Alcohol-related protective behavioral strategies as a mediator of the relationship between drinking motives and risky sexual behaviors

Revised Alcohol Protective Behavioral Strategies Scale-20 (PBSS-20) Sub-Types: An Analysis of Direct/Controlled Consumption and Indirect/Harm Reduction PBS

Alcohol protective behavioral strategies (PBS) are commonly conceptualized with a three-factor model, as used in the Protective Behavioral Strategies Scale-20 (PBSS-20). However, inconsistencies exist between factors and drinking outcomes. The current study used factor analysis to test a two-factor structure directly via controlled consumption (Direct/CC) and indirectly via harm reduction (Indirect/HR) using the PBSS-20 among a combined sample of n = 4,883 drinkers. Both the two- and three-factor structures evince similar model fit. A two-factor model yielded more concise PBS measurement. Negative associations were observed with consumption (Direct/CC PBS) and problems (Indirect/HR). A condensed, eight-item, two-factor model accounted for less variance in alcohol consumption, however more variance in alcohol-related problems. A more consistent framework for understanding the impact of PBS on alcohol-related outcomes is provided.

Correlates of College Women's Sexual Assault Resistance Self-Efficacy

Studies suggest that actively fighting back against an attacker is effective in decreasing the severity and completion of a sexual assault, yet little is known about the factors that contribute to women's confidence in fighting back. Accordingly, the present study examines correlates of college women's self-efficacy in resisting unwanted sexual advances (N = 650). Results suggest that fewer psychological barriers to resistance, greater sexual communication, increased use of dating self-protective behaviors, and greater sexual assertiveness were associated with increased sexual resistance self-efficacy. Findings underscore the importance of developing sexual assault prevention programs that increase women's confidence in fighting back.

Contextual Use of Protective Behavioral Strategies for College Drinking

Background: Alcohol use on college campuses in the United States is a public health concern. Some students engage in protective behavioral strategies (PBS) before, during, or after their alcohol consumption (e.g., designated driver) to try to mitigate negative alcohol-related negative consequences. There is a gap in the literature on the use of different PBS in different situations commonly experienced by students (e.g., game day). The goal of the present study was to determine whether students would use different PBS for different situations, and to determine which PBS they would encourage their peers to use in these same situations. Objectives: A total of 182 undergraduate students were presented with three different hypothetical drinking scenarios (i.e., a friend's 21^st birthday celebration, football game day, and a house party) and asked which PBS they would use (i.e., limit drinking, change their manner of drinking, serious harm reduction strategies) and which they would recommend to their friends. They were also given the option to not drink at all. Results: Overall, students chose different strategies for different situations: they chose to limit their drinking at their friend's 21^st birthday or the game day tailgating event, to alter the manner of their drinking for the game day tailgating event, to reduce the potential of harm at the house party, and to not drink at their friend's 21^st birthday or the house party event. Students' personal choices matched their recommended choices for their friends. Conclusions: Results may have implications for prevention programs that teach harm reduction strategies such as PBS.

Harm Reduction Strategies among University Students Who Use Alcohol and Cannabis, and Related Psychological Variables: A Systematic Review

This systematic review identifies the psychological variables associated with the use of harm reduction strategies (HRS) among university students who use alcohol or cannabis. The reviewed studies are categorized according to the psychological variables studied and the different analytic approaches used (direct effects, mediation, and moderation). Among the empirical peer-reviewed studies identified (n = 76), most (94.7%) were cross-sectional studies conducted in the US (90.8%) with samples of alcohol-using university students (86.8%). Five categories were identified: mental health, motives/expectancies, personality, social cognition, and self-efficacy. The most studied constructs were motives, anxiety and depression, impulsivity, and social norms. Most studies conducted mediation or moderation analyses including psychological variables, HRS and alcohol outcomes. Social, enhancement and coping motives, impulsivity, and social norms of alcohol use were associated with lower use of HRS, which, in turn, was associated with a higher number of alcohol/cannabis outcomes. The results of moderation studies consistently suggest that HRS use was more protective for students with poor mental health, high impulsivity, and low self-regulation. The synthesis of evidence provided in this review could be useful for guiding future research and informing the design of interventions aimed at promoting the use of HRS among university students who use alcohol and/or cannabis.

Rethinking Unhealthy Alcohol Use in the United States: A Structured Review

Greater than moderate alcohol use spans a continuum that includes high levels of total alcohol consumed per period (heavy drinking) as well as episodes of intense drinking (binges) and can give rise to alcohol use disorder (AUD) when associated with an inability to control alcohol use despite negative consequences. Although moderate drinking and AUD have standard, operable definitions in the United States (US), a significant “gray area” remains in which an individual may exceed recommended drinking guidelines but does not meet the criteria for AUD (hereafter referred to as unhealthy alcohol use). To address this need, we conducted a structured literature search to evaluate how this gray area is defined and assess its burden within the US. For purposes of this review, we will refer to this gray area as “unhealthy alcohol use.” Although numerous terms are used to describe various unsafe drinking practices, our review did not find any studies in which the specific prevalence and/or burden of unhealthy alcohol use was evaluated. That is, we found no studies that focus exclusively on individuals who exceed moderate drinking guidelines but do not meet AUD criteria. Furthermore, we did not discover an established framework for identifying individuals with unhealthy alcohol use. The lack of a consistent framework for identifying unhealthy alcohol users has significant implications for patient management and disease burden assessment. Therefore, we propose the following framework in which unhealthy alcohol use comprises 2 distinct subpopulations: those at risk of experiencing alcohol-related consequences and those who have subthreshold problems associated with use. The former, termed “risky drinkers,” are defined by exceeding recommended guidelines for moderate drinking (⩽1 or 2 drinks per day for women and men, respectively). People with subthreshold problems associated with use, defined as exhibiting exactly 1 AUD symptom, would be classified as “problematic drinkers” within this proposed framework. These definitions would help bring the core elements of unhealthy alcohol use into focus, which in turn would help identify and provide management strategies sooner to those affected and reduce the overall burden of unhealthy alcohol use.

Further validation of the Treatment Self-Regulation Questionnaire for assessing motivations for responsible drinking: A test of self-determination theory

Alcohol protective behavioral strategies (PBS) are cognitive-behavioral strategies used before, during, and/or after drinking to reduce alcohol use and alcohol-related problems. Self-determination theory (SDT) provides a potentially useful framework to understand motivations for responsible drinking, which is operationalized in the present study as PBS use. In the present study, we examined the relation of motivations for responsible drinking, as assessed by the Treatment Self-Regulation Questionnaire (TSRQ), with other SDT constructs (psychological need satisfaction and dispositional autonomy) and PBS use. A sample of 507 college students who reported consuming alcohol at least once in the past 3 months were recruited from a random sample of students enrolled at a Hispanic serving institution to complete an online survey. Consistent with SDT and previous studies of the TSRQ, we found support for a 4-factor structure of the TSRQ. The TSRQ demonstrated measurement invariance across several sociodemographic subgroups within the sample (e.g., biological sex, age, year in school), supporting the use of the TSRQ across these subgroups. Further, consistent with SDT-based hypotheses, greater psychological need satisfaction and dispositional autonomy were related to more self-determined motivations for responsible drinking. Also consistent with SDT, more self-determined motivations for responsible drinking were related to more frequent PBS use. The present findings further support the utility of the TSRQ for assessing motivations for responsible drinking and support SDT as a framework for understanding responsible drinking. Future directions for research applying SDT to understand and promote responsible drinking among college students are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Psychological Distress as a Primer for Sexual Risk Taking Among Emerging Adults

Emerging adults experience increased morbidity as a result of psychological distress and risky sexual behavior. This study examines how sexual behaviors (e.g., condom use inconsistency and past year STI history) differ among emerging adults with low, moderate, and high psychological distress. Participants are 251,254 emerging adults attending colleges and universities in the United States who participated in the National College Health Assessment (NCHA). Findings suggest a dose-response relationship between psychological distress, condom use inconsistency, and past STI history, such that an association between greater psychological distress and condom use inconsistency and/or past year history of sexually transmitted infections (STIs).

Internalizing Symptoms, Alcohol Use, and Protective Behavioral Strategies: Associations with Regretted Sexual Experiences of College Students

One of the most pervasive forms of regret, often connected to alcohol use, is sexual regret. Lifetime rates of regretted sexual experiences (RSE) for college students is between 29%-71.9%, with 31.8% endorsing past year RSE and 31.7% stating alcohol negatively influenced decision making. While past research has focused on psychological symptoms following sexual assault, psychological effects and subsequent outcomes of RSE remains under-studied. Whether a history of sexual regret is associated with mental health symptoms, alcohol use, and protective behavioral strategy (PBS) use in the past month was analyzed. Participants (n = 1,394; 57.68% females, 26.96% racial/ethnic minority) reported on internalizing symptoms (anxiety, depression, trauma symptoms, and suicidal ideation) and externalizing and protective behaviors (problematic alcohol use and PBS). It was hypothesized that those with a history of RSE would report heightened current psychological symptoms compared to those without a history of RSE, regardless of when the RSE occurred. Of the n = 1,394 participants, 39.96% reported sexual regret and 26.11% endorsed a history of sexual victimization. Results indicate that among participants with an RSE, past month symptoms of anxiety, depression, trauma, and suicidal ideation were heightened. A similar pattern emerged for problematic alcohol use, as those with a history of RSE engaged in more problematic alcohol use in the past month. For PBS, those with a history of RSE engaged in fewer PBS than those without. Understanding these factors may provide novel insight for mental health prevention efforts and intervention targets for individuals who experience sexual regret.

Drinking and alcohol-related problems among at-risk adolescents: The role of protective behavioral strategies

INTRODUCTION

Protective Behavioral Strategies (PBS) are an alcohol-specific cognitive-behavioral strategies that may be employed before, during and/or after drinking, in order to reduce alcohol consumption and related consequences, particularly in the at-risk populations. Previous research on PBS was limited to North American college students. The purpose of this study was to examine the role of PBS use in a sample of Polish adolescents attending Special Educational Centers (SEC).

METHOD

Data were collected from a nationwide sample of 12-19 year-old (Mean = 15.8; SD = 1.22) students attending SEC in Poland (N = 1585; about 33% female). The self-administered anonymous questionnaires were completed on-site in the SEC. PBS were measured by the authors adaptation of the PBSS-20. Alcohol-related problems were assessed by the Polish adaptation of the measures used in the MINI-KID tool. Alcohol use was measured by a single question on drinking frequency. These two latter variables were measured in the past year timeframe. Hierarchical regression models were used to test the main and interaction effects of employing PBS (total and subscales scores) on alcohol-related problems, after adjusting for demographics (gender, family composition and type of SEC) and alcohol use.

RESULTS

The majority (about 94%) of study participants reported employment of some PBS. Regression analyses indicated that PBS use was associated with reduced risk of alcohol use and alcohol-related problems. We found that PBS significantly moderated the relationship between alcohol use and alcohol-related problems, for PBS total scale (F-change (1,1555) = 15.96, p < .001) and one of the PBS subscale: Limiting/Stopping Drinking (F-change (1,1555) = 4.80, p < .029). Findings were discussed within the results of PBS literature and resilience theory framework.

CONCLUSION

The use of PBS helps to reduce alcohol-related problems among adolescents attending SEC. Implementation of tailored interventions that teach PBS among vulnerable adolescents may be an effective way to strengthen adolescent self-protection, reduce risky alcohol use and related negative consequences.

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.

Peer-Led Training to Reduce Alcohol Misuse and Related Harm among Greek-Affiliated Students

High-risk alcohol use on college campuses is a significant public health concern, especially among students in fraternities and sororities. Alcohol harm-reduction programs that include protective behavioral strategies (PBSs) provide a promising approach to curb drinking among students, yet results have been inconsistent among high-risk drinkers. Purpose: To evaluate the impact of a harm-reduction, peer-led training program called "Voice of Reason" (VOR) on alcohol knowledge and behaviors among students in Greek chapters. Methods: We conducted two studies with students directly trained in VOR (Study 1: N = 118; Study 2: N = 53) and with students in affiliated Greek chapters (Study 1: N = 1363; Study 2: N = 1446). Study 1 included 13 chapters and Study 2 included 15 chapters. Results: Results of analyses across both studies showed that among those directly trained in VOR, there were pre-post increases in alcohol knowledge, medical amnesty law awareness, talking with friends about PBS, use of PBS, and intentions to use PBS, as well as pre-post decreases in drinking and driving and riding with drinking drivers. In addition, VOR had an impact on students in affiliated chapters, indicating an increase in medical amnesty law awareness and a decrease in the number of drinks consumed on a typical day. Conclusions: Overall, results provide some early evidence of VOR impact, while also demonstrating the challenge of changing normative drinking behaviors among high-risk college students. Ongoing research is needed to assess the effectiveness of VOR, especially after successive implementations with the same chapters.

Protective behavioral strategies predict alcohol-related problems among injured patients following a brief intervention

BACKGROUND

Alcohol protective behavioral strategies (PBS) have been proposed as mechanisms of change underlying interventions for reducing alcohol use and alcohol-related problems. Few studies have examined PBS use among non-college student populations and no study has examined PBS use among adult injured patients. The current study tested types of PBS as mediators of the effects of a brief motivational intervention (BMI) delivered in the trauma care setting on alcohol-related problems.

METHOD

Secondary data analyses were conducted using data from a multisite randomized controlled trial of brief intervention in the trauma care setting. The current study used data from a subset of participants who reported having consumed alcohol at least once at 3-month follow-up (N = 324). Following a baseline assessment, participants were assigned to either brief advice (BA; n = 107), BMI (n = 119), or BMI with a telephone booster (BMI + B; n = 98). Participants completed measures of PBS at 3-month follow-up and of alcohol-related problems at baseline and 6-month follow-up. A multiple mediation model was conducted to simultaneously test the mediation effects of types of PBS.

RESULTS

BMI and BMI + B relative to BA did not increase PBS use. However, more frequent use of certain types of PBS at 3-month follow-up were predictors of greater reductions in alcohol-related problems from baseline to 6-month follow-up. There were no statistically significant mediation effects.

CONCLUSIONS

The present study suggests that PBS use reduces alcohol-related problems among trauma patients and implications for future studies are discussed.