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alcohol, colleges, nursing students, Photovoice, qualitative, risk and protective factors, students, universities



  1. Nair, Julie McCulloh PhD, RN, CCRE
  2. Nemeth, Lynne S. PhD, RN, FAAN
  3. Sommers, Marilyn PhD, RN, FAAN
  4. Newman, Susan PhD, RN, CRRN
  5. Amella, Elaine PhD, RN, FAAN


Background: Rates and frequencies of alcohol consumption remain unknown among nursing students, and risk and protective factors associated with alcohol misuse are poorly understood. Nursing curricula often lack content on substance use disorders among nurses, which is reported to begin prior to or during college.


Purpose: The aims of the study were to examine nursing students' perceptions of the risk and protective factors associated with alcohol behaviors among themselves and their peers and to identify substance use policies and their influence.


Methods: We used the Photovoice method, which employs participatory action research. Participants were screened for alcohol misuse via AUDIT-C, and thoughts and perceptions were obtained regarding their alcohol consumption behaviors through self-expression and group advocacy. Data were collected from four focus groups that included nine undergraduate nursing students.


Results: Data reflected the following key issues: stress, environmental influences, societal acceptance, and availability of alcohol. Participants identified that the following problems place them at risk for alcohol misuse: lack of addiction/alcohol education; nursing program expectations increase stress/anxiety; unhealthy habits, social isolation, and individual influences; peer influence/the college experience; and ineffective and unenforced campus policies. Protective factors included university policies; life experiences; and nursing program policies, responsibilities, peer influences, and perceived reputation.


Conclusion: This action research informed a dialogue with colleagues regarding nursing students' stressors and resulting professional ramifications. Recommendations for future work include investigation of expressed social isolation from university peers and its effects on their alcohol consumption behaviors and increase alcohol education with emphasis on adaptive coping strategies in a stressful professional role in Bachelor of Science in Nursing curricula.