Beyond Drinking-Age Thresholds: Alcohol Misuse and Alcohol-Related Harms Among University Students in Trinidad and Tobago.

Objective This study aimed to examine the prevalence and patterns of alcohol use and misuse among undergraduate students aged 18-25 years in Trinidad and Tobago and to assess whether students younger than 21 years were more likely to report alcohol misuse and alcohol-related harms. Methods A quantitative cross-sectional design was used, involving a secondary analysis of two harmonized surveys conducted at the University of Trinidad and Tobago (UTT) and The University of the West Indies, St. Augustine (UWI). The analytic sample included 800 undergraduate students aged 18-25 years, who were selected through multistage sampling. Alcohol misuse was defined as binge drinking or heavy drinking during the past 30 days. Analyses included descriptive statistics, chi-square tests of homogeneity to assess differences in prevalence, and binary logistic regression to identify factors associated with current alcohol misuse. Results Current alcohol use was reported by 60.8% of students with valid responses (471/775; 95% confidence interval (CI): 57.3-64.2), and 29.1% (225/772; 95% CI: 26.0-32.4) of students with valid responses met the criteria for alcohol misuse. Students aged 21-25 years had significantly higher odds of alcohol misuse than those aged 18-20 years (adjusted odds ratio (aOR): 1.50, standard error (SE) = 0.19, 95% CI: 1.03-2.17, p = 0.034). Male students had similar odds of alcohol misuse compared with female students (aOR: 1.07, SE = 0.189, 95% CI: 0.74-1.55, p = 0.725). Lifetime alcohol use was reported by 93.0% (744/800; 95% CI: 91.1-94.6) of students. Among UWI students, 82.5% (254/308) of students with valid responses reported initiating alcohol use during primary or secondary school. Among UTT students, selected alcohol-related harms, including unprotected sex (p = 0.032) and driving under the influence (p < 0.001), were more prevalent among students aged 21-25 years than among those aged 18-20 years. Conclusions Undergraduate students aged 21-25 years were at greater risk of alcohol misuse and selected alcohol-related harms, including driving under the influence and unprotected sex, than students aged 18-20 years. Female students had similar odds of alcohol misuse compared with male students. The findings also suggest a high prevalence of early alcohol initiation among undergraduates in Trinidad and Tobago. These results support the need for public health interventions that extend beyond legal drinking-age thresholds.