Jessica Sloan Kruger, MSHE Daniel J. Kruger, Ph.D

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1 THE IMPACT OF ALCOHOL CONSUMPTION ON FOOD CHOICES AMONG Jessica Sloan Kruger, MSHE Daniel J. Kruger, Ph.D COLLEGE STUDENTS Abstract: Although the associations between the consumption of alcohol, unhealthy foods, and obesity are known, there is no consensus on the mechanisms involved. Previous research demonstrates that the type of foods available during the peak times for alcohol consumption diff er from those available at other times. Advertisements targeting college students indicate an awareness of increased cravings for junk foods following alcohol consumption, however there is no previous research on how alcohol consumption aff ects actual dietary choices diff erentially by type of food, in comparison to non-alcohol related food consumption. e current study demonstrates that college students food cravings increase, consumption of fruits and vegetables is lower, and consumption of junk foods is higher with alcohol consumption than at other times. Respondents reported eating something that they were craving the majority (57%) of the time; however, on average they ate something healthier than what they were craving 27% of the time. ese ndings help to clarify the behavioral mechanisms underlying the relationship between alcohol consumption, unhealthy dietary behaviors, and obesity. Keywords: food choices; alcohol consumption; junk food; drunchies INTRODUCTION College students have a high prevalence of alcohol consumption (Ham & Hope, 2003; Jones, Chryssanthakis, & Groom, 2014). In 2008, 69% of college students reported drinking alcohol in the past month (Ilgen et al., 2011). Drinking alcohol can reduce students inhibitions and lead them to engage in behaviors that they may not engage in when they are not drinking (Ilgen et al., 2011). e drunchies is a portmanteau of drunken munchies, a colloquial term for cravings for food, especially those foods high in fat and sodium, occurring due to alcohol consumption. is term is currently used in the marketing of fast food to college students (Eatstreet. com, 2014), though it has not been previously documented in the scienti c literature. Alcohol consumption can have a signi cant impact on college students dietary patterns, among other health related behaviors. Eating more and/or consuming less nutritious foods while drinking may impact many negative health outcomes such as obesity. College freshman who drank more alcoholic beverages had a higher rst semester Body Mass Index (BMI) (Lloyd-Richardson, Lucero, DiBello, Jacobson, & Wing, 2008). Lloyd-Richardson et al. (2008) found that students engaged in late-night eating and experienced the drunk munchies, which is considered to be a disinhibition leading to eating large quantitates of high-fat foods. is late night eating is common among college students (Lloyd-Richardson, Bailey, Fava, & Wing, 2009) and students who drank alcohol consumed lager quantities of food and made less healthy food choices as a result of drinking. College students alcohol consumption typically occurs during the evening and weekends. e highest rates of drinking are seen on ursday, Friday, and Saturday evenings, due to many students not having Friday classes or classes until Monday (Wood, Sher, & Rutledge, 2007). Because alcohol drinking begins later in the day, food options are scarcer when it occurs. Typically, foods considered to be unhealthy are more readily available during the time most college students would be consuming alcohol compared to healthier foods. Most wait service dinner restaurants close between 9:00 and 11:00 pm, yet the food providers with high fat, high calorie options stay open 24 hours a day or into the early morning hours (Nelson, Kocos, Lytle, & Perry, 2009). e lack of access to healthy foods could explain, in whole or part, the higher intake of high-fat foods among college students who drink alcohol. e nutritional literature continually debates the identity of the mechanism linking alcohol consumption and food consumption. Previous papers have concluded that there is no clear explanation for the short term ability for alcohol to enhance appetite (Yeomans, 2004; Yeomans, 2010). Some hold that alcohol enhances the short-term rewarding effects of ingestion, most likely through pharmacological action (Yeomans, 2010). Others provide evidence that alcohol con- Send correspondence to: Jessica Sloan Kruger, MSHE currently a Ph.D. Student in Health Education at the University of Toledo, Phone , Fax University of Toledo Mailstop 119, Office #1003K Toledo, Ohio 43606, jessica.sloan2@rockets.utoledu.edu; Daniel J. Kruger, Ph.D. is a Research Assistant Professor in the School of Public Health at the University of Michigan

2 sumption increases the in uence of implicit attitudes while decreasing the in uence of re ective cognition towards food cues (Hofmann & Friese, 2008). Alcohol is a diuretic (Murray, 1932); dehydration associated with alcohol consumption may induce cravings for salt in order to promote water retention (Beauchamp, Bertino, Burke, & Engelman, 1990). Rather than resolve the debate on internal mechanisms, the current study focuses on proving a better understanding of how alcohol consumption may differentially affect the consumption of healthy and unhealthy foods among college students. Little is known on how alcohol consumption affects actual dietary choices, in comparison to food consumption at other times. We hypothesized that college students would be more likely to consume fast foods and less likely to consume fruits and vegetables after drinking alcohol, compared to at other times. MATERIALS Participants e University of Michigan s Institutional Review Board approved this study prior to data collection. A sample of ethnically diverse undergraduates at a large public university in the Midwestern United States completed an anonymous on-line survey at their convenience. Respondents enrolled in the Introductory Psychology Participant Pool received course credit for completing the survey, and the sample represents researcher participant pool allocations for two academic terms (Fall 2014 and Winter 2015). All participants completed the survey. We retained participants who reported ever using alcohol for the current study (N = 262; 51% female, M age = 19, SD age = 1), we excluded 77 participants who reported not ever drinking alcohol. ese participants reported that their grandparents were Western European (51.1%), Eastern European (42.7%), East Asian (9.9%), Arab/Middle-Eastern (5.7%), African-American (5.3%), South Asian (5.0%), Latino/a or Hispanic (5.0%), Native American/Alaskan Native (1.1%), Paci c Islander (1.1%), and Other (5.0%), inclusively. is sample size enables statistical power (1 - B) of.89 for small effects (d =.20) and.99 for medium (d =.50) and large (d =.80) effects in two-tailed tests and.94,.99, and.99 respectively for one-tailed tests of directional predictions (see Cohen, 1988). We anticipated a medium effect size, for comparison the average effect size in social psychology is d =.43 (Richard, Bond, & Stokes- Zoota, 2003). us, our analyses are adequately powered. Survey e survey included the Behavioral Risk Factor Surveillance System (BRFSS) fruit and vegetable consumption items, and parallel items on junk food consumption (including salted snack foods, candy, sweet desserts, fried fast food, ham- Kruger.J, Kruger D. burgers, pizza, tacos, and soda/pop with sugar). Participants indicated how many drinks they consumed on average and answered an additional set of items based on the BRFSS fruit and vegetable and junk food items, "Are you more or less likely to eat or drink the following kinds of foods when you drink alcohol" (1 = Much less likely...5 = Much more likely). Participants also answered: "How frequent are your food cravings when you drink alcohol, compared to other times?," "How intense are your food cravings when you drink alcohol, compared to other times?," "How many alcoholic drinks does it usually take for you to get food cravings?," "When you drink alcohol, what percentage of the time do you:-have food cravings?/eat something you are craving?/ Eat something healthier than what you are craving?" e last three items were answered with a sliding scale ranging from 0 to 100 and initially set at 50. RESULTS Participants reported that their food cravings were more frequent, t(261) = 13.21, p <.001, d =.82, and more intense, t(261) = 13.18, p <.001, d =.81, when they consumed alcohol compared to other times. Participants were less likely to consume nutritious foods and more likely to consume junk foods when they consumed alcohol compared to other times (See Table 1). Participants reported having food cravings 58% of the time when they were drinking (SD = 26), eating something they were craving 57% of the time (SD = 25), and eating something healthier than what they were craving 27% of the time (SD = 23). Tendencies to eat something healthier than what participants were craving were associated with higher overall fruit and vegetable consumption, r(262) =.170, p =.007, and lower overall junk food consumption, r(262) = -.161, p =.009. Although we did not assess self-perceived levels of intoxication, 48% of women and 50% of men reported average alcohol consumption consistent with binge drinking (4 and 5 alcoholic drinks at one time, respectively; NIAAA, 2004). e level of average alcohol consumption directly predicted the increased frequency of food cravings after consuming alcohol, r(301) =.316, p <.001, the frequency of consuming something being craved, r(301) =.405, p <.001, and the increased overall likelihood of consuming junk foods, r(259) =.157, p =.012. However, the reported level of average alcohol consumption did not predict increased intensity of food cravings, eating something healthier than what they were craving, or fruit and vegetable consumption after consuming alcohol. CONCLUSION Alcohol consumption is a risk factor for unhealthy dietary behaviors and obesity. We demonstrate that the foods students consume when drinking alcohol are less healthy than what the

3 American Journal of Health Studies Vol 30 (2) 2015 same individuals consume at other times. Consumption of fruits and vegetables is lower and consumption of junk foods is higher comparted to dietary behaviors at other times. ese ndings help clarify the behavioral mechanisms underlying the relationship between alcohol consumption, unhealthy dietary behaviors, and obesity. Another contributing factor is the food landscape available in the late evening (Nelson et al., 2009). Food providers surrounding university campuses are likely aware of the types of food students crave when they are drinking alcohol and likely shape As with all research, this study has strengths and limitations. Strengths include the use of standard validated measures for diet recall, so that results can be compared to those of many other studies. Additionally, testing this hypothesis among college students is useful because they are at most risk of engaging in unhealthy eating behaviors resulting in weigh gain termed the Freshman 15 (Mihalopoulos, Auinger, & Klein, 2008). e Freshman 15 is the belief that students gain 15 lbs. during their freshman year of college. Although, most students do not Table 1 Are you more or less likely to eat or drink the following kinds of foods when you drink alcohol? Food Items M SD t p d 100% PURE fruit juices Fresh, frozen, or canned fruit Cooked or canned beans Dark green vegetables Orange-colored vegetables OTHER vegetables Salted snack foods Candy Sweet desserts Fried fast food Hamburgers Pizza Tacos Soda/pop with sugar Note: 1= Much less likely, 2 = Somewhat less likely, 3 = About the same, 4 = Somewhat more likely, 5 = Much more likely their offerings to attract such individuals. ese ndings are consistent with previous work on by (Lloyd-Richardson et al., 2009) that students who drank alcohol made less healthy food choices as a result of drinking. is study builds on those ndings demonstrating that students crave unhealthy foods and act on those cravings more often when drinking gain 15 lbs., freshman weight gain was 5.5 times greater than that experienced by the general population (Mihalopoulos et al., 2008). In another study, 70% of students experienced weight gain in the rst semester of their freshman year (Lloyd- Richardson et al., 2009). Limitations are related to the self-report cross-sectional survey design. Participants may

4 have answered the questions in a socially desirable manner, though they were instructed to take the on-line survey in private and were able to complete it at their convenience. Self-report responses are also subject to inaccurate recall. We also did not determine the time of day for eating after alcohol consumption or at other times. Examination of dietary patterns by time could assess the in u- ence of differential food environments. Further research should include observational studies completed at various times of the day, which document the true number of alcoholic beverages students consume along with the type and amount of food they tend to consume while drinking. Some people are able to resist unhealthy food cravings, thus interventions to help reduce the impact of the "drunchies" may improve student health behaviors and outcomes. Reducing the amount of unhealthy foods that college students consume while drinking alcohol may reduce obesity and improve other health outcomes. Acknowledgements We would like to thank Dr. Jon Elhai at the University of Toledo for his guidance on this manuscript. References Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). New York: Academic Press. Beauchamp, G. K., Bertino, M., Burke, D., & Engelman, K. (1990). Experimental sodium depletion and salt taste in normal human volunteers. e American journal of clinical nutrition, 51(5), Eatstreet.com. (2014, September 3). Got Drunchies? [Advertisement]. Michigan Daily, 12. Retrieved from Ham, L. S., & Hope, D. A. (2003). College students and problematic drinking: A review of the literature. Clinical Psychology Review, 23(5), doi: S (03) Ilgen, M. A., Schulenberg, J., Kloska, D. D., Czyz, E., Johnston, L., & O'Malley, P. (2011). Prevalence and characteristics of substance abuse treatment utilization by US adolescents: National data from 1987 to Addictive Behaviors, 36(12), doi: addbeh Jones, K. A., Chryssanthakis, A., & Groom, M. J. (2014). Impulsivity and drinking motives predict problem behaviours relating to alcohol use in University students. Addictive Behaviors, 39(1), doi: addbeh Lloyd-Richardson, E. E., Bailey, S., Fava, J. L., & Wing, R. (2009). A Prospective Study of Weight Gain During the College Freshman and Sophomore Years. Preventive medicine, 48(3), doi: /j.ypmed Lloyd-Richardson, E. E., Lucero, M. L., DiBello, J. Kruger.J, Kruger D. R., Jacobson, A. E., & Wing, R. R. (2008). e relationship between alcohol use, eating habits and weight change in college freshmen. Eating Behaviors, 9(4), doi: org/ /j.eatbeh Mihalopoulos, N. L., Auinger, P., & Klein, J. D. (2008). e Freshman 15: is it real? Journal of American College Health, 56(5), Murray, M. M. (1932). e diuretic action of alcohol and its relation to pituitrin. e Journal of Physiology, 76(3), doi: /jphysiol.1932.sp Nelson, M. C., Kocos, R., Lytle, L. A., & Perry, C. L. (2009). Understanding the Perceived Determinants of Weight-related Behaviors in Late Adolescence: A Qualitative Analysis among College Youth. Journal of Nutrition Education and Behavior, 41(4), doi: org/ /j.jneb Wood, P. K., Sher, K. J., & Rutledge, P. C. (2007). College Student Alcohol Consumption, Day of the Week, and Class Schedule. Alcoholism: Clinical and Experimental Research, 31(7), doi: /j x Yeomans, M. R. (2004). Effects of alcohol on food and energy intake in human subjects: evidence for passive and active over-consumption of energy. British Journal of Nutrition, 92(S1), S31-S34. Yeomans, M. R. (2010). Alcohol, appetite and energy balance: Is alcohol intake a risk factor for obesity? Physiology & Behavior, 100(1), doi: dx.doi.org/ /j.physbeh

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