PURPOSE: Determine whether college students and non-students seeking emergency medical care experience different lifestyle choices, alcohol-use patterns, and risk profiles.METHODS: Patients aged 18-25 seen in a university-affiliated ED between August 1998 and June 1999 who had >/=1 drinks within the past year were eligible. Patients scoring >5 out of a possible 40 on the Alcohol Use Disorder Identification Test (AUDIT) were considered at elevated risk for alcohol problems and were interviewed further to determine alcohol-use patterns and history.RESULTS: Of 1,436 consenting patients, students were more likely to screen positive for alcohol problems than non-students (55% vs 43%; 478/870 vs 245/566). Furthermore, among screen-positive patients, students were more likely than non-students to binge drink in the two weeks prior to screening (82% vs 65%) and to drink illegally (60% vs 38%). Students needed fewer drinks to feel the effects of alcohol (3.9 drinks vs 5.1) and were less likely to request a referral for alcohol treatment (2% vs 8%). However, students had lower baseline risk for alcohol problems than non-students (AUDIT = 11.2 vs 13.2). Students were younger than non-students (20.2 years vs 21.4), older at their first drunken experience (15.3 vs 14.7), and less likely to smoke (51% vs 76%) or have a family history of heavy drinking (5% vs 23%). (p <.01 for all comparisons).CONCLUSIONS: Students exhibit a higher risk than non-students for behaviors associated with acute alcohol-related problems. However, they may be at lower risk for chronic alcohol problems. This university-based ED seems an appropriate venue for early identification and brief, on-site intervention for students with alcohol problems.