fayette PSU- Greater All W&J 45 56 4 4 91 22.5 28 2 2 45.5 Table 2 reports year in college. The participants were given choices ranging from Freshman to Graduate. Participants who reported being Freshman had the highest 14 response rate (67) and Graduate Students had the lowest (4). Table 2. Frequency Table of Year in College Year Frequency Percentage Freshman Sophomore Junior Senior Graduate 67 48 43 38 4 33.5 24 21.5 19 2 Table 3 reports the findings for sports. The participants could select the sports they participated in from the 17 choices. Soccer had the highest response rate (43) and of the sports that had responses, Cheerleading had the lowest response rate (1). No one reported having played Hockey. Table 3. Frequency Table of Sports of Participants Sport Frequency Percentage Baseball Basketball Cheerleading Cross Country Field Hockey Football Golf Hockey Lacrosse Soccer Softball Swimming Tennis Track and Field Volleyball 10 10 1 9 15 33 6 0 12 43 10 12 4 19 12 5 5 0.5 4.5 7.5 16.5 3 0 6 21.5 5 6 2 9.5 6 15 Water Polo Wrestling 2 2 1 1 Table 4 reports the findings of age. Participants were asked to report how old they were. With the assumption that the one participant who reported being 25 or older is 25, the mean score was 19.9 (± 1.30). Participants reporting their age as 19 had the highest response rate (56) and participants reporting their age at 23 or 25 had the lowest response rate (1). There were no participants who were 24 years of age. Table 4. Frequency Table of Age of Participants Age Frequency Percentage 18 19 20 21 22 23 24 25+ 27 56 50 41 24 1 0 1 13.5 28 25 20.5 12 .5 0 .5 16 Hypothesis Testing The level of significance used for testing all hypotheses was set at .05. Hypothesis 1: There will be a difference in knowledge about alcohol’s effect on performance scores when comparing males and females. An independent t-Test was used to determine if there was a difference in total scores on the Knowledge About Alcohol Questionnaire between males and females. The results of the analysis are presented below in Table 5. Table 5. T-test between Gender and Total Score on Knowledge about Alcohol Questionnaire Gender N Mean Standard Std Error t Sig Deviation Mean Male 88 17.69 1.783 .190 .334 .692 Female 112 17.61 1.832 .173 .335 Results: An independent t-Test was calculated comparing the mean knowledge score of male participants and the mean knowledge score of female participants. No significant difference was found (t(198) = .334, p > .05). Conclusion: The mean knowledge scores of the males (m = 17.69, sd = 1.783) was not significantly different from the mean knowledge scores of the females (m = 17.61, sd = 17 1.832). There was no difference in knowledge about alcohol by gender. Hypothesis 2: There will be a difference between the scores on Knowledge about Alcohol Questionnaire in members of individual sports teams and members of team sports teams. An independent t-Test was used to determine if there was a difference in total scores on the Knowledge about Alcohol Questionnaire between members of individual sports teams or team sports teams. The results of the analysis are presented below in Table 6. Table 6. T-test between type of sports team and Total Score on Knowledge about Alcohol Questionnaire Type N Mean Standard Std Error t Sig Deviation Mean Ind 51 17.51 1.804 .253 -.618 .603 Team 149 17.69 1.812 .148 Results: An independent t-Test was calculated comparing the mean knowledge score of members of individual sports teams and the mean knowledge score of members of team sports team. No significant difference was found (t(198) = -.618, p > .05). Conclusion: The mean knowledge scores of the members of individual sports teams (m = 17.51, sd = 1.804) was not 18 significantly different from the mean knowledge scores of the members of team sports teams (m = 17.69, sd = 1.812). There was no difference in alcohol knowledge based on the sport type. Hypothesis 3: Knowledge About Alcohol scores will vary significantly based on how frequently the participant consumes alcohol. A one way ANOVA was used to compare the mean knowledge scores between participants, who drink a few times a year, participants who drink a few times a month, participant who drink once a week, and participants who drink three or more times a week. The results of the analysis are presented below in Table 7. Table 7. One-way ANOVA between Total Score on Knowledge about Alcohol Questionnaire and Frequency of Alcohol Consumption Variables Sum of df Mean F Sig Squares Square Between Groups 4.568 3 1.523 .463 .709 Within Groups 645.227 92 3.292 Total 649.795 98 Results: A one-way ANOVA was used to compare mean knowledge scores between groups of people with varying alcohol consumption frequency. No significant difference 19 was found (F(3, 196) = .463, p > .05). The mean knowledge scores can be found in Table 8. Conclusion: Drinking habits had no effect on alcohol knowledge. Table 8. Mean Scores for Frequency of Alcohol Consumption Groups Frequency of Mean Knowledge Std Alcohol consumption Score Deviation Few times a year Few times a month Once a week 3 or more times a week 17.63 17.79 17.59 17.29 1.496 1.942 1.829 1.848 Additional Findings Several tests were conducted using the demographic part of the questionnaire along with the total scores on Knowledge about Alcohol Questionnaire in an attempt to discover additional findings. An independent t-Test was used to determine if there was a difference in total scores on the Knowledge about Alcohol Questionnaire between members of the NCAA Division II school and members of the NCAA Division III schools. The results of this test are represented below in Table 9. 20 Table 9. Independent t-Test Between NCAA Divisions and Total Score on Knowledge about Alcohol Questionnaire Division N Mean Standard Std Error t Sig Deviation Mean II 45 17.36 1.694 .253 -1.222 .614 III 155 17.73 1.835 .147 Results: An independent t-Test was used to compare the mean knowledge scores of members of NCAA Division II teams and members of NCAA Division III teams. No significant difference was found (t(198) = -1.222, p > .05). Conclusion: The mean knowledge scores of student athletes at the NCAA Division II school (m = 17.36, sd = 1.694) was not significantly different than the mean knowledge score of student athletes at the NCAA Division III schools. This shows that athletes from both NCAA Divisions included in this study have the same understanding of how alcohol consumption can effect athletic performance. Another independent t-Test was used to determine if there was a difference in total scores on the Knowledge about Alcohol Questionnaire between participants that reported they have never practiced or competed with a hangover and those who reported they have practiced or competed with a hangover. The results of this test are represented below in Table 10. 21 Table 10. Independent t-Test Between Student Athlete’s Hangover Practice and Game Status and Total Score on Knowledge about Alcohol Questionnaire Hangover N Mean Standard Std Error t Sig Status Deviation Mean Never 158 17.76 1.732 .138 1.747 .274 Have 42 17.21 2.031 .313 Results: An independent t-Test was used to compare the mean knowledge scores of participants who reported they have never practiced or competed with a hangover and the mean knowledge scores of participants who reported they have practiced or competed with a hangover. No significant difference was found (t(198) = 1.747, p > .05). Conclusion: The mean knowledge scores of participants who reported they have never practiced or competed with a hangover (m = 17.76, sd = 1.732) and the mean knowledge scores of participants who reported they have practiced or competed with a hangover (m = 17.21, sd = 2.031) were not significantly different. The results of this study show that both athletes who do not practice or compete with a hangover and athletes who do have similar understandings of how alcohol consumption can effect athletic performance. Another independent t-Test was used to determine if there was a difference in total scores on the Knowledge about Alcohol Questionnaire between participants who reported being under the age of 21 (the legal drinking age) 22 and participant who reported being over the age over 21. The results of this test are reported below in Table 11. Table 11. Independent t-Test between Age and Total Score on Knowledge about Alcohol Questionnaire Age N Mean Standard Std Error t Sig Deviation Mean Under 21 133 17.66 1.779 .154 .183 .963 Over 21 67 17.61 1.875 .229 Results: An independent t-Test was used to compare the mean knowledge scores of participants who reported being under the age of 21 and the mean knowledge scores of participants who reported being over the age of 21. No significant difference was found (t(198) = .183, p > .05). Conclusions: The mean knowledge scores of participants under the age of 21 (m = 17.66, sd = 1.779) was not significantly different than the mean knowledge scores of participants over the age of 21 (m = 17.61, sd = 1.875). The results of this test show that athletes under the legal drinking age, as well as athletes who are over the legal drinking age, have similar understandings of the effects alcohol consumption can have on the body. Furthermore, the number of participants in this study who were under the age of 21 more than doubled the number of participants who were over the age of 21. In the Drinking Habits section of the Knowledge about Alcohol 23 Questionnaire, a question asking “How often do you drink alcohol?” was asked and there were no participants in this study that answered “Never”. The following figures illustrate the drinking habits of underage student athletes as compared to student athletes who are of legal drinking age. Figure 1. Drinking Habits Question 1 Figure 1 describes the frequency of alcohol consumption between participants under the age of 21 and participants over the age over 21. 24 How often do you get drunk? Over 21 Under 21 Figure 3. Drinking Habits Question 5 7.46% 9.02% Everytime I drink 32.83% Once a week 15.03% 25.37% A few times a month 31.57% 20.89% A few times a year 33.08% 13.43% 11.27% Never Figure 2. Drinking Habits Question 3 Figure 2 describes the how often participants under the age of 21 and participants over the age over 21 report getting drunk. Have you ever practiced or competed with a hangover? Over 21 5 or more times per season Once or twice per season Under 21 1.40% 0.75% 26.86% 16.54% Never Figure 3. Drinking Habits Question 5 71.64% 82.70% 25 Figure 3 illustrates how often the participants who are under the age of 21 and the participants who are over the age of 21 practice or compete in athletic competition with a hangover. Has drinking alcohol ever effected you academically? Over 21 Under 21 50.74% No 80.54% 49.25% Yes 19.54% Figure 4. Drinking Habits Question 6 Figure 4 illustrates if participants who are under the age of 21 and if participants who are over the age of 21 have ever had their academic roles or status be effected by their alcohol consumption. This included, but was not limited, to going to class hung-over, missing class because of hangover, or forgetting to study for an exam because of a party. 26 Has drinking alcohol ever effected your athletic status? Over 21 Under 21 88.05% No 92.48% 11.94% Yes 7.51% Figure 5. Drinking Habits Question 7 Figure 5 illustrates if participants who are under the age of 21 and if participants who are over the age of 21 have ever had their athletic status be effected by their alcohol consumption. This included, but was not limited to, going to being suspended from a game for getting an alcohol citation or missing a practice or game because of a hangover. 27 Has drinking alcohol ever negatively impacted your personal life? Over 21 Under 21 62.68% No 69.92% 37.31% Yes 30.07% Figure 6. Drinking Habits Question 8 Figure 6 illustrates if participants who are under the age of 21 and if participants who are over the age of 21 have ever had their personal life impacted by alcohol consumption. Has drinking alcohol ever effected your ability to handle professional responsibilities? Over 21 Under 21 86.56% No 92.48% Yes 13.43% 7.51% Figure 7. Drinking Habits Question 9 28 Figure 7 illustrates if participants who are under the age of 21 and if participants who are over the age of 21 have ever had alcohol effect their ability to handle their professional responsibilities. This included, but was not limited to, being unable to go to work because of a hangover or going to work late because of a hangover. 29 DISCUSSION Discussion of Results This survey studied the amount of knowledge collegiate athletes have on how alcohol consumption can affect their athletic performances. The researcher examined specific discriminators such as gender, sport team type, frequency of alcohol consumption, etc can affect the amount of knowledge a student athlete has on the subject matter. Hypothesis 1 stated there will be a difference in knowledge about alcohol’s effect on performance scores when comparing males and females. The researcher proposed that males and females will have different levels of understanding the ways alcohol consumption can affect athletic performance. This idea was based on previous research that associated males with higher drinking incidence than females.2,10-13 The results showed no significant difference between the two groups. The mean scores of both the males and females were statistically the same. Bulmer et al studied alcohol consumption patterns and trends at a public university over a span of 6 years. When comparing data between genders, Bulmer et al found no significant 30 increases in rate of consumption and frequency of consumption in the male population but very significant increases in the female population. When the Bulmer study began men showed consistently higher rates of alcohol consumption, but over the period of the study the females began bridging the gap in alcohol consumption frequency and volume between males and females.13 Hypothesis 2 stated there will be a difference between the scores on Knowledge about Alcohol Questionnaire in members of individual sports teams and members of team sports teams. The researcher proposition this claim based on research suggesting that athletic teams commonly participate in off-the-field social activities that often involve alcohol as a way to promote team unity.14 No significant difference was found in the mean scores of individuals who participated in individual sports teams and individuals who participated in team sports teams. The sports teams that were considered individual sports teams in this study included track and field, cross country, golf, swimming, tennis, and wrestling. In some of these sports, there is a team score in competition but it is based off of individual performance, thus possibly leading to a decreased need for team unity. Participating in athletics already puts an individual in a high risk 31 population for problem drinking.2-4,10,11 Individuals who participate in team sports are at an even higher risk because their sports depend on group cohesion. Zamboanga et al discovered that there was high team social cohesion in teams with increased frequency of team social events that involved alcohol.14 Hypothesis 3 stated that Knowledge about Alcohol scores will vary significantly based on how frequently the participant consumes alcohol. This declaration was based on the assumption that if athletes understood how alcohol impacts athletic performance, they would consume alcohol less. Thomas et al claimed that understanding the perceived negative effects athletes associate with illicit “recreational” drug use may assist in the development of appropriate drug education messages that may prove to be successful in deterring use among high-level athletes.15 However, no significant difference was found when comparing the mean scores of those who drank alcohol more frequently with those who drank alcohol less frequently. In 2000, Wechsler et al found that only 59% of colleges with athletic programs provide their athletes with alcohol education programs.16 But in 2002 Wechsler et al surveyed 474 colleges and found that 84% reported they provided alcohol education to freshman.17 It is clear, that 32 education alone is not enough to prevent athletes from becoming part of the problem drinking norm associated with athletics. Thadani et al examined on the success rates of multicomponent prevention programs in the decrease of drinking. According to their research education only programs do not reduce drinking, and in fact, they have been found to produce little measurable change in drinking behaviors. The control group in the study was provided with just educational programming and at the end of the study there was a positive correlation between alcohol knowledge and drinking (those who drank more also had more knowledge about alcohol.18 In addition to hypothesis testing, some other statistics were performed using other information from the Demographic section and the Drinking Habits section of the Knowledge about Alcohol Questionnaire. The first additional find examined the mean knowledge scores of the two NCAA Divisions that were represented in the study. Green et al found that 76% of Division I colleges provide alcohol education programs while only 50% of Division II schools and 41% of Division III programs provide alcohol education programs.19 There was no significant difference in the mean scores of student athletes from the NCAA Division II 33 institution and student athletes from the NCAA Division III institutions. The second addition find examined the mean knowledge scores of people who reported they have practiced or competed with a hangover and people who reported they have never practiced or competed with a hangover. There was no significant difference between the mean scores of these two groups. The findings from this statistic determined that people who choose to consume copious amounts of alcohol that would result in a hangover understand the physiological effects of alcohol and how it affects their athletic performance. The last additional statistic examined the mean knowledge scores of participants who were under the age of 21 and participants who were over the age of 21. There was no significant different between the two sets of mean knowledge scores. There was however, a profound discrepancy in the number of subjects from each category. The number of participants who were under the legal drinking age of 21, more than doubled the number of participants who were over the legal drinking age. According to the 2008 Monitoring the Future Survey almost 72% of high school seniors reported consuming alcohol during the lifetime, 43% reported consuming alcohol in the past 30 days, 28% 34 reported being drunk in the last 30 days, and 25% reported binge drinking in the past 2 weeks.20 Conclusions The results of the study revealed the following major conclusions: 1. Both male and female student athletes had similar amounts of alcohol knowledge. 2. Members of individual sports teams and members of team sports team had similar amounts of alcohol knowledge. 3. People who consume alcohol more frequently have similar amounts of knowledge as people who consume alcohol less frequently. 4. Members of NCAA Division II athletic programs have similar amounts of alcohol knowledge as members of NCAA Division II athletic programs. 5. The amount of knowledge a student athlete has does not affect drinking habits preceding practice or games. 6. People under the age of 21 have similar alcohol knowledge scores as people over the age of 21. 7. People under the age of 21 have similar drinking habits as people over the age of 21. 35 Recommendations Based on the results of this study, the following research recommendations were made. 1. Future studies should include a larger sample size. 2. Future studies should include representation of all NCAA Divisions. 3. Future studies may want to consider a using a different instrument that can yield more specific alcohol knowledge data. 4. More studies should be done to understand the reasons why athletes consume more alcohol than do non-athletes. 5. More studies should be done to understand what type of intervention programming would be effective in lowering the alcohol consumption rate and frequency of student athletes. Policy Recommendations Because the amount of knowledge student athletes have on how alcohol consumption can effect athletic performance 36 was not the problem, the following recommendations were made. 1. Regulations need to be put in place to begin regulating alcohol, a mostly unregulated drug. 2. Programming that goes beyond the scope of educating athletes on the effects of alcohol needs to be implemented into athletic programs. 37 REFERENCES 1. Shirreffs SM, Maughan RJ. The effect of alcohol on athletic performance. Current Sports Medicine Reports, 2006;5:192-196. 2. Wilson GS, Pritchard ME, Schaffer J. Athletic status and drinking behavior in college students: the influence of gender and coping styles. J Am Coll Health, 2004;52(6):269-273. 3. Doumas DM, Turrisi R, Coll KM, Haralson K. High risk drinking in college athletes and nonathletes across the academic year. Journal of College Counseling, 2007:10. 4. Ford JA. Alcohol use among college students: a comparison of athletes and nonathletes. Subst Use Misuse, 2007;42:1367-1377. 5. El-Sayed MS, Ali N, Zeinab, AE. Interaction between alcohol and exercise. Sports Med, 2005;35:257-269. 6. Suter PM, Schutz Y. The Effect of exercise, alcohol or both combined on health and physical performance. Int J Obesity, 2008;32:48-52. 7. Maughan RJ. Alcohol and Football. J Sport Sci, 2006;24(7):741-748. 8. Szabo G, Mandrekar P. A recent perspective on alcohol, immunity, and host defense. Alcohol Clin Exp Res, 2009;33(2):220-232. 9. O'Brien CP, Lyons F. Alcohol and the athlete. Sports Med. 2000;5:295-300. 10. Brenner J, Swanik K. High risk drinking characteristics in collegiate athletes. J Am Coll Health. 2007;56(3). 38 11. Martens MP, Dams-O'Conner K, Duffy-Paiement C. Comparing off-season with in-season alcohol consumption among intercollegiate athletes. J Sport Exercise Psy, 2006;28:502-510. 12. Quarrie KL, Feehan M, Waller AE. The new zealand rugby injury and performance project: alcohol use patters within a cohort of rugby players. Addiction. 1996;91(12):1865-1868. 13. Bulmer S, Irfan S, Mugno R, Barton B, Ackerman L. Trends in alcohol consumption among undergraduate students at a northeaster public university, 20022008. J Am Coll Health. 2010;58(4):383-390. 14. Zamboanga BL, Rodriguez L, Horton NJ. Athletic involvement and its revelance to hazardous alcohol use and drinking game participation in female college athletes: a preliminary investigation. J Am Coll Health, 2008;56(6):651-656. 15. Thomas JO, Dunn M, Swift W, Burns L. Elite athletes' perceptions of the effect of illicit drug use on athletic performance. Clinical Journal of Sports Medicine, 2010;20(2):189-192. 16. Wechsler H, Kelley K, Weitzman ER, Giovanni, PS, Seilbring M. What colleges are doing about student binge drinking. J Am College Health, 2000;48: 219-226. 17. Wechsler H, Seibring M, I-Chao L, Ahl M. Colleges respond to student binge drinking: reducing student demand or limiting access. J Am Coll Healthy. 2004; 52:159-168. Thadani V, Huchting K, LaBrie J. Alcohol-related information in multi-component interventions and college students’ drinking behavior. J Alcohol Drug Educ. 2009; 52(2):31-51. 18. 19. Green GA, Uryasz FD, Petr TA, Bray CD. NCAA study of substance use and abuse habits of college studentathletes. Clin J Sport Med. 2001;11:51-56. 39 20. Windle M, Zucker RA. Reducing underage and young adult drinking. Alcohol Res Health. 2010;33(1):29-44. 40 APPENDICES 41 APPENDIX A Review of Literature 42 REVIEW OF LITERATURE The purpose of this Review of Literature is to discuss the relationship between alcohol knowledge and use among intercollegiate athletes. There are many studies done surrounding the topic of alcohol and athletes but this literature review will look into a few specifically. A study done by Zamboanga et al1 examined the role alcohol plays to facilitate social activities among athletes in the way of drinking games. A study done by Doumas et al examined whether there is a relationship between alcohol consumption rates in season or out of season.2 Alcohol has always been synonymous with the sportsman’s world and continues to be the most commonly used substance among athletes1; however, this review will examine the role of alcohol as it relates to collegiate athletes. The topics discussed in this review are alcohol’s role as a social facilitator, athletes’ drinking habits, the effects alcohol has on athletic performance, common risk factors associated with alcohol, and athletes’ knowledge about alcohol’s effects on athletic performance. 43 Athletes vs. Non-athletes There has always been a strong societal connection between sports and alcohol. It is not uncommon for a sports fan to consume alcohol while celebrating a win or while watching or attending sporting events. There is a long history of sponsorship of athletic clubs by alcohol companies; therefore, the connection between sport and alcohol has deep roots.3 In addition, studies have demonstrated that athletes are more likely to regularly consume alcohol and binge drink in comparison to nonathletes.2,4-6 A study by Brenner et al5 found that 78% of athletes in a Division I setting, 76% of athletes in a Division II, and 68% of athletes in Division III reported participating in high risk drinking during their noncompetitive season. Further, Martin completed a study to determine if drinking rates changed between traditional and non-traditional seasons. He reported that 56% of Division I athletes report binge drinking out of their competitive seasons and 35% report binge drinking during their competitive season.7 Alcohol consumption may be statistically lower when athletes are in season, but some still participate in problem drinking. 44 There is a common belief that participation in athletics would help decrease the number of kids engaging in unhealthy behaviors, such as consuming high quantities of alcohol, but this is not necessarily the case. One study aimed to compare the patterns of alcohol abuse and engagement in organized collegiate sports and found that current and former athletes showed an increase in risky behavior involving alcohol when compared to non-athletes.6 Research indicates that athletes and even former athletes are more likely to begin drinking at a younger age, participate in binge drinking more frequently, suffer from high alcohol-related consequences, and are more likely to suffer from alcoholism in the future.6 Another study, by J. A. Ford, had similar findings but also speculated on reasons why athletes tend to have higher tendencies to use alcohol. He states that because athletes tend to be in a “peer intensive” state, meaning they usually socialize with their teammates or other athletes in which alcohol consumption is the norm for their group, then other individuals will also feel compelled to partake in activities involving alcohol.4 This is only one reason why there may be an increase in alcohol consumption in athletics. In order to fully understand consumption in athletes, it is important to view drinking habits. 45 Drinking Habits There are numerous studies arguing that athletes are far more likely to consume alcohol more frequently and have higher consumption rates as compared to non-athletes.2,4,5,6 When analyzing alcohol consumption it is important to examine drinking habits. More importantly it is vital to determine whether or not drinking habits change over the course of the academic year or during the in-season or offseason. Further, it is warranted to study whether male or female athletes participate in binge drinking more often. Factors including the awareness of the cultural connection between athletics and drinking alcohol, increased peer pressure and personality factors are just some of the reasons that have been speculated as possible reasons for the heightened alcohol statistics among athletes.8 Also, some literature discusses team member’s perceptions of their teammate’s drinking habits and how these perceptions determine alcohol consumption among athletes. Student athletes have multiple role demands and higher standards that are expected of them by professors, coaches, teammates, and friends.2 Maintaining a social life along with balancing schoolwork and team responsibilities can 46 place stress upon the student athlete which may lead them to consume alcohol. Leichliter et al mentions that team leaders and team members with more stress, report higher levels of binge drinking as compared to other team members.9 The increase in stress associated with being a team leader or a student athlete could lead the student to team social functions often involving alcohol. J. A. Ford states, “Failure to conform to group norms, by not using alcohol, may result in rejection by peers and social isolation”.4 One researcher, Berkowitz, examined the social norm theory in an attempt to explain the increased incidence of athletes involved with drinking problems. According to him, this model is built on the assumption that individual behavior can be greatly influenced by peer influence rather than biological, cultural, personal, or family beliefs or influences.10 In a study done by Lewis he examined whether or not this theory was valid regarding athletes and their consumption of alcohol. The results showed that team leaders who were not binge drinkers perceived more strictness on the subject from coaches and team leaders who were identified as binge drinkers perceived greater leniency from coaches.11 On the other hand, this study supports the beliefs in that athletes, who perceived their 47 fellow teammates were drinking, were more likely to consume alcohol and vice versa.11 Another drinking habit that was examined by researchers focused on gender. It has been shown that male athletes are much more likely to consume alcohol, binge drink, and drink more frequently than female athletes.12 One study conducted by Wilson et al12 concluded that men drank more frequently than women and male athletes drank more heavily than non-athletic males. The same results were concluded when comparing the quantity of alcohol consumed on each drinking occasion and the amount of times they drank to intoxication.12 Moreover, it was noted that male athletes in particular were more likely to drink for social reasons, such as to get a high, and to use alcohol to relax.12 Martens et al8 assessed the differences in in-season and off-season alcohol consumption in athletes. The authors researched a theory in which if an athlete were to recognize the negative effects of alcohol on athletic performance; this awareness would lead to a decrease in the amount of alcohol consumed. They concluded that college athletes were less likely to drink during their competitive season and more likely to drink during their off-season.8 One reason for this decrease could be because there is more 48 time for social activities in the off season. However, another explanation for this increase may be athletes believe alcohol will have no effect on future athletic performances if consumed days or weeks before activity. Alcohol’s Effects on Performance It has been considered that alcohol in moderation may offer some health benefits.13 While most studies on this topic are non-conclusive, Suter et al identify that that health benefits associated with proper nutrition and exercise are well established14 and the consumption of alcohol can have a number of negative effects, both acute and chronic, on the body. Alcohol causes impairments on psychomotor skills, strength and power, and aerobic fitness.3,13-17 Most individuals binge drink so they can have an immediate effect of alcohol called euphoria. After the immediate sensation of elation, psychomotor skills will soon begin to decrease. Ingesting low amounts of alcohol can alter reaction time, fine motor movements, and hand eye coordination.14 With a moderate to high amount of alcohol consumption these skills are further impaired along with decreased balance and accuracy, coordination, response 49 skills, speech impairments, and recognition abilities.13,14,16,18 These impairments typically only affect an athlete’s performance if alcohol was consumed prior or during activity because most of these are short term effects. However, there are a number of effects that are more long term and have the potential to effect athletic performance post-consumption. One study in particular showed that alcohol is thought to decrease muscular work capacity therefore resulting in slower running and cycling speeds along with a faster onset of fatigue during high intensity exercises.14 There is evidence showing moderate amounts of alcohol consumed will decrease grip strength, vertical jump height, and sprint speed.3 Exposure to alcohol will interfere with the release of calcium necessary for proper and efficient muscle contractions.19 The authors of The effect of Alcohol on Athletic Performance identified the fact that even low amounts of alcohol in a person’s body can impair glucose synthesis in both the liver and in oxidative skeletal muscle therefore, would decrease an athlete’s performance during prolonged moderate-intensity activities.17 Dehydration is thought to be a large contributor to the hangover effect after alcohol consumption.17 During this phase of recovery there are disturbances in cardiovascular 50 function including an increased resting heart rate, increased blood pressure, and decreased left ventricular performance.17 Because alcohol has a diuretic affect it will cause dehydration which in turn will impair aerobic function during exercise.20 This effect will also slow the recovery process after exercise as well. Some of the chronic effects are associated with long term alcohol use include cellular changes in the liver, heart, brain and muscles leading to increased risk for liver disease, heart disease, stroke, and decreased muscular work capacity.3,13,14 An article discussing the health implications associated with alcohol discussed specifically the increased risk of developing breast cancer in women who consistently drink heavily and the increased risk for men to develop colon cancer. This article also mentions how alcohol can reduce the oxidation of fat and enhance the consumer’s appetite and therefore, it can lead to increased fat storage21 which could be detrimental to athletes who need to strictly regulate their weight such as wrestlers, gymnasts, boxing, and pole vaulters. Alcohol use can also impair temperature regulation during athletic activity in adverse weather conditions.20 A study done by Yoda et al, on the effects alcohol can have on a person in a cold environment showed that although 51 alcohol does not affect core temperature, it does have a direct effect on the central nervous system thus decreasing a person’s perception of cold.22 This substantial decrease in cold perception greatly increases an athlete’s chances of developing hypothermia when participating in activities in a cold environment. Injuries often occur when participating in intercollegiate sports and studies show that the risk of injury increases when an athlete has consumed alcohol3,15 and recovery from injury can be impaired due to alcohol.23 In addition, researchers believe that even one episode of moderate to heavy alcohol consumption can lead to impairment in immune responses including inflammatory cell function. Also, the same article by Szabo et al discussed other deficiencies in host defense and immune responses that could lead to increased incidence of infections and prolonged recovery from burns, traumatic injury, and infections.24 This would include increasing recovery time for athletic injuries. A study done by Vargas et al, demonstrated that alcohol intake will accelerate atrophic responses in disused muscles and prolong reinitiating weight bearing activities. This was due to the impairments of protein synthesis and degradation.23 If athletes are unaware of the impact alcohol can have on their body while 52 it is healing after sustaining an injury or undergoing surgery it will only prolong the healing process and lose more playing time. For these reasons it is demonstrated that acute alcohol intake will increase an athlete’s risk for injury but a study done by O’Brien and Lyons describes just how much of an increase to expect. In their study they found that athletes who drank alcohol at least one time per week had an injury rate of 54.8% and the nondrinking population had an injury rate of just 23.5%.20 Athlete’s Knowledge of Alcohol’s Effects on Performance There is a need for something more than educational programs teaching athletes the effects alcohol can have within collegiate sports. The National Collegiate Athletic Association has increased their efforts by creating prevention programs in conjunction with the Betty Ford Center.20 Educating athletes will be the corner stone in start to change the fact that alcohol is the most commonly used drug among athletes. K. M. Hildebrand et al, propose colleges requiring a wellness course to be taken by all student athletes and a course like this would address alcoholism and alcohol related issues with the hope to improve behavior management.6 But a study by Thadani et al 53 describes the need for even more. Their study demonstrates that education alone is not enough to change drinking behaviors. The control group in their study received only educational programming and the results at the end of the trial showed participants who drank more also had more knowledge about alcohol. They suggest using multi-component intervention programs that use information about drinking in the context of skills training, normative feedback, and motivational interviewing in a group setting.25 In 2000 Wechsler et al found that only 59% of colleges with athletic programs provide their athletes with alcohol education programs26 and Martin et al found that Division I female athletes averaged between 4 and 8 hours of alcohol education courses during their college careers with a majority of them reporting they wanted more educational programming.7 Then, in 2002 Wechsler et al found that out of 747 4-year colleges, 84% provided alcohol education to freshman.27 Although athletes may be receiving the information, and understanding that competing or practicing while intoxicated or hung-over will cause suboptimal performance, they may not fully understand the long term effects heavy alcohol use can have.8 Also, the information may be spiking the interest of the student athletes, thus leading to more problematic drinking.25 This is why it is 54 important for coaches, athletic trainers and sport psychologists to be proactive in helping athletes recognize the impact alcohol can have on their personal and athletic lives8 and implementing programs that will be effective in creating positive changes. Summary Athletic involvement is clearly a link to increased risk to alcohol related problems. It is important for athletes to be aware that alcohol may impair performance of endurance exercises because of its effects on metabolic, cardiovascular, and thermoregulatory function as well as altering their ability to perform skilled tasks because of its effects on reaction time, fine motor control and judgment and to understand what exactly this means.3 Participating in the consumption of alcohol can promote social interaction within teammates thus leading to better team cohesion1; however, there are other, healthier, ways for athletes to bond as a team and coaches and team leaders need to be involved in creating healthier lifestyle choices in their team and fellow teammates. 55 APPENDIX B The Problem 56 THE PROBLEM There is a clear and long standing relationship between sports, exercise, athletes, and alcohol use.23 Alcohol is now and will continue to be the most commonly consumed drug in the athletic population.20 It very common for athletes to consume alcohol to the point of intoxication more frequently than non-athletes do.12 Research has even indicated that due to the high amount of alcohol consumed and the greater chance of athletes having drinking related consequences, some researchers even classify athletes as an at risk subpopulation of students.11 With athletes being classified under an at risk category regarding alcohol, do they really know what they are doing to their bodies but consuming large amounts of alcohol? Furthermore, do athletes understand the effect it can have on their performance? It is important for athletic trainers, coaches, and even athletes to be aware of the negative consequences alcohol can have on athletic performance. But first, they need to understand exactly how much of the information they do not have. The purpose of this study to determine whether or not athletes know about the way alcohol can alter athletic performance. 57 Definition of Terms The following definitions of terms will be defined for this study: 1) Athlete: A person who participates in NCAA division I, II, or III athletics. 2) Binge drinking: Consuming 5 or more drinks in a row for men and 4 or more drinks in a row for women on 1 or more occasions during the past two weeks12. 3) Team Sports: Sports in which 4 or more team members compete towards a common goal (football, baseball, softball, volleyball, soccer, basketball, lacrosse). 4) Individual Sports: Sports in which individuals participate rather than groups (cross country, golf, track & field, swimming, tennis). 5) Drinking Habits: How often a person drinks and how much alcohol they consume on a regular basis. Basic Assumptions The following are basic assumptions of this study: 1) The subjects are NCAA Division II and III athletes. No individuals who participate in only intramural or club sports were included in this study. 2) All the subjects answered each question honestly and to the best of their knowledge. 58 3) No individual received any assistance from an outside participant or resource to answer a question. Limitations of the Study The following are possible limitations of the study: 1) The subjects may have received assistance in answering a question or may not have done so honestly. 2) A true sampling was not received because only one NCAA Division II program was included and no NCAA Division I programs were. 3) Because the internal reliability of the Knowledge about Alcohol Questionnaire was not performed, the reader is cautioned when interpreting the results. Significance of the Study Determining whether athletes understand the negative consequences alcohol can have on the body and athletic performance will promote the need for more alcohol education within our athletic programs. If athletes do have a solid understanding of the negative consequences that come from consuming alcohol in regards to athletics, then we will know that there must be another reason for why athletes continue to participate in unhealthy drinking behaviors. If the athletes do not have a clear 59 understanding, then Athletic Trainers and coaches will need to realize that education is could be the key. Hopefully, through educating our athletes on how alcohol consumption will affect their performance, athletes will come to realize it’s not worth the risk. If this study can prove that our athletes simply do not have enough knowledge on the topic, incorporating more alcohol education seminars into our athletic programs can be one way of educating athletes and start changing the stereotypes having to do with alcohol and athletes. This way, athletes can start focusing more on training to win the competition, rather than training to undo the effects from last night’s party. 60 APPENDIX C Additional Methods 61 Appendix C1 Knowledge about Alcohol Questionnaire 62 Knowledge about Alcohol Questionnaire 1. What is your Gender? Male Female 2. What sport do you play? Football Basketball Soccer Lacrosse Track and Field Volleyball Swimming Cross Country Tennis Wrestling Field Hockey Golf Baseball Softball 3. What School do you attend? California University of Pennsylvania Frostburg State University Penn State Greater Allegheny Penn State FayetteEberly Campus Washington and Jefferson College 4. What year in college are you? Freshman Sophomore Junior Senior Graduate 5. What is your age? Drinking Habits 1. What kind of alcohol do you drink? Beer Mixed drinks Shots Wine Malt Beverages 2. How often do you drink alcohol? Never A few times a year A few times a month Once a week 3 or more times a week 3. How often do you get drunk? Never A few times a year A few times a month Once a week Every time I drink 4. Who do you usually drink alcohol with? Teammates Other friends By myself 5. Have you ever practiced or competed with a hangover? Never Once or twice per season more than 5 times in a season 6. Has Drinking alcohol ever effected you academically (going to class hung-over, missing class because of a hang-over, etc) yes no 7. Has drinking alcohol ever affected you athletically? (practicing or competing while intoxicated or hungover, getting a citation and being suspended from the team, etc) yes no 8. Has drinking ever negatively impacted your personal life? Yes no 63 9. Has drinking ever affected your professional responsibilities? (could not go into work because of a hang-over, etc) Yes no Alcohol Knowledge Questions Please answer each of the following questions to the best of your ability without any outside assistance. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. Drinking alcohol will increase accuracy True False Drinking alcohol will slow reaction time True False Drinking alcohol will increase hand-eye coordination True False Drinking alcohol will increase fatigue during exercise True False Exercise will increase alcohol metabolism True False Alcohol will increase muscular work capacity (i.e. make you run faster and longer) True False Drinking alcohol will increase the loss of muscle mass when recovering from an injury True False Drinking alcohol will increase your chances of sustaining a sports related injury True False Drinking alcohol will increase your vertical jump height True False Drinking alcohol will help your body recover after exercise True False Drinking alcohol will cause an increase in blood pressure True False Drinking alcohol will cause you to stay warmer when exercising in the cold True False Drinking alcohol will increase muscular power True False Alcohol promotes body fat accumulation True False Exercise after drinking alcohol can cause an increase in muscle damage True False Drinking alcohol will decrease the pumping forces of the heart True False Drinking alcohol can negatively impair your immune system True False 64 18. 19. 20. Drinking alcohol within 24 hours of athletic performance will not have an effect aerobic performances True False Alcohol will increase your blood sugar levels enabling you to exercise longer True False Alcohol will change the body’s hormonal balances making it more conductive to increases in muscle mass True False NOTE: The Bolded test marks the correct answer for each knowledge question. 65 APPENDIX C2 Institutional Review Board – California University of Pennsylvania 66 67 68 69 70 71 72 73 74 75 76 APPENDIX C3 Cover Letter 77 March 16, 2011 Dear Student Athlete: My name is Joanna Murray and I am currently a graduate student at California University of Pennsylvania pursing a Master of Science in Athletic Training. Part of the graduate study curriculum is to complete a research thesis through conducting research. I am conducting survey research to determine if athletes understand how alcohol consumption can impact their athletic performance. Athletes from your institution, as well as four others, are being asked to participate; however, your participation is voluntary and you do have the right to choose not to participate. You must be 18 years of age or older in order to participate in this study. You also have the right to discontinue participation at any time during the survey completion process at which time your data will be discarded. The California University of Pennsylvania Institutional Review Board has reviewed and approved this project. The approval is effective 03/03/2011 and expires 03/02/2012. All survey responses are anonymous and will be kept confidential, and informed consent to use the data collected will be assumed upon return of the survey. Aggregate survey responses will be housed in a password protected file on the CalU campus. Minimal risk is posed by participating as a subject in this study. I ask that you please take this survey at your earliest convenience as it will take no more than 20 minutes to complete. If you have any questions regarding this project, please feel free to contact the primary researcher Joanna Murray at mur7552@calu.edu. You can also contact the faculty advisor for this research Dr. Robert Kane by phone at 724-938-4011 or email at kane@calu.edu. Thanks in advance for your participation. Please click the following link to access the survey: https://www.surveymonkey.com/s/9HKY52X. 78 Thank you for taking the time to take part in my thesis research. I greatly appreciate your time and effort put into this task. Joanna M. Murray, ATC, PES Primary Researcher California University of Pennsylvania 250 University Ave California, PA 15419 301-412-4308 Mur7552@calu.edu 79 APPENDIX C4 Coach Information Letter 80 Date Dear Coaches, My name is Joanna Murray and I am currently a graduate student at California University of Pennsylvania pursing a Master of Science in Athletic Training. I recently contacted (Athletic Director’s name) asking for permission to contact (Institution’s name) athletes to take part in my research thesis. On March 3, 2011 the California University of Pennsylvania's Institutional Review Board approved my research proposal. I would like to begin distributing the link to my online questionnaire. All the information your athletes need is in the cover letter I have attached to this email. If you could please copy and paste it into an email to all the members of your team, it would be greatly appreciated. Please let me know if you need any other information from me. Thank you again for your cooperation. Sincerely, Joanna M. Murray, ATC, PES Primary Researcher California University of Pennsylvania 250 University Ave California, PA 15419 301-412-4308 Mur7552@calu.edu Robert Kane, EdD, PT, ATC Research Advisor California University of Pennsylvania 250 University Ave California, PA 15419 kane@calu.edu 81 REFERENCES 1. Zamboanga BL, Rodriguez L, Horton NJ. Athletic involvement and its revelance to hazardous alcohol use and drinking game participation in female college athletes: a preliminary investigation. J Am Coll Health, 2008;56(6):651-656. 2. Doumas DM, Turrisi R, Coll KM, Haralson K. High risk drinking in college athletes and nonathletes across the academic year. Journal of College Counseling, 2007;10. 3. Maughan RJ Alcohol and Football. J Sport Sci, 2006;24(7):741-748. 4. Ford JA. Alcohol use among college students: a comparison of athletes and nonathletes. Subst Use Misuse, 2007;42:1367-1377. 5. Brenner J, Swanik K. High risk drinking characteristics in collegiate athletes. J Am Coll Health, 2007;56(3). 6. Hildebrand KM, Johnson DJ, Bogle K. Comparison of patterns of alcohol use between high school and college athletes and nonathletes. College Student Journal, 2001;35(3):358. 7. Martin M. The use of alcohol among NCAA Division I female college basketball, softball, and volleyball athletes. J Athl Train, 1998;29:295-300. 8. Martens MP, Dams-O'Conner K, Duffy-Paiement C. Comparing off-season with in-season alcohol consumption among intercollegiate athletes. J Sport Exercise Psy, 2006;28:502-510. 9. Leichliter JS, Meilman PM, Presley CA, Cashin JR. Alcohol use and related consequences among students with varying levels of involvement in college athletics. J Am Coll Health, 1998;46:257-262. 10. Berkowitz A. The social norms approach: Theory, research, and annotated bibliography August 2004. Higher Education Center for Alcohol and Other Drug Prevention. Available: 82 www.edc.org/hec/socialnorms/theory.html. Accessed July 12, 2006. 11. Lewis TF. An explanatory model of student athlete drinking, the role of team leadership, social norms, perceptions of risk, and coaches attitudes toward alcohol consumption. College Student Journal, 2008;42(3). 12. Wilson GS, Pritchard ME, Schaffer J. Athletic status and drinking behavior in college students: the influence of gender and coping styles. J Am Coll Health, 2004;52(6):269-273. 13. Clark N. The Quick and The Drunk. American Fitness, 2005;43: 42-43. 14. Suter PM, Schutz Y. The Effect of exercise, alcohol or both combined on health and physical performance. Int J Obesity, 2008;32: 48-52. 15. El-Sayed MS, Ali N, Zeinab, AE. Interaction between alcohol and exercise. Sports Med, 2005;35:257-269. 16. Gutgesell M, Canterbury R. Alcohol usage in sport and exercise. Addict Biol, 1999;4:373-383. 17. Shirreffs SM, Maughan RJ. The effect of alcohol on athletic performance. Current Sports Medicine Reports, 2006;5:192-196. 18. Thomas JO, Dunn M, Swift W, Burns L. Elite athletes' perceptions of the effect of illicit drug use on athletic performance. Clin J Sport Med, 2010;20(2):189-192. 19. Poulsen MB, Jakobsen J, Aagaard NK, Anderson H. Motor performance during and following acute alcohol intoxication in healthy non-alcoholic subjects. Eur J App Physiol, 2007;101:, 513-525. 20. O'Brien CP, Lyons F. Alcohol and the athlete. Sport Med, 2000;5, 295-300. 83 21. Gronbaek M. The positive and negative health effects of alcohol and the public health implications. J Intern Med, 2009;265:407-420 22. Yoda T, Crawshaw LI, Kumiko S, Nakamura M, Nagashima L, Kanosue K. Effects of alcohol on autonomic responses and thermal sensation during cold exposure in humans. Alcohol, 2008;42:207-212. 23. Vargas R, Lang CH. Alcohol accelerates loss of muscle impairs recovery of muscle mass resulting from disuse atrophy. Alcohol Clin Exp Res, 2008;32(1):128-137. 24. Szabo G, Mandrekar P. A recent perspective on alcohol, immunity, and host defense. Alcohol Clin Exp Res, 2009;33(2):220-232. 25. Thadani V, Huchting K, LaBrie J. Alcohol-related information in multi-component interventions and college students’ drinking behavior. J Alcohol Drug Educ. 2009; 52(2):31-51. 26. Wechsler H, Kelley K, Weitzman ER, Giovanni JPS, Seilbring M. What colleges are doing about student binge drinking. J Am College Health, 2000;48: 219-226. 27. Wechsler H, Seibring M, I-Chao L, Ahl M. Colleges respond to student binge drinking: reducing student demand or limiting access. J Am Coll Healthy. 2004; 52:159-168. 84 ABSTRACT Title: Collegiate Athletes’ Knowledge on the Effects of Alcohol Consumption on Athletic Performance Researcher: Joanna M. Murray Advisor: Dr. Robert Kane Purpose: The primary purpose of this to examine the amount of knowledge collegiate athletes have in regards to the effects of alcohol consumption on athletic performance. Methods: Participants included 200 student athletes from five collegiate institutions. The Knowledge about Alcohol Questionnaire was distributed electronically to the subjects and completed. The data was analyzed using Independent t-Tests and an ANOVA with an alpha level set at .05. Findings: Gender had no effect on the amount of knowledge the student athletes had on the subject of alcohol consumption and its effect on athletic performance. Members of individual sports teams and members of team sports team had the same amount of knowledge on the subject of alcohol. Student athletes who consume alcohol more frequently have the same amount of knowledge as student athletes who drink less frequently. There were 133 participants who were under the age of 21 and they all reported having drunk alcohol. Conclusions: It was determined that gender, type of sports team, and drinking frequency had no effect on knowledge about alcohol knowledge scores.