Description and predictors of positive and negative alcohol-related consequences in the first year of college

Effects of nicotine-alcohol co-use on alcohol-induced blackouts and other alcohol-related consequences in college students

RATIONALE

Alcohol-induced blackouts (AIBs) are common in college students and are associated with other alcohol-related consequences. Alcohol-nicotine co-use is also common in this population. Nicotine has cognitive-enhancing properties impacting multiple cognitive domains, including those impaired by alcohol (e.g., attention), but it is unclear whether nicotine affects AIB risk or the relationship between AIBs and other alcohol-related consequences.

OBJECTIVES

We examined the moderating effects of nicotine use on the associations between (a) alcohol and AIBs and (b) AIBs and other consequences (total and serious: sexual, legal, or those with potential to cause great harm).

METHODS

College students who reported past semester heavy drinking and at least 1 AIB (N = 79, 55.7% female, 86.1% White) wore alcohol sensors and completed daily diaries over four consecutive weekends (89.9% completion). Multilevel models were conducted to test for moderating effects of nicotine (yes/no) on the alcohol-AIB relationship and the AIB-consequence relationship, adjusting for sex, race/ethnicity, and baseline nicotine use.

RESULTS

Concurrent alcohol and nicotine use did not moderate the alcohol-AIB relationship, but weakened the associations between AIBs and both (1) total consequences and (2) serious consequences. On days with nicotine use, AIBs were associated with approximately 30% fewer total consequences and 50% fewer serious consequences than days without nicotine use.

CONCLUSIONS

College students experienced fewer total and serious consequences on AIB nights when nicotine was used compared to AIB nights when nicotine was not used. Future research should explore potential mechanisms underlying the observed effects.

Factors that increase risk for alcohol-induced blackouts in high-intensity drinking young adults

BACKGROUND

Alcohol-induced blackouts are prospectively associated with negative drinking outcomes. While typically requiring heavy drinking, blackouts are not reported on all heavy drinking events or by all individuals who drink heavily. This study extends previous research by identifying the young adults most likely to experience blackouts assessed prospectively. Hypotheses focused on previously supported (female sex, White race, younger age, family history of alcohol problems, lower subjective response to alcohol, and higher tolerance) and novel predictors (possible traumatic brain injury; TBI) of alcohol-induced blackouts.

METHODS

Young adults (n = 203, 57% female, Mage = 22.07) recruited for high-intensity drinking (8/10+ drinks/occasion for females/males) completed a baseline survey and a 28-day ecological momentary assessment protocol. Hierarchical linear modeling was used to test between-person predictors of fragmentary (temporary) or en bloc (permanent) blackout likelihood during the 28 days, and moderators of the effect of day-level estimated blood alcohol concentration (eBAC) on blackout likelihood.

RESULTS

Controlling for event-level and average eBAC, both types of blackouts were more likely among those with higher subjective response to alcohol. Fragmentary blackouts were more likely among younger participants and those with possible prior TBI. Day-level eBAC was more strongly associated with both types of blackouts among non-Hispanic White participants and those with lower mean eBACs. Day-level eBAC was most strongly associated with fragmentary blackouts among those with a first-order family history of alcohol problems.

CONCLUSIONS

Younger age and greater sensitivity to alcohol may confer risk for blackouts above and beyond intoxication levels. Future work is needed to understand mechanisms that explain why these factors confer risk for blackouts.

Profiles of transdermal alcohol concentration and their prediction of negative and positive alcohol-related consequences in young adults' natural settings

OBJECTIVE

Transdermal alcohol concentration (TAC) sensors provide a multidimensional characterization of drinking events that self-reports cannot. These profiles may differ in their associated day-level alcohol-related consequences, but no research has tested this. We address this using multilevel latent profile analysis.

METHOD

Two hundred twenty-two young adults who regularly engage in heavy drinking (Mage = 22.3, 64% female, 79% non-Hispanic White) responded to surveys and wore TAC sensors for 6 consecutive days. We tested whether four previously identified TAC profiles: (1) high-fast (8.5% of days), (2) moderate-fast (12.8%), (3) low-slow (20.4%), and (4) little-to-no-drinking days (58.2%) differed in numbers of negative and positive consequences and in the odds that both consequence types occurred on the same day.

RESULTS

High-fast (incident rate ratio [IRRlow-slow] = 6.18; IRRlittle-to-no-drinking = 9.47) and moderate-fast (IRRlow-slow = 3.71; IRRlittle-to-no-drinking = 5.68) days contained more negative consequences compared to low-slow and little-to-no-drinking days. High-fast (IRR = 2.05), moderate-fast (IRR = 1.88), and low-slow (IRR = 1.43) days contained more positive consequences than little-to-no-drinking days. The odds of having only positive consequences were highest on low-slow, χ²(3) = 9.10, p < .05, days but the odds of experiencing both consequence types increased on moderate-fast and high-fast days, χ²(3) = 39.63, p < .001.

CONCLUSIONS

Compared to little-to-no-drinking days, TAC profiles indicative of drinking (high-fast, moderate-fast, and low-slow) contained more negative and positive consequences. However, the odds of experiencing only positive consequences were highest among low-slow days and decreased on moderate-fast and high-fast days as the odds of negative consequences rose. These findings provide novel evidence reinforcing harm reduction approaches that seek to maximize positives and minimize negatives of alcohol consumption through emphasis on slow-paced, low-volume drinking. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Associations Between Food Restriction, Alcohol and Marijuana Use and Co-Use, and Consequences Among College Students

BACKGROUND

Simultaneous alcohol and marijuana use (SAM) and food restriction on days students intend to drink are associated with an increased risk of substance use-related consequences. However, these negative outcomes have been studied mostly in alcohol-only use contexts. Little is known about the combination of alcohol, marijuana, SAM, and food restriction. Therefore, the current cross-sectional study investigated whether alcohol, marijuana, or SAM use and food restriction on substance use days were associated with an increased risk of negative substance-use outcomes.

METHOD

901 college students completed a survey about their substance use and eating behaviors. Hierarchical regression analyses tested the relations between these patterns and use-related consequences.

RESULTS

Among past 30-day alcohol users, alcohol use quantity and food restriction on substance use days independently associated with greater alcohol use consequences. Past 30-day frequency of food restriction on alcohol use days moderated the effect between average drink quantity and alcohol use consequences. Among past 30-day marijuana users, number of hours high and food restriction on use days independently associated with greater marijuana use consequences. For past 30-day SAM users, alcohol use quantity on SAM days significantly associated with greater alcohol consequences. Food restriction on SAM days moderated the effect of marijuana use quantity (i.e., number of times used) on marijuana use consequences.

CONCLUSIONS

These results provide the basis for further exploration of food restriction and SAM, as well as targeted interventions among at-risk populations.

Influencer Drinking Norms: Cross-Sectional Mediators of Alcohol-Related Social Media and College Drinking

Background: Social influences from peers, such as the perceptions of how much one's peers drink (i.e., descriptive drinking norms) are robust predictors of college drinking. In the digital age, these influences can happen on social media through viewing posts shared by peers depicting drinking (alcohol-related content). Social media influencers also post alcohol-related content and are popular among students. However, less is known about whether influencer drinking norms potentially mediate the association between viewing influencer alcohol-related content and drinking. Methods: College students who drink alcohol (N = 528) completed an online survey which assessed if they followed influencers who posted alcohol-related content, how often they perceived the influencer shared the content, influencer norms, and personal alcohol consumption and consequences. Results: Findings from two cross-sectional mediation models revealed that influencer norms mediated associations between following more influencers who shared alcohol-related content or frequency of influencer content and participant drinking. Conclusions: These findings suggest that influencer norms are uniquely linked to students' drinking habits. Further, it extends prior research in the influencer domain by examining how perceptions of how much influencers drink (i.e., descriptive norms) may impact college drinking.

Prototype Specificity Matters When Predicting Later Alcohol-Related Content Posting and Alcohol Use Among Adolescent and Young Adults

Background: Drinking prototypes (i.e., images of the type of individual who engages in specific alcohol use behaviors) are associated with alcohol use, with self-identified similarity to the prototype possibly driving this connection more than one's favorability of the prototype. Alcohol-related content (ARC; posts featuring alcohol or drinking) posting prototype favorability is also associated with ARC posting and drinking. However, the effects of ARC posting prototype similarity on posting or drinking behavior are unexamined. Prior research suggests specificity of antecedents (e.g., attitudes, prototypes) matters in predicting subsequent behavior. The current study examined which types of prototype similarity (e.g., drinking, ARC posting) are most strongly associated with later ARC posting and drinking behavior, respectively. Methods: Adolescents and young adults who reported alcohol use (N = 274) were recruited to complete two online surveys at baseline and 1-month later. Results: Controlling for abstaining, heavy episodic drinking (HED), and ARC posting prototype similarity, only greater baseline ARC posting prototype similarity was associated with posting ARC 1-month later. Zero-inflated negative binomial regressions revealed greater abstaining prototype similarity was associated with lower drinking frequency 1-month later. Higher HED prototype similarity was associated with likely drinking on at least one day in the past month (i.e., drinking frequency). Higher ARC posting prototype similarity was associated with likely reporting no negative alcohol consequences. Conclusions: Findings suggest that interventions targeting reductions in ARC posting should aim to change ARC posting prototype similarity whereas drinking prototype similarity should be highlighted in alcohol interventions.

A text message intervention aimed at nurturing peer outreach to help meet drinking limit goals: A remote pilot randomized trial in non-collegiate young adults

OBJECTIVE

Scalable interventions attempting to nurture peer outreach to help young adults meet drinking limit goals remain under-developed. To address this gap, we developed ASPIRE, a text message intervention focused on coaching individuals to engage with close peers to assist them in meeting drinking limit goals.

METHOD

Non-collegiate young adults who had reported one or more heavy drinking days in the preceding month and were at least contemplating change were recruited through social media. Participants were randomly assigned to one of three 6-week text message interventions: Control, Goal Support, or ASPIRE. All groups completed baseline assessments and received weekly text message assessments on Thursdays and Sundays. Control and ASPIRE groups were prompted to complete web-based outcome assessments at 6- and 12-weeks.

RESULTS

We enrolled 92 young adults from 31 US states (65% female; 73% White). All groups had high text response rates but intervention usability was sub-optimal. Follow-up rates were 87% at 6-weeks and 79% at 12-weeks. Compared to Control, ASPIRE participants reported significantly more peer support and less peer pressure to drink. ASPIRE exhibited higher goal confidence compared to the Goal Support group. Using multiple imputation, there were no significant differences in drinking outcomes between groups.

CONCLUSIONS

Preliminary findings from this pilot study suggest that a text message intervention focused on nurturing peer outreach to help meet drinking limit goals holds promise in altering peer support and pressure as well as boosting drinking limit goal confidence. Design improvements are needed to reduce alcohol consumption.

Risky Alcohol Use and Romantic Relationships Among College Students: A Longitudinal Study

BACKGROUND

Risky alcohol use is frequent among college students and can be associated with functional outcomes. Bidirectional associations have been shown between alcohol use and the stability of romantic relationships, though little is known about the longitudinal association between risky alcohol use and romantic relationships in college and about college students' perceived stress regarding one's love life. Objectives: The present study aims to explore these relationships both cross-sectionally and at one-year follow-up.

METHOD

Data were drawn, from the French portion of the World Mental Health International College Student Survey initiative (WMH-ICS). First-year college students who completed an online survey (n = 1,624) and a second survey at one-year follow-up (n = 727) were included. Current romantic relationship status and stress regarding one's love life, past-year risky alcohol use, lifetime presence of DSM-5 mental health disorders and sociodemographic correlates were assessed.

RESULTS

Risky alcohol use was cross-sectionally associated with dating in multivariate models adjusting for lifetime mental disorders (aOR = 1.70, 95%CI = 1.31-2.20), and in particular with unsteady relationships (aOR = 2.87, 95%CI = 2.01-4.10), but was no longer associated with both one year later. Risky alcohol use was, however, not associated with severe perceived stress regarding one's love life in multivariate models adjusting for lifetime mental disorders in both cross-sectional and longitudinal analyses, while it was associated in bivariate models for both analyses.

CONCLUSIONS

These findings extend our understanding of the association between excessive drinking and romantic relationship patterns among college students underlying the importance of comorbid disorders.

Pregaming potentiates risk between UPPS-P impulsivity and day-level drinking behavior: A test of person-environment transactions theory

Pregaming represents a uniquely high-risk drinking event for young adults, and subfacets of impulsivity are robust predictors of alcohol use and related negative outcomes. Further, it is likely that pregame events contain social and physical stimuli that are particularly appealing for impulsive individuals, thus exacerbating risk for negative outcomes. However, no prior studies have investigated the extent to which impulsive personality traits interact with pregame events to confer alcohol-related risk. Thus, the present study examined the extent to which UPPS-P (urgency-perseverance-premeditation-sensation seeking-positive urgency) subfacets of impulsivity interact with the occurrence of pregaming to predict relations between pregaming, drinking quantity, and negative alcohol-related outcomes. College students (N = 737) completed a modified, online version of the 30-day Timeline Followback in which they reported drinking quantity, negative consequences, and whether they engaged in pregaming on a given day. Results indicated that sensation seeking and a lack of premeditation moderated relations between pregaming and drinking quantity such that those who are higher in sensation seeking and lower in their ability to plan ahead drank more on pregaming days. Sensation seeking and positive urgency moderated relations between pregaming and negative consequences such that those who are higher in positive urgency experience more consequences on pregaming days whereas those who are higher in sensation seeking experience less consequences. Future studies may benefit from more granular assessments of pregame-related risk as subfacets of impulsivity may confer momentary risk. Prevention efforts targeting the reduction of pregaming frequency, particularly among impulsive individuals, may lower overall risk for heavy drinking. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Negative consequences associated with daily alcohol use as a nonlinear function of number of drinks in a daily diary study

INTRODUCTION

Drinking intensity among young adults is associated with greater negative alcohol-related consequences, but often studied using categorical drinking thresholds. This study examined how alcohol-related consequences varied as a continuous function of number of drinks consumed, without imposing thresholds, to identify drink ranges for which risk is greatest.

METHODS

Analyses included daily surveys from the Young Adult Daily Life study (2019-22) in which individuals reported drinking 1 or more alcoholic drinks (n=5219 days; 832 individuals). Time-varying effect models estimated total number of negative alcohol-related consequences and five individual consequences (hangover, drank more than planned, nausea/vomiting, did something embarrassing, blacked out) as a function of the number of drinks consumed among young adult males and females.

RESULTS

Often, increases in the number and prevalence of negative consequences were a nonlinear function of the number of drinks consumed. Females reported few negative consequences on 1-to-3-drink occasions but steep increases in consequences on 4-to-9-drink occasions. Among females, the prevalence of blacking out increased six-fold from 4-drink (3.4%; 95% CI=2.6,4.7) to 9-drink occasions (20.6%; 95% CI=16.1,26.1). Among males, the prevalence of some consequences, while not linear, increased across the full drink range. Blacking out among males increased from 9.6% (95% CI=6.2,14.7) on 10-drink occasions to 23.9% (95% CI=15.0,35.8) on 15-drink occasions.

CONCLUSIONS

Substantial heterogeneity is missed when typical drinking categories are used. In particular, variability in consequences across levels of the traditional binge drinking category suggests that important differences in risk may be missed when assessed as a uniform category.

Characterizing Alcohol Consumption and Positive and Negative Consequences During Simultaneous Alcohol and Cannabis Use Events

OBJECTIVE

Young adults who engage in simultaneous alcohol and cannabis use report heavy use of both substances. Event-level studies examining differences between consequences experienced on simultaneous use compared with single substance use days have been mixed. Although studies often control for alcohol use levels, few have examined how quantity of alcohol may influence consequences experienced on simultaneous use days. Furthermore, little research has examined the relationship between simultaneous use and positive consequences or explored individual consequences. This study examined differences in consequences experienced on simultaneous use versus single substance use days (alcohol-only, cannabis-only) including endorsement of specific consequences and examined the relationship among simultaneous use, consequences, and alcohol consumption.

METHOD

Young adults who engage in simultaneous use (N = 86) completed 30 days of daily surveys reporting substance use and positive and negative consequences.

RESULTS

Simultaneous use days were associated with more negative and positive consequences than single substance use (alcohol-only and cannabis-only) days. We also examined endorsement of specific positive and negative consequences on alcohol-only, cannabis-only, and simultaneous use days. The effect of day type (simultaneous use vs. alcohol-only) on consequences was moderated by alcohol quantity. On lighter drinking days, more positive and negative consequences were endorsed if it was a simultaneous use versus alcohol-only day. On heavier drinking days, number of consequences did not differ between simultaneous use and alcohol-only days.

CONCLUSIONS

Findings from this study point to simultaneous use as both reinforcing and high risk and highlight the importance of intervening even on lighter drinking simultaneous use occasions to reduce harms.

The role of impulsivity in the relationship between affect and alcohol consumption in young adults

BACKGROUND

Theoretical models of alcohol use posit that individuals consume alcohol to ameliorate negative affect or to heighten positive affect. It is important, however, to consider the influence of factors that may determine an individual's tendency to consume excessive amounts of alcohol under positive and negative circumstances. Thus, the current study examined a large sample of young adults to clarify whether positive and negative affect predict total alcohol consumption on drinking days and whether facets of impulsivity moderate these relationships.

METHODS

Six-hundred ninety-three young adults (Mage  = 19.71 years, SD = 2.04; female = 62.9%) completed the Behavioral Inhibition System/Behavioral Activation System (BIS/BAS) scales at baseline followed by daily measures of positive and negative affect and self-reported alcohol use for 13 days. Generalized linear mixed models were specified to assess the role of pre-consumption affect on total drinks consumed across drinking days and to determine the moderating effect of each BIS/BAS subscale.

RESULTS

Participants were significantly more likely to drink in greater quantities on occasions preceded by higher positive affect but not negative affect. While fun-seeking positively predicted total drinks consumed, there were no significant interaction effects between the BIS/BAS subscales and affect on total drinks consumed.

CONCLUSIONS

These findings challenge existing affect regulation models and have implications for ecological momentary interventions aimed at addressing hazardous drinking behaviors.

Alcohol-induced blackouts among college student drinkers: A multilevel analysis

OBJECTIVE

To identify factors (manner of drinking, combined alcohol and other substance use, physiology) that are associated with alcohol-induced blackouts (AIBs) over and above estimated blood alcohol concentration (eBAC).

METHODS

Students (N = 462, 51.7 % female, 87.7 % White, Mage = 20.1) were assessed across 6 weekends via e-surveys (80-97 % response rate). eBAC was calculated using standard number of drinks, drinking duration, sex, and weight. Three-level multilevel models (days, weeks, persons) were conducted to test for main effects, controlling for eBAC.

RESULTS

Protective behavioral strategies (PBS) were associated with decreased odds of AIBs on the daily (OR = 0.64, 95 % CI: 0.53, 0.77), weekly (OR = 0.84, 95 % CI: 0.72, 0.98), and person-levels (OR = 0.62, 95 % CI: 0.51, 0.74). Combined cannabis with alcohol was associated with increased odds of AIBs on the weekly (OR = 2.13, 95 % CI 1.13, 4.07) and person-levels (OR = 3.56, 95 % CI 1.60, 7.93). People who more frequently played drinking games (OR = 1.41, 95 % CI: 1.12, 1.77), pregamed (OR = 1.55, 95 % CI: 1.19, 2.03), and showed higher tolerance (OR = 1.22, 95 % CI: 1.08, 1.37) showed increased risk of AIBs, over and above eBAC levels.

CONCLUSION

We identified a number of daily-, weekly-, and person-level factors that uniquely contribute to the prediction of AIBs even at equivalent eBACs. Many of these factors were behavioral, suggesting that they may serve as malleable prevention targets for AIBs in college student drinkers.

A randomized pilot trial of a mobile delivered brief motivational interviewing and behavioral economic alcohol intervention for emerging adults

OBJECTIVE

Mobile health (mHealth) interventions show potential to broaden the reach of efficacious alcohol brief motivational interventions (BMIs). However, efficacy is mixed and may be limited by low participant attention and engagement. The present study examined the feasibility, acceptability, and preliminary efficacy of a live text-message delivered BMI in a pilot randomized clinical trial.

METHOD

Participants were 66 college students (63.6% women; 61.9% White; Mage = 19.95, SD = 1.66) reporting an average of 11.88 (SD = 8.74) drinks per week, 4.42 (SD = 3.59) heavy drinking episodes (HDEs), and 8.44 (SD = 5.62) alcohol-related problems in the past month. Participants were randomized to receive either (a) education or (b) an alcohol BMI plus behavioral economic substance-free activity session (SFAS), each followed by 4 weeks of mini sessions. All sessions were administered via live text-message. Participants completed assessments postintervention (after the 4th mini session) and at 3-month follow-up.

RESULTS

90.9% completed both initial full-length sessions and at least two of the four mini sessions with 87.9% retention at 3-month follow-up. Participants found the interventions useful, interesting, relevant, and effective, with no between-group differences. There were no statistically significant group differences in drinks per week or alcohol-related problems at follow-up, but BMI + SFAS participants reported fewer past-month HDEs than those who received education.

CONCLUSIONS

Live text-messaging to deliver the BMI + SFAS is feasible and well-received. The preliminary efficacy results should be interpreted cautiously due to the small sample size but support further investigation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Emotional Reactions to High-Risk Sex among Sexual Minority Men: Exploring Potential Opportunities for Just-In-Time Intervention

Rates of HIV and other sexually transmitted infections (STIs) are high among sexual minority men (SMM). A large body of research has explored determinants of HIV/STI risk behavior, but few studies have explored emotional consequences of these events. Understanding the valence, timing, and strength of emotional reactions to sexual risk could inform use of specific behavior change techniques in interventions (such as anticipated regret) and identify new opportunities for intervention, including just-in-time interventions. We analyzed data from an ecological momentary assessment (EMA) study of 100 HIV-negative/unknown-status SMM to understand patterns of positive affect, negative affect, shame, and stress in the 24 hours after sex. Mixed-effects models showed that the probability of negative affect was higher in the hours following condomless anal sex (CAS) with high-risk partners during which SMM reported being under the influence of alcohol or drugs (A/D involved CAS), versus all other types of sex events (OR = 0.92, SE = 0.03, p = .017). The probability of shame was also higher after A/D-involved CAS, versus other sex events (OR = 1.14, SE = 0.07, p = .035). Findings suggest that the hours following A/D-involved CAS events may be an opportune time to intervene to help SMM avoid similarly aversive experiences in the future.

A retrospective examination of changes in drinking motives during the early COVID-19 pandemic

OBJECTIVE

The COVID-19 pandemic has led to substantial changes in college student alcohol use. Changes in drinking motives may explain some of these changes in drinking patterns. The purpose of the present study is to explore how drinking motives and alcohol use have changed amongst college students considering the timeframes before and after the onset of COVID-19 pandemic (i.e., March 2020) in the United States. We hypothesized that there would be significant changes in drinking motives after March 2020, which would be significantly related to changes in alcohol use.

METHODS

Participants for the current study were undergraduate students reporting lifetime alcohol use (n = 198, M_age = 21.3, 66.7% female, 86.4% White) recruited through online advertisements in classes to complete an online survey in April 2020. Participants were asked to report on their drinking motives and alcohol use considering the timeframes before and after the onset of closures and stay-at-home orders during the COVID-19 pandemic (i.e., before and since March 2020).

RESULTS

Paired samples t-tests revealed that endorsement of social (t[171) = 12.79, p < .001, d = 1.16) and conformity motives significantly decreased (t[170] = 4.46, p < .001, d = 0.31), while endorsement of coping motives significantly increased (t[172] = -2.70, p = .008, d = .15) after the onset of COVID-19. Linear regression analyses, controlling for drinking motives before March 2020, revealed that changes in enhancement (β = -.47, p < .001) and coping motives (β = -.22, p = .04) were significantly associated with changes in alcohol use quantity.

CONCLUSIONS

Findings of the present study support the need for interventions to target coping and social drinking to reduce risk for alcohol use.

Examining Attitude, Norms, and Intentions as Predictors of Prospective Change in Alcohol-Induced Blackouts

OBJECTIVE

Alcohol-induced blackouts are a marker of risk such that they are strong independent predictors of experiencing other adverse alcohol-related social and health effects. Existing work informed by the Theory of Planned Behavior suggests that several of the constructs contained within it, such as perceived norms, personal attitudes toward consumption, and drinking intentions, are reliable predictors of alcohol use, related problems, and blackout experiences. However, research to date has not examined these theoretical antecedents as predictors of change in the occurrence of alcohol-induced blackout. The current work aimed to evaluate descriptive (the rate a behavior occurs) and injunctive (the approval of a behavior) norms, attitudes toward heavy drinking, and drinking intentions as predictors of the prospective change in experiencing a blackout.

METHOD

Using existing data from two samples (Sample 1: N = 431, 68% male; Sample 2: N = 479, 52% male), students mandated to complete an alcohol intervention completed surveys at baseline and 1- and 3-month follow-ups. Latent growth curve models evaluated perceived norms, positive attitude toward heavy drinking, and drinking intention as prospective predictors of the change in blackout over 3 months.

RESULTS

Across both samples, descriptive and injunctive norms and drinking intentions were not significantly predictive of the change in blackout. Only attitude toward heavy drinking significantly predicted prospective change (the slope factor) in blackout in both samples.

CONCLUSIONS

Given the strong association between heavy drinking attitudes and change in blackout, attitudes may represent an important and novel target for prevention and intervention efforts.

Use of protective behavioral strategies and blackout experience among mandated college students

OBJECTIVE

Alcohol-induced blackouts are experienced by approximately half of college students who drink. People who use protective behavioral strategies (PBS) tend to experience fewer alcohol-related consequences of drinking, but the relationship between PBS and blackouts is unknown. This study examines the associations among the use of protective behavioral strategies and blacking out.

METHODS

Participants were 484 college students, aged 18-22 (56% male, 51% first-year), who were mandated to complete alcohol education following an alcohol violation. Before the intervention, participants completed questionnaires that included questions about past month peak consumption, alcohol-related consequences, marijuana use frequency, and frequency of PBS use. Logistic regression analyses were conducted to evaluate how use of PBS was related to the odds of experiencing a blackout, controlling for consumption and other risk factors.

RESULTS

Participants endorsing greater overall use of PBS had decreased odds of having experienced a blackout. However, this association depended on the type of PBS being used. Participants endorsing greater use of PBS regarding manner of drinking and stopping/limiting drinking had decreased odds of having experienced a blackout, but those who endorsed greater use of PBS relating to serious harm reduction did not.

CONCLUSIONS

This study adds nuance to the idea that PBS protect against adverse alcohol-related consequences. Only PBS that serve to limit or slow consumption appear to be protective against experiencing blackouts. Research on specific associations between types of PBS and consequences may lead to improved outcomes in interventions that incorporate PBS.

A mixed-methods approach to improve the measurement of alcohol-induced blackouts: ABOM-2

BACKGROUND

Alcohol-induced blackouts describe memory loss resulting from alcohol consumption. Approximately half of college students report experiencing a blackout in their lifetime. Blackouts are associated with an increased risk for negative consequences, including serious injury. Research has documented two types of blackouts, en bloc (EB) and fragmentary (FB). However, research is limited by the lack of a validated measure that differentiates between these two forms of blackout. This study used a mixed-methods approach to improve the assessment of FB and EB among young adults. Specifically, we sought to improve the existing Alcohol-Induced Blackout Measure (ABOM), which was derived from a relatively small pool of items that did not distinguish FB from EB.

METHODS

Study 1 used three rounds of cognitive interviewing with U.S. college students (N = 31) to refine existing assessment items. Nineteen refined blackout items were retained for Study 2. Study 2 used face validity, factor analysis, item response theory, and external validation analyses to test the two-factor blackout model among U.S. heavy-drinking college students (N = 474) and to develop and validate a new blackout measure (ABOM-2).

RESULTS

Iterative factor analyses demonstrated that the items were well represented by correlated EB and FB factors, consistent with our hypothesis. External validation analyses demonstrated convergent and discriminant validity. These analyses also provided preliminary evidence for the two factors having differential predictive validity (e.g., FB correlated with enhancement drinking motives, while EB correlated with coping and conformity motives).

CONCLUSIONS

The Alcohol-Induced Blackout Measure-2 (ABOM-2) improves the measurement of blackout experiences among college students. Its use could facilitate the examination of EB and FB as differential predictors of alcohol-related outcomes in future studies.

Consequences, Motives, and Expectancies of Consumption as Predictors of Binge Drinking in University Women

The increasing presence of women, especially university women, in risky alcohol consumption such as Binge Drinking (BD), which is associated with gender-specific biopsychosocial problems, makes it necessary to analyze the variables underlying BD in order to adjust possible interventions more in line with their reality. The motives and expectancies of this pattern of consumption, as well as the consequences derived from it, are some of the variables that are shown to have the greatest weight in the prediction of BD. In the present study we analyze, on the one hand, the performance of these variables among college women with alcohol use, and on the other hand, which of these variables allow us to classify BD. A total of 501 female university consumers of alcohol (mean age 19.02 years) were assessed. Specifically, they completed a self-report of alcohol consumption (77.1% engage in BD), the Expectancy Questionnaire (EQ), the Drinking Motives Questionnaire (DMQ-R) and the Alcohol Consumption Consequences Evaluation (ACCE). BD female students scored significantly higher on these instruments, except for compliance motives. The logistic regression analysis carried out to estimate the probability of performing BD using the social and conformity motives, the ACCE and positive expectancies correctly estimated (χ2 8 = 9.149, p < 0.33) 88.6% of the cases and explained 26.2% of the BD. Thus, young women with a level of consequences classified as high risk (>25 in ACCE) have a 3.55-fold increase in the probability of having BD, compared to women classified as low risk by the ACCE. On the other hand, women classified as moderate risk by the ACCE have a 4.77-fold increase in the probability of having BD. In the case of social motives and positive expectancies, their increase multiplies by 1.165 and 1.024, respectively, the probability of having BD. The results of this study highlight the importance of adapting preventive measures to the consequences experienced by BD university students, especially in relation to the social motives and positive expectancies that modulate decision-making when engaging in this pattern of consumption.

Expectancies and Motives as Predictors of Risky Alcohol Consumption in College Women

Despite the consequences of alcohol use, it continues showing a high incidence among college students. Besides, the increasing presence of women in risk alcohol patterns calls for a gender-sensitive approach to design specific actions. Some variables have been analyzed as underlying alcohol consumption (expectations and motives). This paper assesses the type and influence of both variables on female university alcohol consumers at different levels of risk. Five hundred four college women were assessed using the Spanish adaptations of the Expectancy Questionnaire, the Drinking Motives Questionnaire-Revised, and the AUDIT. We determine the unique contributions of expectancies, motives, and the presence of binge drinking (BD) to the pattern of risky drinking. The percentage of variance explained by risky drinking is 37.7%. Negative expectancies (20.4%) are the most explanatory variables, followed by enhancement motives (10.4%). Interventions with university women should focus on their negative expectancies, in addition to addressing for improvement, coping with depression, and conformity motives.

Prospective Effects of UPPS-P Impulsivity and Typical Drinking Context on Future Drinking Behavior

OBJECTIVE

Research suggests that impulsivity is a risk factor for problem drinking, but prior studies have yet to examine typical drinking context as a potential moderator of relations between impulsivity and drinking outcomes. Guided by Person-Environment Transactions Theory, the current study tested whether five facets of impulsivity (negative urgency, positive urgency, lack of premeditation, lack of perseverance, and sensation seeking) interacted with typical drinking context to prospectively predict drinking quantity.

METHOD

Young adult participants (N = 448; mean age = 22.27) were recruited from a southwestern university and the surrounding community. Data from a baseline survey (Time [T] 1) and a 1-year follow-up (T2) were used for the current analyses. Impulsivity (UPPS-P Impulsive Behavior Scale), typical drinking context, and typical drinking quantity were assessed at T1, and typical drinking quantity at T2.

RESULTS

Context items were loaded onto latent factors comprising high-arousal (e.g., at a tailgate, large house party) and low-arousal (e.g., at a restaurant, on a date) drinking contexts. In univariate (separated by UPPS-P facet) and multivariate (UPPS-P facets together) models, lack of premeditation and positive urgency interacted with high-arousal drinking contexts to predict T2 drinking, such that individuals at high/mean levels of impulsivity drank more heavily the more frequently they drank in high-arousal contexts. Only interactions in univariate models remained significant after a false discovery correction, although effect sizes were very similar across univariate and multivariate models.

CONCLUSIONS

Individuals high in positive urgency and lack of premeditation may be particularly vulnerable to riskier drinking behavior in high-arousal environments. Findings advance the literature on context-specific cues that may be important intervention targets, particularly for individuals high in positive urgency and lack of premeditation.

Prospective Effects of UPPS-P Impulsivity and Typical Drinking Context on Future Drinking Behavior

OBJECTIVE

Research suggests that impulsivity is a risk factor for problem drinking, but prior studies have yet to examine typical drinking context as a potential moderator of relations between impulsivity and drinking outcomes. Guided by Person-Environment Transactions Theory, the current study tested whether five facets of impulsivity (negative urgency, positive urgency, lack of premeditation, lack of perseverance, and sensation seeking) interacted with typical drinking context to prospectively predict drinking quantity.

METHOD

Young adult participants (N = 448; mean age = 22.27) were recruited from a southwestern university and the surrounding community. Data from a baseline survey (Time [T] 1) and a 1-year follow-up (T2) were used for the current analyses. Impulsivity (UPPS-P Impulsive Behavior Scale), typical drinking context, and typical drinking quantity were assessed at T1, and typical drinking quantity at T2.

RESULTS

Context items were loaded onto latent factors comprising high-arousal (e.g., at a tailgate, large house party) and low-arousal (e.g., at a restaurant, on a date) drinking contexts. In univariate (separated by UPPS-P facet) and multivariate (UPPS-P facets together) models, lack of premeditation and positive urgency interacted with high-arousal drinking contexts to predict T2 drinking, such that individuals at high/mean levels of impulsivity drank more heavily the more frequently they drank in high-arousal contexts. Only interactions in univariate models remained significant after a false discovery correction, although effect sizes were very similar across univariate and multivariate models.

CONCLUSIONS

Individuals high in positive urgency and lack of premeditation may be particularly vulnerable to riskier drinking behavior in high-arousal environments. Findings advance the literature on context-specific cues that may be important intervention targets, particularly for individuals high in positive urgency and lack of premeditation.

The Effect of Momentary Affect on Substance Use among Young Adults Who Experience Homelessness

IntroductionLittle is known about the momentary patterns and predictors of substance use among young adults who experience homelessness. To enhance understanding of substance use patterns, smartphone-based ecological momentary assessment (EMA) was utilized to examine the real-time association between affect and substance use. Methods: 251 young adults (aged 18-27) with history of homelessness were recruited from supportive housing programs and drop-in facilities in Los Angeles. Exploratory factor analysis was used to examine the latent structure of positive and negative affective states and mixed-effects logistic regression models were completed separately for both the full remaining sample (n = 227) and a subsample of alcohol or cannabis users (n = 145) to evaluate whether positive or negative affect predicted lead, recent, or lagged substance use. Results: Greater positive affect within-person was associated with greater odds of alcohol or cannabis use within the past two hours, and participants who reported feeling more negative than their peers experienced greater odds of reporting use within the past 4 h and the following two hours. Conclusion: Results suggest that individuals experience a heightened positive mood compared to their own average mood, concurrently or immediately after engaging in alcohol or cannabis use. Heightened positive mood might be an anticipatory effect of drinking or cannabis use. Future research should consider a longer study period to capture multiple drinking or drug use events over a longer period and consider more environmental exposures that may influence the frequency or intensity of substance use.

Drinking to Fit in: The Effects of Drinking Motives and Self-Esteem on Alcohol Use among Female College Students

Over the past two decades, rates of alcohol use among female students have risen to meet or even surpass those seen among males. Yet, little is known about factors that play a role in the relationship between drinking motives and alcohol consumption for female college students. The present study examines self-esteem as a moderator in the association between categories of drinking motives and alcohol use in a sample of female college students. Participants included 196 female undergraduates who reported drinking alcohol at least once in the preceding month (M_age= 19.5 years, 88.8% White) at a northeastern public university. Participants completed an online questionnaire assessing self-esteem, drinking motives, and past month alcohol use. Self-esteem was significantly negatively correlated with coping (r=-.40, p<.001) and conformity motives (r=-.22, p=.002) but not enhancement or social motives. Main effects predicting alcohol use were detected for enhancement (b = 1.49, p<.001), coping (b = 1.73, p<.001), and social motives (b = 1.34, p<.001), but not conformity motives or self-esteem. The interaction of conformity motives and self-esteem was significant (b=-0.17, p=.04). Simple slopes analyses revealed that conformity motives were significantly positively related to alcohol consumption for at low (b = 1.53, p=.001), but not high levels (b=-0.39, p=.61) of self-esteem. No other interactions were significant. Assisting female college students with increasing their self-esteem may be an effective component of intervention programs targeting alcohol consumption, particularly among those who report drinking to fit in.

The experience of physiological and psychosocial alcohol-related harms across adolescence and its association with alcohol use disorder in early adulthood: A prospective cohort study

BACKGROUND

Different forms of alcohol-related harm (e.g., hangovers, fighting) may confer differential risk of clinically relevant alcohol problems. We examine: (i) patterns of transition in experiencing alcohol-related harms across adolescence; (ii) whether factors in early adolescence predict transition patterns; and (iii) whether transition patterns predict later alcohol use disorder (AUD) symptoms.

METHODS

We used a longitudinal Australian cohort (n = 1828) to model latent class transition patterns of alcohol-related harms across three timepoints (M_age  = 13.9, 16.8, 18.8 years). Regression models assessed whether child, peer, and parent factors in early adolescence (M_age  = 12.9) predicted harms transition patterns and whether these patterns predicted AUD symptoms in early adulthood (M_age  = 19.8).

RESULTS

Five transition patterns characterized most of the cohort (n ≈ 1609, 88.0%): (i) minimal harms (n ≈ 381, 20.8%); (ii) late physiological harms (n ≈ 702, 38.4%); (iii) early physiological harms (n ≈ 226, 12.4%); (iv) late all harms (n ≈ 131, 7.2%); and (v) gradual all harms (n ≈ 169, 9.2%). With late physiological harms as the reference, females had increased risk of experiencing early physiological harms (relative risk [RR]: 2.15; 99.5% CI: 1.19, 3.90). Late all harms (RR: 1.71; CI: 1.19, 2.47) and gradual all harms (RR: 1.84; CI: 1.37, 2.47) were each associated with increased odds of meeting criteria for AUD, even when patterns of alcohol consumption are considered.

CONCLUSIONS

Adolescents display heterogeneous transition patterns across physiological and psychosocial alcohol-related harms. Females are at greater risk of experiencing early physiological harms. Experience of both physiological and psychosocial harms in late adolescence is an important and potentially modifiable precursor to clinically relevant alcohol problems in early adulthood.

Associations between alcohol demand and both the experience and subjective evaluation of positive and negative alcohol-related consequences

BACKGROUND

Considerable variation exists in the extent to which alcohol-related consequences are evaluated as positive or negative. These evaluations, in turn, predict subsequent drinking behavior. Understanding the etiological pathways to positive and negative alcohol-related consequences is essential to the design of interventions aimed at reducing drinking consequences. Behavioral economic models posit that excessive alcohol valuation contributes to problematic use. Elevated alcohol demand (i.e., relative alcohol value) is associated with negative alcohol-related consequences; however, it is unclear whether demand is related to positive consequences or subjective consequence evaluations.

METHODS

College student drinkers (n = 114; 74.6% female) completed an online survey. Participants indicated whether they had ever experienced any of 24 negative and 14 positive consequences and subjectively evaluated their most recent experience of each consequence endorsed. An alcohol purchase task assessed hypothetical alcohol consumption across 14 prices and three observed demand indices were calculated: intensity (i.e., consumption at zero cost), O_max (i.e., maximum expenditure), and P_max (i.e., price associated with maximum expenditure). Bivariate correlations and hierarchical regressions were used to test associations between observed demand indices and the number and subjective evaluations of positive and negative (researcher- and participant-defined) consequences.

RESULTS

Intensity and O_max , but not P_max , were bivariately associated with researcher- and participant-defined negative and positive consequences. However, in hierarchical regression models that controlled for the maximum number of drinks consumed in a single day over the past month, only intensity was significantly associated with more negative and positive consequences. Intensity was associated with positive consequence evaluations in bivariate but not regression models.

CONCLUSION

Students with higher intensity reported more prior alcohol consequences (positive and negative), independent of drinking level. However, subjective evaluations of recent consequences did not vary as a function of demand. Results support using behavioral economic models to facilitate identifying etiologic pathways to alcohol consequences and suggest that novel interventions incorporating demand manipulation may reduce drinking consequences.

Traditional feminine gender roles, alcohol use, and protective behavioral strategies among Latina college students

OBJECTIVE

Studies conducted with Latina/o populations suggest there are gendered norms surrounding drinking behavior, but research examining alcohol use among Latina college students in the context of traditional feminine gender role (TFGR) norms, is scarce.Participants and Methods: 405 Latina undergraduates completed a web-based study of sociocultural factors and alcohol use. Path analyses assessed the relation between TFGR , alcohol use, and alcohol-related protective behavioral strategies (PBS).

RESULTS

A dimension of TFGR characterized by purity was related to (a) reduced alcohol use in general, and (b) PBS designed to modify the manner of drinking among drinkers. In turn, this dimension of PBS related to a lower likelihood of experiencing drunkenness.

CONCLUSIONS

These findings support the notion that enacting some dimensions of TFGR among Latina college students may limit general alcohol use (directly) and high-risk drinking (indirectly through use of PBS), while enacting other dimensions may place Latinas at risk of alcohol misuse.

Trajectories of alcohol-induced blackouts in adolescence: early risk factors and alcohol use disorder outcomes in early adulthood

BACKGROUND AND AIMS

Experience of alcohol-induced memory blackouts in adolescence may be an important risk factor for later harms. This longitudinal study (i) modelled trajectories of alcohol-related blackouts throughout adolescence, (ii) explored early-adolescent predictors of blackout trajectories and (iii) examined the association between blackout trajectories and alcohol use disorder (AUD) symptoms.

DESIGN

Longitudinal study in which data from six annual surveys of a longitudinal cohort of Australian adolescents were used to model latent class growth trajectories of blackouts, adjusting for alcohol consumption frequency and typical quantity. Regression models were used to determine whether parent, child and peer factors at baseline (mean age = 12.9) predicted profiles of blackout trajectory membership and whether blackout trajectories predicted meeting criteria for AUD in early adulthood (mean age = 19.8).

SETTING AND PARTICIPANTS

Australian adolescents (n = 1821; mean age = 13.9-18.8 years).

MEASUREMENTS

Alcohol-related blackouts, alcohol consumption frequency, typical consumption quantity and DSM-5 AUD in early adulthood were all self-reported.

FINDINGS

We identified a three-class solution: delayed alcohol initiation, rare blackouts (n = 701; 38.5%); early initiation, rare blackouts (n = 869; 47.7%); and early initiation, increasing blackouts (n = 251; 13.8%). Female sex was associated with increased risk of early initiation, increasing blackouts relative to delayed initiation, rare blackouts [relative risk ratio (RRR) = 3.90; 99.5% confidence interval (CI) = 1.96, 7.76] and relative to early initiation, rare blackouts (RRR = 2.89; 99.5% CI = 1.42, 5.87). Early initiation, rare blackouts [odds ratio (OR) = 1.96; 99.5% CI = 1.17, 3.29] and early initiation, increasing blackouts (OR = 4.93; 99.5% CI = 2.32, 10.48) were each associated with increased odds of meeting criteria for AUD in early adulthood relative to delayed initiation, rare blackouts. Early initiation, increasing blackouts was associated with increased odds of meeting criteria for AUD in early adulthood relative to early initiation, rare blackouts (OR = 2.51; 99.5% CI = 1.18, 5.38).

CONCLUSIONS

Females in Australia appear to be at higher risk of adolescent alcohol-related blackouts independent of alcohol consumption levels and age of initiation. Alcohol-related blackouts may be associated with later alcohol use disorder.

Opportunities for reducing college drinking: The roles of drinking attitudes and blackout experience

BACKGROUND

As many as 35% of college students report having been drunk in the past month, and greater alcohol use and alcohol-related problems are associated with a positive attitude toward heavy drinking. One serious consequence of heavy drinking is alcohol-induced blackout. When they occur, alcohol-induced blackouts present a unique opportunity to increase motivation to change drinking. However, it is unclear under what conditions an alcohol-related heavy drinking attitude and experiencing a blackout represent an opportunity to change and how experiencing a blackout(s) influences an individual's motivation to reduce drinking and actual behavior.

METHODS

This study tested the interplay between one's positive attitude toward heavy drinking and experiencing a blackout in the past year in predicting motivation to reduce drinking (Study 1) and its impact on drinking over time (Study 2). Data were derived from complementary datasets collected at two universities (Study 1 n = 703, mean age = 20.63 years, 44% male, 52% White; Study 2 n = 568, mean age = 19.18 years, 72% male, 84% White). Drinking behavior was measured using a modified Daily Drinking Questionnaire, the Drinking Norms Rating Form, the Alcohol Use Disorders Identification Test (AUDIT), and estimated peak blood alcohol concentration (BAC). Regression analyses were conducted to determine whether a blackout would moderate the association between attitude and motivation to reduce drinking (Study 1) and drinking over time (Study 2).

RESULTS

Results revealed a significant interaction between attitude and blackout, such that individuals who experience a blackout (vs. those who do not) and positively evaluate heavy drinking evidenced lower motivation to reduce drinking (Study 1) and higher levels of estimated peak BAC (Study 2).

CONCLUSIONS

Drinkers with a negative attitude toward heavy drinking who have experienced a blackout have the strongest motivation to reduce drinking and the greatest reductions in peak drinking behavior over time. These effects are over and above that related to the level of alcohol consumed. For young adults who do not positively endorse heavy drinking, blackouts may present a "moment of opportunity" for intervention.

An International Comparison of a Web-Based Personalized Feedback Intervention for Alcohol use During the Transition out of High School in the United States and Sweden

Young adult drinkers engage in a range of drinking patterns from abstaining to heavy drinking in both the United States and Sweden. Heavy drinking during young adulthood in both countries is associated with a variety of negative consequences. Personalized feedback interventions have been identified as effective prevention strategies to prevent or reduce heavy drinking in the United States. This study examined transitions in drinking profiles and compared the efficacy of a personalized feedback intervention for 3965 young adults in the United States (1,735) and Sweden (2230) during their transition out of high school. Using goodness-of-fit criteria, results indicated that three drinking profiles exist among young adults transitioning out of high school: very low drinkers/abstainers, moderate to heavy drinkers, and very heavy drinkers. Latent Markov models revealed a moderating effect of country on personalized feedback intervention such that intervention condition participants in the United States were more likely to belong to the light drinker/abstainer or moderate to heavy profile relative to the very heavy drinking profile at 6-month follow-up. There was no significant effect of personalized feedback intervention in Sweden. Future research could investigate the impact of when personalized feedback interventions are administered and could examine if personalized feedback interventions should be more intentionally culturally adapted in order to be more effective.

The morning after the night before: Alcohol-induced blackouts impair next day recall in sober young adults

Binge-drinking in adolescents and young adults is a widespread problem, however, an often unreported consequence of binge-drinking behaviour is an alcohol-induced memory blackout (MBO). An MBO is a transient amnesic event resulting from rapid, excessive alcohol consumption. Here, we examine the short-term impact of an alcohol-induced MBO event (testing < 20 hours after blackout) on memory performance in people who have experienced a high volume of MBOs. In addition, we aimed to test the hypothesis that people who experience a high volume of MBOs may have poorer recall than non-blackout controls in either sober or intoxicated states. Three episodic memory paradigms consisting of free recall, serial recall, and depth of encoding tasks, were conducted by a group of alcohol drinkers who had never experienced a memory blackout, and those who reported at least 9 in the preceding 12-months. Studies were completed sober and after alcohol by all participants, and sober but after blackout by the experimental group. Accuracy of recall was assessed with linear mixed effects modelling for all experiments and conditions. Recall rate both before and after alcohol consumption was similar between groups, with poorer recall after drinking alcohol by all participants in all three studies. After blackout, MBO participants showed no significant improvement from their intoxicated state in serial recall and depth of encoding tasks, but an improvement in free recall. Further analysis of these findings revealed that 10 out of 23 participants showed significantly impaired performance after blackout during free recall, extending up to 17 participants in serial recall. In general, alcohol reduced recall rate in both blackout and control participants similarly, but recall following MBO remained poor. Our evidence suggests that alcohol-induced blackouts impair memory functioning the next day, and future research should establish the duration of deficits after an acute alcohol-induced blackout episode.

The grey zone of collegiate sexual regret: questionable consent and sexual victimisation

Research identifies sexual regret as the most common source of regret in the USA; however, few studies have explored this phenomenon. This study utilised a mixed-methods approach to explore sexual regret in a sample of 189 US college students. Quantitative analyses assessing who is most likely to experience sexual regret revealed no significant differences in experiences of sexual regret based on most demographics; however, individuals involved in fraternity and sorority life and/or college athletics were significantly more likely to report experiences of sexual regret. Additionally, students who reported experiences of sexual victimisation were more likely to report experiences of sexual regret. Qualitative analyses attempting to determine students' reasoning for experiencing sexual regret revealed five distinct content areas: 1) altered judgement, 2) motivations, 3) partner characteristics, 4) social judgement, and 5) unsatisfying or unpleasant sexual experiences. Results from both quantitative and qualitative analyses demonstrate significant overlap between experiences of sexual regret and sexual victimisation, highlighting the importance of future research and programming regarding sexual regret to increase understanding of the complex relationships between sexual consent and sexual behaviour.

The Mediated Moderation Model of Depressive Symptoms, Alcohol Use, and Consequences: The Protective Role of Executive Function

Heavy episodic drinking (HED) and negative drinking consequences represent prevalent and serious health concerns for college students. Depressive symptoms may elevate students' risk for engaging in HED and experiencing negative consequences, but levels of risk may vary by executive function (EF) capabilities. Growing evidence suggests that EF deficits are associated with comorbid depressive symptoms and alcohol misuse. Nevertheless, little is known about unique and shared risks that depressive symptoms and EF may interactively pose for HED and negative drinking consequences. Methods: To address these gaps, the study assessed depressive symptoms, multiple domains of EF via multimethod approach, HED, and negative drinking consequences in a sample of 446 undergraduate students. Mediated moderation models were conducted to examine associations between depressive symptoms and alcohol use behaviors and modulating roles of EF. Results: Depressive symptoms, poor planning, and self-reported executive dysfunction were significantly associated with HED and negative drinking consequences. HED mediated the effect of depressive symptoms and executive dysfunction on negative consequences. A significant interaction indicated that better EF (i.e. low or average self-reported executive dysfunction) may buffer the risk depressive symptoms present for negative drinking consequences. Conclusions: The current findings suggest that among college students, risk and resilience factors for HED and negative drinking consequences may vary. Effective EF capabilities may be especially helpful for reducing students' risk for more serious drinking consequences.

How much and how fast: Alcohol consumption patterns, drinking-episode affect, and next-day consequences in the daily life of underage heavy drinkers

BACKGROUND

Understanding how alcohol consumption patterns are associated with negative and positive outcomes can inform efforts to reduce negative consequences through modification of those patterns. This is important in underage drinkers, many of whom drink heavily despite negative consequences. Most work has focused on the amount of alcohol consumed, but amount provides limited information about consumption patterns compared to rate of consumption, or how fast individuals drink. We therefore examined associations of both amount and rate of consumption with negative and positive outcomes (immediate affective states and next-morning consequences) in daily life.

METHOD

Ninety-five college students aged 18-20 years completed ecological momentary assessment over 28 days. Participants reported number of standard drinks consumed and positive and negative affect hourly within drinking episodes. Estimated blood alcohol concentration (eBAC) values were used to create amount and rate of consumption indicators. Each morning after drinking, participants reported negative (e.g., blackout, hangover) and positive (e.g., new friend, making others laugh) consequences.

RESULTS

Within drinking episodes, multilevel models showed faster consumption was associated with reduced negative affect and both larger amount and faster consumption were associated with greater positive affect. Further, amount and rate were both associated with greater likelihood of a negative consequence the next morning. Rate, but not amount, was associated with more positive consequences.

CONCLUSIONS

Not only how much but also how fast individuals drink may be important for the positive and negative outcomes they experience. Interventions to reduce negative alcohol-related outcomes should consider not only amount, but also rate of consumption.

Intentions and motives to experience alcohol-induced blackout among young adults in college

Blackouts are typically considered a negative consequence of alcohol use. Yet some college students report consuming alcohol with the intention of blacking out. This study examined intentions and motives for blackout drinking among young adults in college. College students with a past-year history of blackout (N = 350, 56% female, 73% White) completed an anonymous online survey. Descriptive statistics were used to examine the incidence of blackout intentions, and individuals who did and did not report future blackout intentions were then compared on drinking patterns, depressive symptoms, social norms, and outcome expectancies. Overall, 135 participants (39%) reported consuming alcohol in the past 30 days with the intention of losing memory of the night's events, and 107 (31%) reported blackout intentions in the next 30 days. When asked (via open text box) to indicate their motives for past blackout intentions, the majority of participants provided responses that fit with coping, social, or enhancement drinking motives. A larger proportion of men than women reported blackout intentions. As a group, those reporting future blackout intentions reported heavier, more frequent, and more problematic drinking, as well as more symptoms of depression and more positive (but not negative) outcome expectancies. A substantial subset of college students reporting a blackout in the past year also endorsed intentions to experience a blackout in the next 30 days. Given strong associations between intentions and subsequent behavior, interventions targeting blackout styles of drinking are warranted. The extent to which "blackout" drinking motives differ from traditional drinking motives is unclear. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Negative alcohol-related consequences experienced by young adults in the past 12 months: Differences by college attendance, living situation, binge drinking, and sex

PURPOSE

This study estimated the prevalence of negative consequences associated with alcohol use in a national sample of young adults one or two years after graduating from high school, focusing on differences by college attendance, living situation, binge drinking, and sex.

METHODS

A subsample (N = 1068) of U.S. nationally representative Monitoring the Future study 12th grade students from 2006 to 2016 cohorts was followed-up at modal age 19 or 20 (in 2008-2017) and asked about negative consequences related to their own alcohol use during the past 12 months. Differences in prevalence were estimated and multivariable models examined associations with college attendance, living situation, binge drinking, and sex.

RESULTS

Half of surveyed U.S. 19/20 year-old alcohol users (a third of non-binge drinkers and almost three-quarters of binge drinkers) experienced negative consequences in the past year. The likelihood of experiencing several consequence types was significantly associated with college attendance prior to controlling for living situation. In multivariable models controlling for living situation, unsafe driving due to drinking remained more likely for students attending 2-year colleges or vocational/technical schools than for 4-year college students or non-attenders. In general, negative consequence risk was elevated among young adults not living with parents (vs. those living with parents) and women (vs. men).

CONCLUSION

Negative consequences from alcohol use are prevalent among young adults and differ by college attendance, living situation, binge drinking, and sex. Students at 2-year/vocational/technical schools are at particular risk for unsafe driving, warranting specific research attention and targeted intervention.

Correcting exaggerated drinking norms with a mobile message delivery system: Selective prevention with heavy-drinking first-year college students

Many efficacious interventions designed to reduce college student drinking aim to correct misperceptions of peers' drinking behavior. The present study tested the efficacy of a novel delivery strategy, namely text messages, for promoting promoderation descriptive and injunctive drinking norms. Participants included 121 college students who were randomly assigned to receive daily text messages containing accurate drinking norms (experimental group, n = 61) or historical facts (control group, n = 60) for 10 weeks following a baseline assessment. Participants completed 3-month postbaseline and 6-month postbaseline follow-up assessments. The 3-month assessment revealed that promoderation text messages were effective for reducing peak consumption and alcohol consequences. Changes in descriptive norms and injunctive norms aligned with these two behavioral outcomes. The intervention group reported perceiving others as drinking less on their heaviest drinking day and perceived others as being less approving of alcohol-related consequences than the control group. The intervention group also reported more peer approval of using protective behavioral strategies. Yet intervention effects were not maintained. None of the outcome measures differed by condition at the 6-month postbaseline assessment. Thus, the intervention had short-term effects on self-reported drinking behavior as well as on perceptions of drinking norms. However, the behavioral changes were not maintained when participants were assessed in the second semester after the daily text messages intervention had stopped. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Event-Specific Drinking and Protective Behavioral Strategy Use among College Students

BACKGROUND

Event-specific drinking occasions (e.g. holidays, special occasions, school breaks) have been associated with heavy drinking and negative alcohol-related consequences among college students. The current study extends prior research by examining understudied holidays and changes in protective behavioral strategy use during these event-specific drinking occasions.

METHOD

Participants were 537 college students between the ages of 18 and 24 who retrospectively reported drinking in the past two weeks. Several alcohol use variables (e.g., frequency, quantity, heavy episodic drinking frequency), negative alcohol-related consequences, and protective behavioral strategies were assessed for the previous 14 days. Ten event-specific drinking occasions were coded for the 14-day reporting period. A series of Analysis of Covariance models were conducted to examine differences on alcohol use variables, negative consequences, and protective behavioral strategies for weeks that included an event-specific drinking occasion relative to a no holiday reference timeframe.

RESULTS

Compared to the no holiday reference group, several event-specific drinking occasions (e.g., Labor Day, Martin Luther King Day) were associated with greater alcohol use, negative consequences, and protective behavioral strategy use. In contrast, other occasions were determined to be low-risk holidays (e.g., Veterans Day) when protective behavioral strategies were less frequently used. Some occasions (e.g., spring break) did not exhibit the expected clear pattern of risk.

CONCLUSIONS

College students' alcohol use, negative consequences, and protective behavioral strategy use vary across event-specific drinking occasions. Determining which event-specific drinking occasions are associated with risky alcohol use and the lowest use of harm reduction strategies is important for prevention and intervention programs.

Perpetration of Alcohol-Related Aggression by Male and Female College Students: An Examination of Overt and Relational Aggression

Existing literature exemplifies the relationship between alcohol and overt aggression, especially for adult males. Less clear is the relationship between alcohol and aggression among male and female college students, in particular, the nature of this aggression and the co-occurrence of drinking and aggression on the same day (temporal proximity). This study examines the chronic and temporal nature of males' and females' alcohol-related aggression among college students. Two hundred fourteen students completed a web-based 7-day event-level survey measuring alcohol consumption and perpetration of physical aggression, verbal aggression, anger, and relational aggression over 4 weeks, resulting in 4,256 observations (days). The global analysis revealed students who are heavy drinkers are more likely to perpetrate all four forms of aggression, whereas the event-level analysis revealed that specific forms of aggression are associated with drinking at the time, while other forms were not linked to drinking occasions. Cross-tabulation revealed males and females were more likely to use verbal and physical aggression when drinking. For females, drinking was also associated with relational aggression and anger. Despite often being overlooked in research on aggression during emerging adulthood, relational aggression was prevalent. Discrepancies between the global and temporal analysis revealed factors other than alcohol might explain the relationship between chronic alcohol consumption and specific forms of aggression. This is one of the first event-level studies to show the temporal relationship between alcohol and relational aggression. The distinctions in the current study, exemplifying the diversity of alcohol-related aggression, are critical for understanding aggressive behavior, potential gender differences, and for developing interventions. The temporal relationship between alcohol and aggression suggests health interventions should target drinking and aggression simultaneously.

Evaluating the combination of a Brief Motivational Intervention plus Cognitive Behavioral Therapy for Depression and heavy episodic drinking in college students

[Correction Notice: An Erratum for this article was reported in Vol 34(2) of Psychology of Addictive Behaviors (see record 2020-16883-001). In the original article the order of authorship was incorrect. The correct second and third authors should appear instead as Brian Borsari and Jennifer E. Merrill.] Heavy episodic drinking (HED) and depressive symptoms often co-occur among college students and are associated with significant impairment. However, evidence-based treatments for these common co-occurring conditions are not available for college students. The current study compared the effectiveness of a treatment combining Cognitive-Behavioral Therapy for Depression and Brief Motivational Interviewing (CBT-D + BMI) versus Cognitive-Behavioral Therapy for Depression (CBT-D) alone among 94 college students with HED and depressive symptoms. Both treatment programs were associated with significant reductions of similar magnitude in HED, alcohol-related problems (ARP), and depressive symptoms at the end of treatment and at the 1-month follow-up assessment. Moderation analyses indicated that, among college students with fewer depressive symptoms at baseline, CBT-D was associated with greater sustained reduction in heavy drinking relative to CBT-D + BMI at the 1-month follow-up. Although the study did not include a no-treatment condition, the magnitude of improvement during treatment in both groups was greater than what is expected with passage of time. Although clinicians in college counseling centers may lack specialty training for co-occurring conditions, CBT-D is widely implemented in college settings. Our findings suggest that CBT-D may reduce both depressive symptoms and HED in college students and may be used to address a significant public health problem. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Perceived descriptive norms for alcohol use among tribal college students: Relation to self-reported alcohol use, consequences, and risk for alcohol use disorder

This research addressed gaps in the literature by testing relationships between perceived descriptive alcohol use norms and individual's own alcohol use and consequences among tribal college and university (TCU) students. Survey data were collected from 3239 tribal college students in 22 TCUs across the United States in 2015 and 2016, of whom 3174 provided usable data on the variables of interest for the current manuscript. Results indicated students misperceived the descriptive norms for alcohol use at their TCU, on average estimating students at their college drank more frequently, more per occasion, and more total drinks per week relative to the observed averages on these outcomes. Participants' own drinking was significantly related to their perceived norms, with higher perceived norms related to more drinking. In addition, higher perceived norms were associated with greater alcohol-related negative consequences and lower likelihood of being a non-drinker. These findings extend research with students at majority-serving colleges and universities, indicating normative misperceptions exist and have similar relationships to alcohol use and consequences among TCU students nationwide. These findings support adaptation of normative feedback interventions for use with TCU students to emphasize healthy alcohol norms and correct misperceptions that support the stereotype that all students drink to excess.

Expressing Discrepancies between Religious Affiliations and Drinking Reduces Drinking Intentions

The majority of young adults express a religious affiliation. Most widely-practiced religions have some proscriptions against excessive drinking and/or drunkenness. Yet many religious college students engage in drinking in excess of these proscriptions, albeit at lower levels than non-religious students. At present, virtually no empirically-evaluated brief interventions in this population have directly incorporated religious affiliation.

OBJECTIVE

The present study evaluated an expressive writing intervention that elicits awareness and expression of discrepancy between religious affiliation and drinking behaviors, especially for students expressing moderate to high subjective religiousness and drinking levels. We expected discrepancy to result in lower drinking intentions.

METHOD

Undergraduate students (N=344) were randomly assigned to a 2 (priming: religious affiliation vs. college major) X 2 (comparison of current drinking with: religious affiliation vs. college major) expressive writing design in which those in the experimental condition were asked to describe how their current drinking fit with their religious affiliation.

RESULTS

Writing about the fit between current drinking and one's religious affiliation (versus college major) was associated with expressing more discrepancy, which was, in turn, associated with intentions to reduce drinking. No effects were found for priming, nor for the interaction between priming and comparison. Subjective religiousness and current drinking were evaluated as moderators of the indirect effect of comparing one's current drinking and religious affiliation on future drinking intentions through expressed discrepancy. The effect of comparison on discrepancy was stronger at higher levels of subjective religiousness. The association between discrepancy and intentions to reduce drinking was stronger for heavier drinkers, especially when also accompanied by higher subjective religiousness.

CONCLUSION

Results provide preliminary support for a novel intervention strategy with the potential to reduce drinking in a significant proportion of students that has previously received little consideration.

The Influence of Personality and Drinking Motives on College Student Binge Drinking in the US and Portugal

Abstract. The present study examined whether personality traits and drinking motives interact to predict binge drinking and alcohol-related problems in a cross-cultural sample of college students. Participants were undergraduate drinkers ( N = 904; 66% female) from universities in Portugal ( N = 391) and the US ( N = 513). Participants completed measures assessing neuroticism, extraversion, conscientiousness, drinking motives, frequency of binge drinking, and the number of alcohol-related problems. A significant Country × Neuroticism × Conformity interaction was explained by differences between US and Portuguese samples. The effect of this interaction on alcohol- related problems was mediated by binge drinking. Findings suggest similarities and differences across cultures in the manner in which personality and drinking motives are associated with alcohol outcomes. Across cultures, neuroticism, extraversion, conscientiousness, and drinking motives are key factors to consider in the assessment, prevention, and treatment of alcohol use among college students.

A Daily-Level Analysis of Moderators of the Association between Alcohol Expectancies and Alcohol Use among College Student Drinkers

Background: Alcohol expectancies, or the perceived likelihood of experiencing certain effects after consuming alcohol, are associated with college student drinking such that heavier drinkers expect a greater likelihood of positive effects. However, less is known as to whether day-to-day within-person deviations in expectancies are associated with drinking that same day and for whom and when these associations may be strongest. Objectives: The aim of this study was to examine daily-level associations of positive and negative alcohol expectancies with alcohol use, and whether associations differed according to demographic characteristics and additional alcohol-related constructs. Methods: College student drinkers (N = 327, 53.8% female) participated in an intensive longitudinal study that captured daily-level data. Alcohol use and expectancy measures were utilized from a baseline session and at the daily-level using Interactive Voice Response (IVR). Results: Results found that on days when participants reported stronger positive and negative expectancies than their average, they were more likely to drink as well as consume more alcohol when drinking. Moderation analyses revealed that positive expectancies were more positively associated with the likelihood of any drinking for women relative to men, and more positively associated with the quantity of alcohol consumption for younger students, students with lower baseline rates of drinking, and students with greater overall positive alcohol expectancies. Conclusions/Importance: The findings demonstrate that alcohol expectancies fluctuate within-person across days and these fluctuations are meaningful in predicting same-day drinking. Interventions that seek to modify expectancies proximal to drinking events may be considered to reduce college student drinking.

A Test of the Theory of Planned Behavior in the Prediction of Alcohol-Induced Blackout Intention and Frequency

BACKGROUND

This study examined the theory of planned behavior (TPB) as an explanatory model for alcohol-induced blackouts among college students. Blackouts are periods of time wherein individuals continue to function and engage in their social environment but do not remember it as a result of consuming large quantities of alcohol. Social cognitive factors posited within TPB, such as perceived norms and personal attitudes toward alcohol consumption, are reliable predictors of alcohol use and related problems. However, research to date has not examined these theoretical antecedents as predictors of alcohol-induced blackout.

METHODS

College students with a history of blackout (N = 384) completed a baseline survey, and a subsample (N = 120) completed a 1-month follow-up survey. Negative binomial mediation models were used to evaluate intentions to blackout as a mediator of the norms, attitudes, and self-efficacy to avoid blackout-blackout frequency association at baseline and 1-month follow-up.

RESULTS

Norms, attitudes, and self-efficacy to avoid blackout all significantly predicted blackout intentions at baseline, which in turn predicted more frequent blackouts both at baseline and at 1-month follow-up. Notably, blackout attitudes demonstrated both direct and indirect associations with blackout frequency.

CONCLUSIONS

Prospective analyses provided partial support for the TPB, with only attitudes and intentions demonstrating prospective associations with actual blackout frequency. Given the particularly strong association between blackout attitudes and frequency of blackouts, attitudes may represent an important and novel target for prevention and intervention efforts.

Drinking, Social Abstaining, and Refusing Invitations: Demographic Differences Persist Across College

BACKGROUND

Alcohol use and misuse are prevalent on many college campuses. The current study examined participation in college environments where alcohol is present and being consumed. We documented students' alcohol consumption, social abstaining (i.e., attending an alcohol-present event, but not drinking), and refusing invitations to drinking events. We tested for differences by parental education, immigrant status, race-ethnicity, and gender. We charted longitudinal change across college.

METHODS

First-year students attending a large public US university (n = 681, 18% first-generation college student, 16% first-generation immigrant, 73% racial-ethnic minority group member, 51% women) were recruited and followed longitudinally for 7 semesters. Each semester, students completed up to 14 daily surveys; responses were aggregated to the semester level (n = 4,267).

RESULTS

Multilevel logistic regression models demonstrated that first-generation college students were less likely to drink and refuse invitations to drinking events than students with a college-educated parent (Adjusted Odds Ratios [AORs]: 0.66, 0.72, respectively). Similarly, first-generation immigrants were less likely to drink, socially abstain, and refuse invitations (AORs: 0.58 to 0.73). Compared with White students, Black and Asian American students were less likely to drink (AORs: 0.55, 0.53) and refuse invitations to drinking events (AORs: 0.68, 0.66). The proportion of days spent drinking increased across college, and refusing invitations was the most common at the start and end of college.

CONCLUSIONS

First-generation college students, first-generation immigrant students, and Black and Asian students participated less in prodrinking environments during college. These findings indicate that on drinking and nondrinking days, students' participation in alcohol-present situations differed by background. Furthermore, our results indicate that the students who are most likely to refuse invitations to drinking events are the same students who drink most frequently.

Development and initial validation of the alcohol-induced blackout measure

BACKGROUND

Blackouts are common among young adults and predict alcohol-related harm. However, existing measures do not capture the range of alcohol-induced memory impairment involved in blackout experiences and do not differentiate between fragmentary and en bloc blackouts. This study aimed to develop and validate a brief, reliable measure of alcohol-induced blackouts among young adults.

METHODS

College students reporting alcohol-induced memory impairment in the past year were recruited via Qualtrics to participate in an online survey (N = 350, 56% female). A subsample (n = 109, 67% female) completed a one-month follow-up. Principal component analysis was used to determine the structure of the Alcohol-Induced Blackout Measure (ABOM), which was designed to reflect two components (fragmentary and en bloc blackouts). The reliability and validity of the total ABOM score was assessed.

RESULTS

The final five items fit in a two-component scale structure; however, a single principal component accounted for 73% of variance in blackout items, all of which demonstrated high component loadings and communalities. The total blackout score demonstrated strong internal consistency, test-retest reliability, and convergent and incremental validity. ABOM scores predicted alcohol-related consequences at baseline and one-month follow-up.

CONCLUSIONS

The ABOM is a brief and reliable, self-report measure that quantifies the frequency of a range of blackout experiences in the past 30 days. Accounting for this range of experiences improved predictive validity over single-item blackout measures. Blackout frequency is a strong, unique predictor of alcohol-related problems.