1. Introduction

The legal age for alcohol consumption in China and the United States is 18 and 21 years old, respectively. Consequently, the college student population is at a stage where they are just able to legally access alcohol. There has been an increasing number of cases of college students using alcohol incorrectly (e.g., overdrinking) in recent years. Sun found that 58.22% of Chinese college students and 73.61% of American college students consumed alcohol [1]. The 2017 U.S. National Survey on Drug Use and Health (NSDUH) indicates that 53.6% of college students between the ages of 18 and 22 consumed alcohol in the past month, compared to 48.2% of non-college students [2]. These findings indicate that alcohol consumption is highly prevalent among college students, and that this demographic is even more prone to alcohol misuse than their non-college counterparts. Additionally, the discrepancies between Eastern and Western cultural norms influence the attitudes and behaviors of college students with regard to alcohol consumption. As representatives of East and West, China and the United States exhibit both similarities and differences in their alcohol policies, drinking cultures, and attitudes toward alcohol. Such cultural differences are not only reflected in drinking behaviors but also in the prevention and intervention measures that society employs to address alcohol abuse. In this paper, I will conduct a literature review of studies conducted over the past 10 years to compare and analyze the drinking situation in China and the United States. This will reveal the prevalence and potential harms of alcohol use among college students and help the general public understand more deeply how excessive drinking among college students varies in different cultural contexts.

2. Differences between China and the United States

2.1. Legal Differences

2.1.1. Provisions on Alcohol Consumption

Chinese legislation explicitly prohibits the consumption of alcohol by minors (i.e., those under the age of 18 years), requiring parents or guardians to monitor their behavior, preventing the occurrence of smoking, alcohol abuse and other undesirable behaviors, and guiding minors to participate in activities that are beneficial to their physical and mental health. Furthermore, the legislation prohibits the sale of tobacco and alcohol to minors, and when the age of the purchaser cannot be confirmed, the individual should be required to show identification[3].

In the United States, the legal age for consuming alcohol is 21 years old. The National Minimum Drinking Age Act of 1984 requires states to prohibit individuals under the age of 21 from purchasing or possessing alcoholic beverages in public. If a state fails to comply with this legislation, the federal government will reduce its highway funding by 10 percent[4]. However, some states still have a minimum drinking age of 16 or 18.

2.1.2. Taxation of Alcohol

China's consumption tax regulations stipulate a tax rate of 20% plus RMB 0.5 (approximately USD 0.07) per 500 grams for liquor; RMB 240 (approximately USD 33.82) per tonne for yellow wine. The tax rate for wine is RMB 250 (approximately USD 35.23) per tonne, while the rate for Class A beer is RMB 250 (approximately USD 35.23) per tonne and for Class B beer is RMB 220 (approximately USD 31.00) per tonne. The rate for other alcohols is 10%[5]. In the United States, the tax policies applicable to alcohol vary from one state to another. The tax rates in question range from $0.02 to $1.29 per gallon for beer (5% alcohol content), from $1.50 to $14.25 per gallon for distilled spirits (40% alcohol content), and from $0.20 to $2.50 per gallon for wine (12% alcohol content). It should be noted that certain states do not tax certain types of alcohol[6]. In conclusion, the tax burden on alcohol in the United States is slightly higher than in China.

2.1.3. Driving Under the Influence

In China, a blood alcohol concentration (BAC) of more than 20 mg/100 ml is considered to be above the legal limit for alcohol consumption, while a BAC of more than 80 mg/100 ml is considered to be indicative of driving under the influence (DUI) and is therefore considered to be a criminal offense. China's DUI penalty system comprises fines, detention, suspension or revocation of driving licenses, which are dependent on the circumstances of the DUI or DWI and the severity of the case. In serious cases, individuals are barred from reissuing their driving licenses for the remainder of their lives. In the United States, a BAC of 80 mg/100 ml is considered alcohol, with stricter standards for drivers under the age of 21. The penalties for driving under the influence vary from state to state, with common measures including fines, detention, license suspension, mandatory treatment and community service. Overall, China's alcohol standards are stricter, but the penalties are similar in both countries.

2.1.4. Alcoholic Beverage Advertising and Marketing

China's regulatory framework for alcohol advertising encompasses content and timing restrictions, as well as the protection of minors. The Measures for the Administration of Broadcasting Radio and Television Advertisements prohibit the airing of alcohol advertisements in programmes designed for or likely to appeal to minors. Additionally, the regulations limit the number of advertisements for liquor to a maximum of two per hour[7]. However, China has not yet introduced a comprehensive marketing ban or regulated new forms of alcohol marketing, such as digital marketing and the promotion of online alcohol distribution.

The Federal Alcohol Administration Act (FCA) explicitly mandates that advertisements be truthful and not misleading, particularly in their representation of the benefits of alcohol[8]. Additionally, the Federal Trade Commission Act requires that advertisements not be directed to minors. Furthermore, advertisements must contain basic product information, promote moderate alcohol consumption, and ensure transparency and social responsibility.

2.2. Cultural Differences

As representatives of the East and the West, China and the United States have markedly different value systems. China places a premium on collectivism and the family, with individual interests closely linked to and subordinate to the collective good. Against this background, education in China is generally conducted in an authoritative manner, with both family and school emphasizing academic excellence and obedience. In contrast, American literature celebrates individual freedom and the supremacy of rights, and advocates independent thinking and self-realization within the family structure. Education places more emphasis on the independence and individuality of the child, and both family and school emphasize the development of social and life skills and practical experience. Differences in educational and cultural norms have led to very different perceptions and attitudes among young people in China and the United States towards substances such as alcohol, tobacco and drugs.

Chinese schools educate children from primary school onwards about the use of dangerous substances, including alcohol, tobacco and drugs, including the adverse effects and dangers, ways to avoid them, etc. The obedient education approach makes children tend to follow the teachings imparted by their families and schools. As a result, Chinese adolescents have a restrictive attitude towards the use of substances such as alcohol, tobacco and drugs. However, alcohol is a ubiquitous ingredient in the diet of adults in Chinese culture, playing a pivotal role in many ritual traditions, business socializing and festive celebrations. And ancient Chinese writers have left behind a wealth of poems about wine, contributing to the continuation of wine culture. Most Chinese people consider it an admirable quality, especially for men, to be able to drink a lot without showing signs of drunkenness. In addition, drinking alcohol in the workplace is a common practice during business negotiations, and it is not uncommon for a superior to ask a subordinate to drink.

In the United States, it is generally believed that the use of substances such as alcohol, tobacco and drugs is a personal choice. Although schools have rules prohibiting adolescents from consuming alcohol, American adolescents are more inclined to display rebellious behavior than Chinese adolescents. This is due to their desire for freedom, their temptation to test the prohibitions in the educational environment, and their desire to break through.

3. The Factors that Contribute to the Consumption of Alcohol among College Students

3.1. Mental Development

The tertiary education stage is a critical period in the transition from adolescence to adulthood. Many students believe that they already have the necessary psychological maturity to cope with the challenges of independent life. However, they still lack the experience and coping strategies to deal with stress and complex emotions, and therefore feel confused and helpless, and find it difficult to find effective ways to relax. As a result, some university students use alcohol to temporarily escape from the pressures of reality[9]. Alcohol seems to provide a quick stress relief, but this approach does not solve the underlying problem. On the contrary, it may exacerbate mood swings or lead to dependence, thus exacerbating psychological problems.

3.2. Social and Peer Pressure

It is uncommon for individuals to decline an invitation to consume alcohol from a friend at social gatherings, which can lead to them being perceived as party poopers. In addition, alcohol consumption is often a point of competition, with high levels of alcohol intake perceived as a source of pride in Chinese social culture. Social occasions and parties frequently encourage heavy drinking. Moderate drinking in social situations is associated with increased likelihood of frequent drinking for the purpose of enhancing alcohol consumption[10]. A survey in the United States demonstrated that alcohol enhances social courage and that providing alcohol attracts more graduate students to events[11].

3.3. Family Education

Research has found that parents typically have five motivations for discussing alcohol with their adult children: prevention, reaction, teaching moderate drinking, maintaining relationships, and family history. Of these, the prevention of alcohol use and the teaching of safe drinking practices were the most common motivations, particularly among children below the legal drinking age. These two motivations can be contradictory, making it challenging for parents to discuss alcohol use, especially with young adult children, and for parents to balance fostering independent choices with reminders of the potential negative effects of alcohol use[12]. One analysis demonstrated that parental permissiveness was consistently and positively associated with college drinking and associated consequences when confounding factors were not considered[13].

4. The Impact of Inappropriate Alcohol Consumption Among College Students

4.1. Health

It is estimated that approximately 4% of cancers worldwide are caused by alcohol consumption[14]. The metabolism of alcohol produces reactive oxygen species (ROS) and nitrogen species (RNS), which lead to oxidative stress, cellular damage, inflammation, and DNA oxidation, thereby increasing the risk of genetic mutations. Furthermore, alcohol has the potential to reduce antioxidant activity, which may contribute to the development of chronic diseases such as diabetes, organ inflammation, cardiovascular problems, or cancer[15]. Therefore, prolonged and incorrect alcohol use may have significant adverse effects on the body.

4.2. Academic and Future Career Development

The misuse of alcohol has a considerable effect on the academic performance of college students. The consumption of excessive quantities of alcohol has been demonstrated to impair brain function, resulting in a reduction in concentration and an increased risk of memory loss. This, in turn, has been shown to lead to a decline in learning outcomes. Furthermore, chronic alcohol abuse can disrupt daily routines, preventing students from attending classes, completing assignments, or preparing for exams on time, which ultimately affects performance. Alcohol abuse is also often accompanied by health and psychological problems, such as anxiety, depression and sleep deprivation, which further diminish the ability to learn and impede academic progress. A study in the United States demonstrated that some undergraduate students wishing to continue their education in graduate programmes were hindered by alcohol abuse[16].

4.3. Emotional Vicious Circle

It is well documented that anxiety and depression are associated with the use of alcohol as a coping mechanism. However, the use of alcohol as a coping mechanism can also lead to an increase in alcohol consumption and a greater likelihood of experiencing negative consequences[17]. Some individuals engage in alcohol consumption as a means of alleviating negative affect. However, the adverse consequences of misuse, such as physical discomfort, absenteeism from school, driving under the influence, public disturbances, and so forth, elicit a greater degree of distress, leading to a vicious cycle wherein alcohol exacerbates the initial negative affect rather than alleviating it. Subsequently, the individual attempts to mitigate the adverse emotions engendered by the aforementioned factors through the consumption of alcohol, thereby precipitating a vicious emotional cycle. This phenomenon is typically observed in individuals who lack effective coping mechanisms.

5. Preventive Recommendations

5.1. National Policies that are Designed to Prevent or Restrict Alcohol Consumption

China has incorporated the dangers of alcohol abuse into the health education curricula of primary and secondary schools. The adverse effects of alcohol on the physical development and mental health of young people are publicized through classroom lectures, case studies and promotional film. Expert or volunteer are invited to deliver lectures on the prohibition of drinking to cultivate students' healthy mentality. Participatory learning methods are used, including class meetings with the theme of anti-alcoholism, art exhibitions, etc., to raise students' awareness of the harm of alcohol and their awareness of self-protection, so as to instill the correct concept of drinking.

The United States Drug Enforcement Administration (DEA) and Discovery Education have initiated Operation Prevention to incorporate alcohol abuse prevention into health education curricula in academic institutions. The aim is to educate students about the adverse effects of alcohol consumption on brain development, including the adverse effects of drinking and the legal consequences. In addition, the program includes training in decision-making and communication skills to help students develop the ability to resist the temptation to drink. The program raises awareness of the dangers of substance abuse and provides the necessary knowledge and refusal skills[18].

5.2. Social Support

Individuals who have misused substances are subjected to discriminatory attitudes and actions. This prejudice causes individuals with substance use disorders to be reticent to divulge their issues, thereby deterring them from seeking medical assistance and exacerbating their distress. To address this issue, it is imperative that the community acknowledge the prevalence of substance use disorders, eliminate the associated stigma, and facilitate the active pursuit of treatment for those affected. Support groups in the community for people with substance use disorders and those who have successfully completed treatment can reduce feelings of isolation by sharing experiences and providing mutual encouragement. In addition, organizations such as CADCA are promoting the formation and support of community coalitions against alcoholism. These coalitions promote community-level policies and interventions against alcoholism through coordinated activities and shared resources.

Individuals must have the necessary coping skills to effectively deal with significant stress. When encountering academic or other forms of stress, alcohol dependence can be reduced by replacing it with physical exercise, meditation, deep breathing and other mind-body activities. In addition, it is also possible to seek help from friends who have experienced similar situations, seeking their advice and assistance rather than bearing the burden alone.

5.3. Socialization

When promoting social events, event organizers should use neutral language, such as ‘social hour’ instead of ‘cocktail hour’, to reduce the impact of alcohol promotion. Meanwhile, waiters should also use similar neutral language when serving, such as ‘May I take your order?’ instead of ‘Would you like a glass of wine/beer?’ Trained waiters can effectively reduce the amount of alcohol consumed by guests[19]. Therefore, incorporating guidance on language use into existing training may further contribute to prevention.

6. Conclusion

The study showed that despite the differences in legal policies and culture regarding alcohol between the two countries, the amount of alcohol consumed by college students was similar. In both China and the United States, prevention policies emphasize alcohol education, with the aim of raising awareness of the harm caused by alcohol from an early age. This article proposes several recommendations based on existing prevention measures. First, society should be encouraged to eliminate discrimination against substance abusers and help them access treatment. Second, neutral language should be used to reduce the impact of alcohol promotions. Third, individuals should be encouraged to develop healthy coping skills and seek help from friends to better cope with stress.

However, this study has some limitations. First, the data in this paper have time lags and problems with sample representativeness. Second, this study did not investigate the specific effects of interventions in different cultural contexts. In the future, research on this topic should focus on the effectiveness of alcohol intervention strategies in different cultural contexts. In addition, cross-cultural comparative studies and gender difference analyses are necessary in order to understand drinking behaviors and the effects of policies in different countries.