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Objective: Brief computer-delivered interventions (CDIs) reduce college student drinking and related problems but can be less efficacious and enduring than in-person interventions. The present study examined: (a) the utility of emailed personalized boosters after an evidence-based online CDI for alcohol (i.e., eCHECKUP TO GO), and (b) the added value of including protective behavioral strategies (PBS) in boosters containing personalized normative feedback (PNF) versus PNF alone. Method: 528 young adult (ages 18-24) college drinkers (71.6% female; 52.5% Black, 40.3% White) with a mean age of 19.9 years (SD = 1.65) were randomized to receive: CDI-only; CDI plus a PNF-only booster; or CDI plus a booster containing both PNF and PBS feedback. Booster emails were sent 2 weeks post-intervention. Online surveys completed pre-intervention and at 1 and 3 months assessed alcohol consumption, problems, descriptive normative perceptions, and PBS use. Results: The CDI led to significant reductions in alcohol consumption across all conditions, with no effect of boosters on drinking. Controlling for quantity, no reductions in problems were observed. Descriptive norms reduced significantly, with no condition differences. Only PBS use showed condition effects, such that the CDI-only and PNF-only booster groups reported reduced PBS use at 1 month, but the norms-plus-PBS booster group did not. Conclusions: The CDI was sufficient to change alcohol consumption and perceived norms without boosters, although the inclusion of boosters with PBS feedback may mitigate against PBS use reductions. Longer follow-ups may detect delayed booster benefits, or a larger dose through repeated exposure over time may be needed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective Heavy episodic drinking (HED) and high-intensity drinking (HID) are common in young adulthood but pose unique risks. Quantitative studies have used the Theory of Planned Behavior (TPB) and the Prototype-Willingness Model (PWM) to understand decision-making processes underlying alcohol misuse. However, our understanding of intentions (plans) and willingness (openness) for HED/HID is in its nascent stages. This study represents the first qualitative examination of relationships between intentions and willingness to engage in HED/HID. Method We conducted individual interviews among 28 young adult high-intensity drinkers (12 male, 15 female, 1 trans male; M age = 23 years). Interviews focused on HED/HID events with open-ended questions examining: (a) variability in intentions/willingness by occasion and within a drinking event; (b) formation of intentions for consumption and/or intoxication; and (c) interplay of willingness and intentions on heavy drinking nights. Verbatim transcripts were coded within NVivo software and content was analyzed using applied thematic analysis. Results Participants described intentions and willingness as varying by occasion and perceived their shifting across a drinking event. Intentions for heavy drinking reflected a desired level of intoxication, rather than a specific number of drinks. Willingness, rather than intentions, to engage in heavy drinking/HID was more evident. Conclusions Findings have significant implications for future measurement work in this area. There may be value in assessing intentions and willingness multiple times per day and during the drinking event itself. We also recommend that intentions for both consumption and intoxication levels be assessed, particularly in studies aiming to examine impaired control. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

One-third to half of emerging adult drinkers report experiencing alcohol-induced blackouts in the past year, and blackouts increase the risk for negative consequences. Qualitative methods provide valuable tools for scientific inquiry, allowing for in-depth understanding of lived experiences. The goal of the present study was to gain insight into emerging adults' recent blackout experiences. One hundred heavy drinking college students (age 18-20) completed a baseline survey, 28 days of ecological momentary assessment (EMA) of their alcohol use and consequences, and a follow-up interview. A subset of 37 (46% female, 13.5% Hispanic/Latinx, 54% non-Hispanic ethnicity/White race) endorsed a blackout (forgot what they did during or after drinking) and were interviewed regarding their recent blackout experience. A semi-structured interview guide focused on several key questions regarding intentions and/or willingness to black out, how friends reacted to their blackout, and social norms for blacking out. A priori as well as emergent themes were generated from review of coded data. Qualitative themes included: blackouts are often unintentional, heavy drinking young adults express willingness to black out, friends react in a variety of ways to blackouts, and blackouts are perceived as common and acceptable. Data provide insight into the phenomenology of blackouts among college students, revealing that although college students may not intend to, they are often willing to black out. Future qualitative studies on blackouts among non-college-attending emerging adults are warranted. Such work can inform theory and future survey studies to better understand this high-risk behavior. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective: Alcohol-related consequences are most often examined as outcomes of alcohol use. However, it is also possible that experiencing consequences may predict future drinking behavior. The predictive power of consequences on future drinking behavior may involve both objective experiences of consequences and subjective evaluations of those consequences (i.e., how positive, how negative). The purpose of the present study was to understand how positive and negative alcohol-related consequences-and evaluations of those consequences-predict elements of the next drinking event among college students. Method: 96 participants reported alcohol use and related consequences over a 28-day daily assessment period. Results: Survival analysis and multilevel modeling were used to examine the influence of positive and negative consequences from a given drinking event on latency to and number of drinks consumed at the next drinking event. Contrary to hypotheses, subsequent drinking was not impacted by recent consequences nor how they were perceived. Conclusions: Though theoretically, experiencing alcohol consequences may impact proximal drinking behavior, findings suggest that, in the current sample, other factors have greater importance in the latency between drinking events and amount of alcohol consumed. Future work should continue to identify event-level predictors that impact behavior at the next drinking event, and ways drinkers attempt to avoid repetition of drinking consequences other than simply drinking less (e.g., protective behavioral strategies), as such factors would be valuable targets for intervention. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

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.

OBJECTIVE: The present study examined if identification with mainstream American culture (acculturation) and heritage culture (enculturation) are differentially associated with blackouts and other drinking consequences among male and female college students of color. PARTICIPANTS: Participants were college students (N=150) who self-identified as a racial/ethnic minority and endorsed blackouts in the past year. METHODS: Regression models were used to examine gender-by-acculturation/enculturation interaction effects on alcohol-induced blackout and other alcohol-related consequences. RESULTS: While acculturation was not significantly associated with either drinking outcome, enculturation showed a significant relationship with blackout frequency. Gender moderated this relationship; greater enculturation was associated with increased blackout frequency among male but not female students. CONCLUSIONS: The present findings suggest the importance of considering the interplay between enculturation and gender in understanding alcohol use among college students of color. Men who endorse high levels of enculturation may be at an increased risk of experiencing negative drinking-related consequences.

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).

The incidence of sexually transmitted infections (STIs) has increased over recent years, particularly among young women. Partner type is believed to influence women’s STI risk. However, researchers often restrict partner type to “casual” versus “committed,” labels that can mask risk variability. Therefore, in this study, we identified and explored a range of sexual partner types in order to understand how young women’s perceived risk and condom use intentions vary by partner type. Data were obtained during six focus groups of young women (N = 25) who were recruited from a community reproductive healthcare clinic. Women described a range of monogamous and non-monogamous partner types that were distinguished based on partner regularity (i.e., whether the sexual partnership was ongoing) and personal relationship (i.e., degree of involvement outside of the sexual relationship). Women’s perceived STI risk was higher and condom use intentions stronger with new partners, particularly unfamiliar partners (i.e., “one-night stand,” “fuck boy”). Women identified potential harm from condom negotiation with all but the “friends with benefits” partners. However, the nature of this harm differed by partner type. Clinicians and researchers should consider how to support women in advocating for safer sexual behaviors across these partner types by understanding how partner regularity, degree of personal relationship, and emotional attachment differentially impact couples’ condom use decisions.

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).

The natural history and treatment of spinal muscular atrophy (SMA) is currently being transformed by the development and availability of novel therapies, with significant related changes in practice. This not only has important implications for the health and wellbeing of patients with SMA and their families, as well as improves the quality of care. The present study aimed to investigate the processes and factors that influence treatment and healthcare decisions for children and adults with SMA and their families and healthcare providers. Four focus groups comprising adults, or parents of children and adolescents, with SMA and an expert panel of healthcare providers (N = 25) explored experiences of SMA, its treatment and related decision making and expectations for future care. Group discussions were recorded and transcribed verbatim for thematic analysis using NVivo12.0. People with SMA, their families and healthcare providers described confronting complex healthcare decisions in the context of a rapidly changing SMA treatment environment. Across all groups, five key themes were identified: hope, yearning and searching, patient-centred care and support, community and a sense of connectedness and weighing up potential treatment benefits and costs. Essential to these themes was the notion of what it means to live with SMA and complexities relating to ‘quality of life’. Identifying and more deeply understanding the factors that influence patient, family and healthcare providers’ decision making regarding SMA treatment is an important first step in improving the quality of patient- and family-centred care and in informing clinical practice and future health policy incorporating personalized medicine and optimal supportive and mental health care.

BACKGROUND: Little is known about whether there are differences in rates of sexual violence and its association with substance use based on women’s identities, specifically the intersection of their race/ethnicity and sexual orientation. METHOD: Women (N = 546; 18 to 29 years of age) recruited from a reproductive healthcare clinic reported their race, ethnicity, sexual orientation, sexual violence history and substance use. Five logistic regressions examined (a) rates of sexual violence, and (b) the strength of the associations between sexual violence and four substance use outcomes (heavy alcohol use, marijuana use, cigarette use, number of cigarettes used) based on sexual orientation. Subsequent logistic regressions examined race/ethnicity as a moderator of the associations between sexual orientation and (a) rates of sexual violence and (b) substance use. RESULTS: Most women surveyed were heterosexual (64%), and 35% of all women reported unwanted sex. Sexual minority women (SMW) reported higher rates of sexual violence and substance use than heterosexual women. Sexual violence was more strongly associated with heavy alcohol use, but not with marijuana or cigarette use, for SMW than heterosexual women. Rates of sexual violence varied based on the intersection of sexual orientation and race/ethnicity. Although SMW were more likely to report sexual violence than heterosexual women, this association was weaker for Black/Latinx women than for non-Hispanic White women (aOR = 0.39, 95%CI [0.18, 0.82]). Race/ethnicity did not moderate the strength of associations between sexual violence and substance use. CONCLUSIONS: SMW exhibit increased risk for sexual violence and substance use, and victimization was associated with heavy alcohol use. Few racial/ethnic differences emerged as a function of sexual orientation, so SMW are a group with unique needs around sexual violence experiences and substance use, regardless of race/ethnicity. Healthcare providers should be aware of the link between substance use and prior victimization when treating SMW.

International audience; The Marijuana Motives Measure (MMM) is commonly used to explore the role of motives in cannabis use and related problems. A recent study suggested that a new Health motives subscale (using cannabis to improve sleep, form, energy, appetite, health) was the strongest motive associated with problematic use among high-school students. The aim of our study was to examine the predictive value of Health motives for cannabis use among college students. Participants were 328 French college students who used cannabis at least once during the last six months and completed the Cannabis Use Disorder Identification Test-Revised (CUDIT-R) assessing the severity of symptoms related to cannabis use disorder (CUD) and the Marijuana Motives Mesure (MMM). Twenty-two percent reached the cutoff score for likely moderate-severe DSM-5 CUD. Multiple regression analyses showed that Health motives were the strongest predictor for the severity of symptoms related to CUD relatively to all other motives. Enhancement and Expansion were also positively associated to symptoms of CUD, far more here than in previous studies among adolescents. This study replicates the findings of a previous study in high-school students. Health motives were found to be a strong predictor of CUD symptoms in college and high-school students which may have implication for both prevention and treatment of cannabis use problems.

Brief motivational interventions (BMIs) are widely used and efficacious interventions that address alcohol misuse in mandated college students. Consistent with motivational interviewing (MI; Miller & Rollnick, 2013) theory, within-therapist improvements in MI-consistent (MICO) skills over time-that is, as a therapist gains skill through repeated practice-may be associated with concurrent increases in client change language and subsequent changes in behavior. This study examined how therapist skill changed over time and whether within-therapist improvement in MICO skills impacted in-session client change language and subsequent alcohol-related outcomes. BMI sessions (N = 228) from 2 randomized clinical trials that had led to significant reductions in alcohol use and alcohol-related problems in mandated student drinkers were coded using the Motivational Interviewing Skills Code 2.0 (Miller, Moyers, Ernst, & Amrhein, 2003). In both studies, the BMI consisted of a single 45- to 60-min session. Analyses examined session-by-session changes in therapist MICO skills, client change language, and alcohol use outcomes. Therapist MICO skills improved over time, and there were significant increases in client change language and decreases in client discussion of topics other than personal alcohol use. Among relatively heavy-drinking clients, those treated by a more experienced therapist demonstrated greater reductions in alcohol use; however, this association was not mediated by client change language. Increased experience conducting BMIs improved therapist MICO skills over time, which in turn increased the focus on personal alcohol use during the session. However, it remains unclear how client language predicts behavior change following a BMI. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

College alcohol beliefs and personal attitudes about alcohol use are important predictors of alcohol use and related problems both cross-sectionally and over time. However, little work has examined these constructs together and how they may influence one another in predicting various alcohol related outcomes over time. The current study aimed to evaluate one's attitude toward heavy drinking as a mediator of the association between college alcohol beliefs and drinking related outcomes over a 12-month period of time. Participants were mandated students (n = 568; 28% female) who violated campus alcohol policy and received a Brief Motivational Intervention. Analyses included the use of linear regression for prospective predictions as well as PROCESS to evaluate the proposed mediation models. Overall, the results indicate that one's attitude toward heavy drinking significantly mediates the association between college alcohol beliefs and drinks per week, binge frequency, as well as alcohol-related problems over 12 months. These findings provide a compelling rationale for incorporating both college alcohol beliefs and attitudes in the development and refinement of intervention strategies.

Alcohol-induced amnesia (‘blackout’) is a reliable predictor of alcohol-related harm. Given its association with other negative consequences, experience of alcohol-induced amnesia may serve as a teachable moment, after which individuals are more likely to respond to intervention. To test this hypothesis, alcohol-induced amnesia was evaluated as a moderator of brief intervention effect on (a) alcohol-related consequences and (b) the proposed intervention mediators, protective behavioral strategies and peak blood alcohol concentration (BAC). Baseline alcohol risk measured using the Alcohol Use Disorders Identification Test (AUDIT) was also evaluated as a moderator to rule out the possibility that amnesia is simply an indicator of more general alcohol risk. College students (N = 198) reporting alcohol use in a typical week completed assessments at baseline and one-month follow-up as part of a larger intervention trial. Participants were randomized to assessment only (AO; n = 58) or personalized feedback intervention (PFI; n = 140). Hierarchical regression was used to examine direct and indirect intervention effects. A significant group by amnesia interaction revealed that only PFI participants who had experienced alcohol-induced amnesia in the past month reported decreases in alcohol consequences at one-month follow-up. The PFI reduced alcohol-related consequences indirectly through changes in peak BAC, but only among those who had experienced amnesia at baseline. In contrast, baseline alcohol risk (AUDIT) did not moderate intervention effects, and use of protective behavioral strategies did not statistically mediate intervention effects. Findings suggest that loss of memory for drinking events is a unique determinant of young adult response to brief alcohol intervention. Normative feedback interventions may be particularly effective for individuals who have experienced alcohol-induced amnesia in the past 30 days.

Background Much of the prior research addressing risky drinking among young adults has focused on heavy episodic drinking (4+/5+ drinks in a single sitting for females/males). However, 1 in 3 young adults engaged in past-year high-intensity drinking (HID, 8+/10+ drinks in a single sitting for females/males). Consuming such large amounts of alcohol is associated with serious acute consequences (e.g., severe injury, overdose) and the development of alcohol use disorder. This qualitative study aimed to gain an in-depth understanding of contextual influences on HID from drinkers' perspectives. Methods We conducted individual interviews of 28 young adults (57% female, aged 20 to 25 years old) who engage in HID to assess the role of context in the prediction of HID (relative to non-HID events). Two authors coded each interview following a structured codebook and thematic analysis was used to analyze the qualitative data. Results Based on identified themes, factors that may increase HID likelihood include being in larger groups or in social contexts where others are drinking heavily, having close relationships with others who are present, on special occasions, when feeling safe, being comfortable in a given situation, and experiencing intense affective states (especially positive ones). Noted deterrents for HID included friends' extreme intoxication, perceptions that heavy drinking is less acceptable in certain contexts (i.e., at work, family events) or among others present, cost/financial constraints, next-day responsibilities, and needing to drive. Conclusions Young adults identified a number of social and psychological factors that they perceived influenced their likelihood of engaging in HID. However, they also generated a number of factors that constrained this style of drinking. Understanding the contexts in which HID is most likely to occur will inform interventions that aim to reduce this high-risk behavior.

The current meta-analysis examined the effects of individual-level alcohol interventions on college students’ knowledge and psychological outcomes at first post-intervention assessment. Data from 34 randomized controlled trials published between 1980 and June 2007 (N = 8,569) were included. Independent raters coded participant characteristics, design and methodological features, and intervention content. Weighted mean effect sizes, using both fixed- and random-effects models, were calculated; positive effect sizes indicated greater improvement in alcohol-related knowledge or psychological outcomes. Compared to controls, alcohol interventions improved participants’ alcohol-related knowledge, attitudes toward drinking, and descriptive norms (vis-à-vis national college students), and intentions to consume alcohol but did not improve alcohol expectancies or self-efficacy. Several sample, study and intervention characteristics moderated the knowledge and psychological outcomes. Implications of these findings are discussed.

BACKGROUND: Prior research on risky alcohol use points to drinking norms as predictors of drinking behavior. Most research to date has only explored global (versus context-specific) drinking norms as they relate to general drinking behavior. To better understand risky drinking behavior in students, how norms may vary across drinking environments should be considered. OBJECTIVES: We sought to explore differences in drinking norms (descriptive, injunctive), personal approval, and alcohol use across specific drinking locations and how these location-specific predictors combine to best predict alcohol consumption in home/dorm locations, bars, and parties. METHODS: College student drinkers (N=115, 76% female) participated in an anonymous online cross-sectional survey in 2015–2016 assessing personal and perceived drinking experiences and attitudes across various locations. RESULTS: Alcohol use, descriptive norms of alcohol use, and injunctive norms of alcohol use (but not personal approval) varied across location. In addition, location-specific descriptive norms were associated with alcohol use in each drinking location, whereas location specific personal approval was associated with alcohol use only at home/dorm and bar locations. Furthermore, descriptive norms and personal approval of drinking in a given location predicted alcohol use in that same location, while norms or approval for other locations did not. CONCLUSION/IMPORTANCE: Results highlight the importance of specificity of perceived drinking norms and personal approval for predicting location-specific alcohol use. These findings have implications for interventions, which may benefit from discussions of students’ preferred drinking locations and providing location-specific normative feedback.

Objective Students in violation of campus alcohol policy often must participate in an alcohol risk reduction intervention, and some mandated students express overt resistance to change. This study tested a priori hypotheses about psychological variables that might predict receptivity to an online brief alcohol intervention. Method Participants were 193 students (56% male, 88% underclassmen, 70% white) who were referred to the campus Office of Alcohol and Other Drugs after being cited for alcohol policy violations. Before their mandated online alcohol intervention, they completed a baseline assessment consisting of demographics and questionnaires about their alcohol use, attitudes toward moderate and heavy drinking, beliefs about the centrality of alcohol in college life, perceived descriptive and injunctive drinking norms, trait defensiveness, social desirability and response to the event leading to their sanction. They also responded to a set of questions about how interested in, open-minded, and likely to benefit they were from the computer-delivered alcohol intervention they were about to take. Results Controlling for covariates and all other predictors, greater receptivity to intervention was predicted by heavier alcohol consumption, positive attitude towards moderate drinking, perceptions that peers were less approving of heavy drinking, and taking personal responsibility for the incident. Conclusions Among students mandated to participate in an alcohol intervention, openness to benefitting from the intervention varies in predictable ways. Because intervention receptiveness is associated with post-intervention change, we offer suggestions to tailor mandated interventions in ways that might improve outcomes.

BACKGROUND. This exploratory trial determined the feasibility, acceptability, and preliminary efficacy of a brief intervention (BI), supplemented with text messaging and a curated website, on alcohol use and sexual risk behavior among young women. METHODS. Young women seeking care at a reproductive health clinic were screened for alcohol misuse and sexual risk behavior. Those who screened positive and who agreed to participate (N = 48; M = 22.67 years) were randomized to either (a) a brief in-person session during which personalized feedback regarding alcohol use and sexual risking taking was provided and discussed, or (b) a control condition. Feasibility was assessed by recruitment and retention rates. Acceptability was assessed with participant ratings of their intervention. Efficacy was measured using self-reported alcohol use and sexual behavior at baseline and during a 3-month follow-up. We supplemented the quantitative data with qualitative data from semi-structured interviews. RESULTS. Feasibility data indicated that 64% of eligible women agreed to participate, 74% of eligible women were enrolled, and 86% of enrolled women were retained through follow-up. Acceptability data showed that women who received the BI reported strong satisfaction with their intervention (M = 4.65 vs. 3.98 on a 5-point scale) and also reported that text messaging was helpful (M = 4.73 on a 7-point scale) and acceptable (M = 5.27 on a 7-point scale). Qualitative data provided additional support for BI feasibility and acceptability. Efficacy data showed that women in both conditions reduced alcohol use and sexual risk behavior over time; women who received the BI reduced their maximum daily alcohol intake more than controls (BI: 7.68 to 4.82 standard drinks vs. Control: 6.48 to 5.65; Wald x(2) = 4.93, p < .05). Women in the BI (Median = 2.50) reported fewer occasions of condomless sex than controls (Median = 5.00) at the follow-up, but this difference was not statistically significant (OR = 0.61, 95%CI [0.32, 1.15]). CONCLUSIONS. A brief intervention, supplemented with text messaging and a website, that targeted alcohol use and sexual behavior was feasible and acceptable to young women, and led to lower levels of alcohol misuse and sexual risk behavior.

Alcohol misuse among college students is a persistent public health problem. Identifying the circumstances which influence alcohol misuse can inform the development of interventions to reduce risk for adverse outcomes in this population. Prior research suggests that people who engage in unplanned drinking report more alcohol-related consequences, and that unplanned heavy drinking is associated with consequences at the within-person level. The present study involved exploration of the within-person relationship between drinking events that were unplanned (vs. planned) in the morning and later quantity consumed, negative and positive consequences, and overall event evaluations. College student drinkers (N = 96) provided data on their drinking experiences each morning during a 28-day ecological momentary assessment study. Hierarchical linear models revealed that unplanned drinking events were associated with lower alcohol quantity, fewer alcohol-related consequences, and lower ratings on how "worth it" the drinking event was, compared to planned events. In contrast to prior work highlighting the risk associated with unplanned heavy drinking, our findings indicate that drinking events that are planned (vs. unplanned) are related to increased consumption and the experience of negative consequences. Additional research is needed to more definitively assess the differences between planned and unplanned drinking events and their relationship to adverse alcohol-related outcomes among college students. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Drinking motives are robustly related to alcohol use behavior from adolescence through young adulthood. Yet, examination of changes in motives during the first year of college, a transitional time associated with both onset of and increases in heavy drinking has been understudied. We examined (a) whether drinking motives change, (b) time-varying effects of motives on alcohol use and consequences, and (c) change in the strength of the association between motives and use and motives and consequences over the first year of college. A sample of 121 heavy drinking first-year students (50% female, 58% Caucasian) completed three assessments (baseline, 3 months, 6 months). Endorsement of social motives declined from 0 to 3 months, while endorsement of coping, enhancement, and conformity motives declined from 3 to 6 months. Social motives were positively associated with alcohol use and consequences across assessments. When motive × time interactions were tested in separate models, the strength of effects of coping motives on drinks per week increased from 0 to 3 months. The strength of the effect of coping and conformity motives on consequences increased from 0 to 3 months and then decreased from 3 to 6 months. Identifying how drinking motives evolve and relate to trajectories of alcohol use may help to understand the development of risky drinking behavior and inform intervention efforts.

For new students, university can be a wonderland of opportunity. But the first few weeks of the university experience are also typified by change, stress and uncertainty. From a health promotion perspective, the first few weeks of the university experience present an important yet understudied opportunity for alcohol misuse prevention. In this narrative review, we distinguish students' alcohol use during their first year at university from what is known about their use in the first few weeks on campus. First, we outline the developmental context of the first year experience and the descriptive epidemiology of alcohol use and consequences. Second, we highlight how distinctly different the first few weeks of the university experience are relative to the rest of the academic year and overview the limited research on alcohol use and consequences during the first few weeks. Third, we overview the limited number of strategies that have focused on reducing alcohol use during the transition to university. Finally, we offer a number of suggestions for future research. A better understanding of the nature and determinants of alcohol use and consequences during the transition to university is critical to designing effective prevention and intervention strategies.

Level of drinking in the social network is strongly associated with college students' alcohol use. However, mechanisms through which networks are associated with personal drinking have been underexplored thus far. The present study examined theoretically derived constructs-sociability outcome expectancies, attitudes toward heavy drinking, self-efficacy for use of protective strategies, and descriptive norms-as potential mediators of the association between egocentric social network drinking and personal consumption. College students (N = 274) self-reported their social network's level of alcohol consumption, all mediators, drinks per week, and consequences at both baseline (Time 1) and a 1-month follow-up (Time 2). Autoregressive mediation models focused on the longitudinal associations between Time 1 network drinking and the Time 2 mediators and between the Time 1 mediators and the Time 2 outcomes. Consistent with hypotheses, Time 1 social network drinking was significantly associated with Time 2 drinks per week and consequences. Only attitudes significantly mediated social network associations with drinks per week and consequences, though the proportion of the total effects accounted for by attitudes was small. After accounting for the stability of constructs over time, social network drinking was generally un- or weakly related to sociability expectancies, self-efficacy, and descriptive norms. Results support reducing attitudes toward heavy drinking as a potential avenue for mitigating network effects, but also highlight the need to evaluate additional potential mechanisms of network effects. Intervention efforts that aim to address the social network have the potential to substantially reduce alcohol consumption, thereby enhancing the overall efficacy of alcohol risk-reduction interventions. (PsycINFO Database Record

The persistence of risky drinking among young adults in college calls for continued efforts to prevent alcohol-related harms. This study tested a novel prevention strategy targeting a specific mechanism of change: creating attitude-behavior dissonance. Informed by an extensive literature showing strong and consistent associations between alcohol attitudes and drinking behavior, we adapted a brief counterattitudinal advocacy (CAA) manipulation to the alcohol prevention context. We conducted a small randomized controlled trial with 49 heavy-drinking students who reported drinking 4/5 drinks in 1 sitting (female/male, respectively) and endorsed ≥2 alcohol-related consequences in the previous month. Participants were randomly assigned to 1 of 2 conditions (CAA or control). We examined the number of words written in response to the prompts, evaluated adherence to the core theoretical principles used in CAA, and calculated between- and within-group effect sizes on preliminary outcomes (drinking intentions and alcohol consumption). We found that participants in the CAA condition wrote more, and the experience was perceived as consistent with CAA theory. The between-group effect sizes on drinking intentions and drinks per week were d = .36 and d = .27, respectively, and the within-group effect size for drinks per week was d = .83 for those in the CAA condition. Overall, the results of this pilot study support the feasibility and acceptability of CAA-based alcohol use interventions. This study represents a promising first step in adapting CAA-based interventions for use in the alcohol use domain. (PsycINFO Database Record

Objective: The current study is aimed to evaluate college student residence as a unique risk factor for a range of negative health behaviors. Participants: We examined data from 63,555 students (66% females) from 157 campuses who completed the National College Health Assessment Survey in Spring 2011. Methods: Participants answered questions about the frequency of recent use of alcohol, tobacco, marijuana, and illicit drugs, as well as sexual risk behavior in the last 30 days. Sexual risk behaviors were operationalized as having unprotected vaginal sex (yes/no) and the number of sexual partners. Results: Logistic regression analyses revealed that living off-campus is a unique predictor of alcohol, tobacco, marijuana, and illicit drug use, as well as engaging in unprotected sex and a greater number of sexual partners (all ps

Objective Brief motivational interventions (BMIs) reduce problematic drinking for some, but not all, college students. Identifying those students who are less responsive can help to guide intervention refinement. Therefore, we examined demographic, personality, and cognitive factors hypothesized to influence change after a BMI. Method Students mandated for intervention following a campus alcohol violation ( N = 568; 28% female, 38% freshmen) completed a baseline assessment, then received a BMI, and then completed a 1-month follow-up. At both assessments, alcohol use (i.e., drinks per week, typical BAC, binge frequency) and alcohol-related problems were measured. Results Latent change score analyses revealed significant decrease in both alcohol use and problems 1 month after the BMI. In the final model that predicted change in alcohol use , four factors (male sex, a “fun seeking” disposition, more perceived costs and fewer perceived benefits of change) predicted smaller decreases in alcohol use over time. In the final model that predicted change in alcohol-related problems , three factors (stronger beliefs about the centrality of alcohol to college life, more perceived costs and fewer perceived benefits of change) predicted smaller decreases in problems over time. Conclusions Participation in a BMI reduced alcohol use and problems among mandated college students at 1-month follow-up. We identified predictors of these outcomes, which suggest the need to tailor the BMI to improve its efficacy among males and those students expressing motives (pro and cons, and fun seeking) and beliefs about the centrality of drinking in college.

Alcohol misuse and associated negative consequences experienced by college students persists as a public health concern. Quantitative studies demonstrate variability in subjective evaluations of consequences, and how positively or negatively consequences are evaluated is associated with drinking behavior. Lacking is a qualitative exploration of how drinkers evaluate consequences and what influences those evaluations. We conducted a series of single-gender focus groups (13 groups; 3-7 per group; n = 62, 48% female) with college student drinkers. Questions focused on: (a) types of negative and positive consequences experienced (b) personal perceptions of negative consequences and (c) factors influencing those perceptions. Verbatim transcripts were content analyzed using applied thematic analysis with NVivo software. Several negative consequences not included in current assessment tools emerged. Reactions to these "negative" consequences of alcohol misuse were not labeled as uniformly negative by participants. Contextual influences on reactions to consequences included: social factors (e.g., normative perceptions, social context, discussions with friends), level of intoxication, concurrent positive consequences, time, and alcohol as an excuse. Future research should focus on consequence measure development and examine interactions between contextual and individual influences on subjective consequence evaluations. (PsycINFO Database Record

The goal of Orientation Week is to help new students adjust to university life. However, it is a period when many new students engage in excessive alcohol consumption and where problematic drinking patterns may be established.The objective is to determine whether returning students drink in a similar manner to students in their first-year of classes and whether Orientation Week drinking predicts semester drinking more strongly for first-year than returning students.We tested 552 students (18 to 25 years old) in their first, second, or third class year of university. Students reported their Orientation Week drinking and then completed daily drinking diaries for 13 consecutive days during the academic year.Orientation Week drinking was similar across class years and also predicted academic year drinking for students in all class years. Conclusion/Importance: Drinking during Orientation Week is not just a first-year problem and prevention efforts should focus on all students.

Introduction College students report high rates of binge drinking yet they reliably endorse elevated perceptions of drinking by their peers. However, the drinking norms literature offers little insight into how college students think about behaviors exhibited while intoxicated. This study aims to determine (a) if the predicted self-other differences (SODs) are seen among college students with respect to approval of intoxicated behaviors and (b) whether gender and race/ethnicity moderate these differences. We hypothesized that students would perceive others as more approving of intoxicated behaviors than they were themselves, resulting in significant SODs. We also predicted that women would have larger SODs relative to their male counterparts, and minority students would have larger SODs relative to their white counterparts. Methods Participants ( N = 233, 63% female) were recruited from an introductory psychology course at a large public northeastern university. They completed online surveys that assessed demographics, and responded to a list of intoxicated behaviors with ratings of personal approval and perceived peer approval. Results Perceived others' approval ratings exceeded personal approval ratings for 42 of the 44 different intoxicated behaviors. Women had significantly higher SODs relative to men and differed on personal approval. Non-white students had significantly higher SODs relative to white students, and differed both on personal approval and perceptions of others' approval of intoxicated behaviors. Conclusions Consistent SODs were observed in the approval of intoxicated behaviors. These findings may help to inform normative feedback interventions by revealing the potential for normative pressure, especially for non-white students.

Objective Symptoms of insomnia and heavy alcohol use tend to co-occur among military and veteran samples. The current study examined insomnia as a moderator of the association between alcohol use and related consequences among young adult veterans in an effort to extend and replicate findings observed in samples of civilian young adults. Method Young adult veterans (N = 622; 83% male; age M = 29.0, SD = 3.4) reporting alcohol use in the past year completed measures of insomnia severity, alcohol use, and alcohol-related consequences as part of a larger intervention trial. Participants were classified as screening ‘positive’ (n = 383, 62%) or ‘negative’ (n = 239, 38%) for insomnia using the Insomnia Severity Index. Hierarchical regression was used to examine the interaction between drinking quantity and insomnia on alcohol-related consequences. Predictor and outcome variables were measured concurrently. Results Both a greater number of drinks per week and a positive insomnia screen were associated with more alcohol-related consequences. Drinks per week and insomnia screen interacted to predict alcohol-related consequences, such that the effect of drinking on alcohol-related consequences was stronger in the context of a positive versus negative insomnia screen. Conclusion Drinking is associated with more alcohol-related consequences in the presence of clinically significant insomnia symptoms. These findings replicate those documented in civilian young adults and indicate that insomnia may be an appropriate target for alcohol prevention and intervention efforts among young adult veterans.

Purpose To determine the efficacy of behavioral and pharmacological interventions for insomnia among individuals with alcohol use disorder (AUD). Procedures Comprehensive literature searches of psychological, medical, and educational databases were conducted through October 2016. Eligible studies evaluated the efficacy of an insomnia intervention, included a comparison condition, sampled individuals with AUD and either insomnia disorder or complaints of insomnia, assessed sleep-related outcomes, and provided relevant statistics to calculate between-group effect sizes. Effect sizes were estimated for sleep quality, days of alcohol abstinence, and symptoms of depression. Type of intervention (behavioral versus pharmacological) was tested as a moderator of intervention efficacy. Main findings Nine studies met eligibility criteria and were included in the final review and meta-analysis. Random-effects models indicated that intervention participants reported greater improvements in sleep quality (d+ = 0.62, 95% CI = 0.28, 0.97) and symptoms of depression (d+ = 0.52, 95% CI = 0.06, 0.98) than control participants. Participants reported significantly greater improvements in sleep quality in response to behavioral (d+ = 1.20, 95% CI = 0.70, 1.70) as opposed to pharmacological (d+ = 0.43, 95% CI = 0.19, 0.67) interventions. Behavioral (d+ = 0.74, 95% CI = 0.31, 1.18) and pharmacological (d+ = 0.08, 95% CI = −0.64, 0.78) interventions did not have significantly different effects on depressive symptoms. Neither behavioral nor pharmacological interventions improved rates of alcohol abstinence. Conclusions Insomnia interventions improve sleep quality and reduce symptoms of depression among individuals with comorbid AUD. Given the methodological weaknesses of studies reviewed, additional research is needed to determine the efficacy of insomnia treatment in improving rates of alcohol relapse within this population.

Students living in off-campus housing consume more alcohol and experience more alcohol-related consequences than those living on campus, yet prevention efforts have not targeted this high-risk group specifically. The present study evaluated the efficacy of a brief, computer-delivered, alcohol intervention (the College Drinkers Check-Up [CDCU]) in reducing alcohol use and related consequences in a sample of college students living off campus.Students who lived off campus and reported at least one heavy drinking episode (4+/5+ drinks for females/males in one occasion) in the past 30 days completed the CDCU or assessment only during the first month of the school year (n = 326; 61% female). Participants in both conditions completed follow-up assessments at 1, 3, and 6 months. We hypothesized that participants who completed the CDCU would report fewer drinks per week and heavy drinking episodes, lower peak drinking quantities, and fewer alcohol-related consequences than those in the control group.Hierarchical linear modeling was used to examine changes in drinking outcomes across groups from baseline to 1-, 3-, and 6-month follow-ups. Significant effects of time indicated less drinking and fewer consequences at each follow-up relative to baseline. Compared with those in the control group, participants who received the CDCU reported significantly fewer heavy drinking episodes at 1 month, lower peak drinking quantities at 3 months, and fewer alcohol-related consequences at 1 and 3 months. Neither sex nor baseline drinking severity moderated intervention effects.The brief, online CDCU reduces heavy drinking and alcohol consequences in the short term among atrisk college students living off campus.

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.

Alcohol use and sexual behavior co-occur frequently in young women, increasing risk for HIV and other sexually transmitted infections. To inform preventive interventions, we used qualitative methods to better understand how women think about the contribution of alcohol use to sexual risk-taking. Young women (N = 25; M = 22.8 years; 64% White) were recruited from a community-based reproductive health clinic to attend focus groups; a semi-structured agenda was used to investigate both a priori explanatory mechanisms as well as participant-driven explanations for the alcohol-sex association. Women reported that alcohol reduced their social anxiety, helped them to feel outgoing and confident, and lowered inhibitions and other barriers to sexual encounters (consistent with alcohol expectancies). During drinking events, women described being less concerned with risks, less discriminating regarding sexual partners, and less likely to insist on safer sex practices (consistent with alcohol myopia). These empirical findings support previous theory-based guidance for tailoring preventive programs for alcohol use and sexual risk reduction for young women.

Background Spinal muscular atrophy (SMA) has profound implications across a lifetime for people with the condition and their families. Those affected need long-term multidisciplinary medical and supportive care to maintain functional mobility, independence and quality of life. Little is known about how adults with SMA experience healthcare, or the components of care perceived as important in promoting well-being. The purpose of this study was to use qualitative research methodology to explore the lived experiences of healthcare and wellbeing of adults with SMA. Purposive sampling was used to recruit adolescents and adults with SMA, their parents and partners. Face-to-face or telephone-based semi-structured interviews were recorded and analysed using inductive thematic analysis. Results Across a total of 25 interviews (19 people with SMA, 5 parents, 1 partner) many participants described disengagement from health services and major gaps in care throughout adulthood. Disengagement was attributed to the perceived low value of care, as well as pragmatic, financial and social barriers to navigating the complex healthcare system and accessing disability services. Adults with SMA valued healthcare services that set collaborative goals, and resources with a positive impact on their quality of life. Mental health care was highlighted as a major unmet need, particularly during times of fear and frustration in response to loss of function, social isolation, stigma, and questions of self-worth. Alongside this, participants reported resilience and pride in their coping approaches, particularly when supported by informal networks of family, friends and peers with SMA. Conclusions These findings provide insight into the lived experiences, values and perspectives of adults with SMA and their carers, revealing major, ongoing unmet healthcare needs, despite many realising meaningful and productive lives. Findings indicate the necessity of accessible, patient- and family-centered multidisciplinary care clinics that address currently unmet physical and mental health needs. Understanding the lived experiences of people with SMA, particularly during times of transition, is critical to advancing health policy, practice and research. Future studies are needed to quantify the prevalence, burden and impact of mental health needs whilst also exploring potential supportive and therapeutic strategies. Electronic supplementary material The online version of this article (10.1186/s13023-019-1052-2) contains supplementary material, which is available to authorized users.

Background: The Positive and Negative Syndrome Scale (PANSS) is a widely used instrument for symptom severity assessment in schizophrenia. Its Abstract Thinking item (N5) was developed for the assessment of thought disorder. This item currently lacks examples of correct and incorrect responses to similarities and proverb items. Different raters may judge these items as correct or incorrect based on their own level of abstraction, cultural background, and familiarity with possible responses. Precision in scoring is especially important, when the instrument is used to evaluate changes in schizophrenia symptoms over time and with treatment. This study proposes a new method of scoring the N5 subscale. Objectives: The aim of the present study was to develop a new scoring guide for the PANSS N5 Similarities and Proverbs scale and to assess inter-rater reliability using the newly developed scoring guide. Method: The authors analysed responses to PANSS questions of subjects who completed a double blind, randomized, placebo controlled clinical trial of oral naltrexone for treatment of alcohol use disorders in schizophrenia. Results: Of the 90 subjects, 45 had schizophrenia and 45 had schizoaffective disorder. 95% of subjects had alcohol dependence, 5% had alcohol abuse. Subjects consumed a median of 21 standard drinks per week at study entry. Participants had low to moderate PANSS Positive, Negative, and General Psychopathology scores. 434 different responses to similarities and 748 different responses to proverbs were sorted independently by two psychologists using a newly developed scoring guide for N5. The guide sorted responses into 4 categories, from correct to marginal, to concrete, to incorrect; examples of almost each type of responses were provided in the guide. Inter-rater reliability for scoring all Similarities responses was 93%, Weighed Cohen Kappa 0.83, p< .001; for scoring all Proverbs was 87%, Weighted Cohen Kappa 0.62, p

Personal attitudes toward alcohol consumption are reliable predictors of alcohol use and related problems, with emerging work suggesting that one’s favorable attitude toward limited drinking (i.e., at levels below the threshold for heavy episodic drinking) is a buffer against alcohol use and binge drinking. However, little work has examined the specific mechanism(s) through which one’s personal attitude toward limited drinking is associated with alcohol use and related problems. One such mechanism may be an individual’s self-efficacy to limit their alcohol use. The current study aimed to evaluate whether self-efficacy to limit one’s alcohol use mediates the association between one’s personal attitude toward limited drinking and actual alcohol use and related problems over time. Participants were mandated students (n = 568; 28% female) who violated campus alcohol policy and received a brief motivational intervention. Mediation models were used to test (a) self-efficacy to limit one’s alcohol use as a traditional mediator of the attitudes—drinking quantity association and (b) self-efficacy and drinking quantity as serial mediators of the attitudes—alcohol-problems link. Favorable attitudes toward limiting drinking at baseline were positively associated with self-efficacy to limit drinking at 1 month, which was associated with a reduction in drinking quantity at 3 months; this, in turn, was associated with a reduction in alcohol-related problems at 5 months. These findings provide a rationale for incorporating attitudes and self-efficacy in the development and refinement of intervention strategies.

Injunctive norms feedback is promising but understudied as a component of college drinking interventions. The aim of the present study was to demonstrate acceptability of injunctive norms feedback delivered to college drinkers via the web. We examined subjective interest in information reflecting peer approval of four sets of drinking behaviors and outcomes, and correlates of interest in the normative feedback. A sample of 221 young adults enrolled in a 2- or 4-year college or university (ages 18-25 years; 52% female) completed online surveys in which they were asked to rate their interest in each of 11 injunctive norms statements. Participants were randomly assigned to one of four sets of statements regarding peer approval of (a) intoxicated behaviors, (b) safe drinking strategies, (c) drinking-related consequences, and (d) drinking behaviors of potential partners. All items were framed to reflect disapproval of risky behaviors and approval of protective behaviors. Across norm sets, participants found the items to be moderately interesting and interest ratings did not differ across sets. Higher scores on the Alcohol Use Disorders Identification Test (AUDIT), stronger perceived approval of drinking in general (injunctive norms), stronger perceptions of drinking among peers (descriptive norms), and female gender were bivariately correlated with more interest. In a multiple regression, female gender, higher AUDIT (consequence subscale), and stronger general drinking injunctive norms remained significantly associated with interest in the pro-moderation statements. An important future direction is to determine whether the presentation of specific types of injunctive norms feedback can result in downward changes in drinking behavior.

Pregaming is highly prevalent on college campuses and associated with heightened levels of intoxication and risk of alcohol consequences. However, research examining the correlates of pregaming behavior is limited. Descriptive norms (i.e., perceptions about the prevalence or frequency of a behavior) are reliable and comparatively strong predictors of general drinking behavior, with recent evidence indicating that they are also associated with pregaming.We tested the hypothesis that higher descriptive norms for pregaming frequency would be associated with personal pregaming frequency. We also tested whether this effect would be stronger in the context of several theory-based moderators: female gender, higher injunctive norms (i.e., perceptions of others' attitudes toward a particular behavior), a more positive attitude toward pregaming, a stronger sense of identification with the drinking habits of other students, and stronger social comparison tendencies.College student drinkers (N = 198, 63% female) participated in an online survey assessing frequency of pregaming, descriptive norms, and hypothesized moderators.A multiple regression model revealed that higher descriptive norms, a more positive attitude toward pregaming, and stronger peer identification were significantly associated with greater pregaming frequency among drinkers. However, no moderators of the association between descriptive norms and pregaming frequency were observed.Descriptive norms are robust predictors of pregaming behavior, for both genders and across levels of several potential moderators. Future research seeking to understand pregaming behavior should consider descriptive norms, as well as personal attitudes and identification with student peers, as targets of interventions designed to reduce pregaming.

A precollege history of sexual victimization predicts revictimization during college, making it important to understand the mechanisms underlying the victimization-to-revictimization pathway. The study aimed to test whether heavy episodic drinking and personal and peer hookup norms mediate revictimization for two types of unwanted sexual contact: sexual coercion (attempted and/or completed sexual assault by the use of verbal coercion) and sexual assault (attempted and/or completed sexual assault by the use of force, threats, or incapacitation). At college entry, 483 first-year college women completed self-report measures of their precollege experiences, including history of sexual victimization and health behaviors (i.e., alcohol use, personal and peer hookup norms). At the end of the first and second semesters, they also completed measures assessing incident sexual victimization. Nearly one half of women (48%) reported an experience of attempted or completed sexual coercion or assault prior to entering college; 33% endorsed sexual coercion and 15% endorsed sexual assault in their first year of college. Structural equation models demonstrated that heavy episodic drinking and personal and peer hookup norms partially mediated revictimization for sexual assault, but not for sexual coercion. Sexual coercion was the most common tactic leading to unwanted sexual contact in this sample. Alcohol use and personal and peer hookup norms mediated revictimization by force, threats, or incapacitation. In contrast, the hypothesized mediators did not explain the revictimization pathway for verbally coerced assaults. Given the prevalence of sexual coercion, research needs to identify risk factors for verbal coercion to guide prevention efforts.

Sexual behavior is associated with increased positive affect and decreased negative affect. However, contextual variables such as partner type, behavior type, and condom use may moderate these associations. The goal of the present research was to examine these contextual moderators using monthly longitudinal data from a sample of young women. Female, first-year college students (N = 477) completed monthly assessments of their sexual behaviors and positive and negative affect. Participants reported more negative affect in months they engaged in sexual behavior compared to months they did not. This association was moderated by partner type, such that only sexual behavior with casual partners was associated with increased negative affect. Participants reported more positive affect during months with kissing/touching only compared to months without sexual behavior; however, this association did not differ significantly from the association between oral/vaginal sex and positive affect. Condom use did not moderate the association between vaginal sex and positive or negative affect. In this sample of young women transitioning to college, engaging in sexual behavior was generally associated with negative affect; however, changes in affect depended on partner type and sexual behaviors. Findings have implications for sexual health education.

Blackouts (periods of alcohol-induced anterograde amnesia) are common among young adults and place individuals at significant risk for alcohol-related harm; thus, researchers have advocated for increased efforts to educate young adults on blackouts. This qualitative study examined college student knowledge of blackouts as well as their ideas for intervening on blackout drinking behavior in order to inform prevention and intervention efforts. College students who had experienced a blackout in the past 6 months participated in eight focus groups, stratified by gender (N = 50, five to eight/group, 56% female). Discussions followed a semistructured agenda. Audio recordings were transcribed verbatim and coded using applied thematic analysis. Themes related to knowledge were reviewed in comparison to the empirical literature. Empirically derived risk factors for blackouts included biology (e.g., genetics, biological sex), drinking behavior (i.e., rate of consumption), other drug use, and "indirect" influences (e.g., pregaming, drinking location). Participants' knowledge of the risk factors for blackout was inconsistent and, in some cases, inaccurate. While participants generally understood the behavioral risk factors for blackouts, they demonstrated less understanding of the role of genetics, biological sex, drinking speed (vs. quantity), and other drug use. They also identified dehydration and sleep as perceived risk factors for blackout. They suggested avenues for intervention at the policy (e.g., amnesty policies), peer (e.g., expressing concern), and individual (e.g., education) levels. College students with a history of blackout have limited understanding of the biological risk factors for blackout. These knowledge gaps represent targets for intervention. Findings indicate promise for blackout-specific interventions. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Blackouts (i.e., alcohol induced memory impairment) are common among college student drinkers, and they are associated with several additional harms. However, alcohol consequences are not perceived universally as negative by the students who experience them, and little is known regarding students' specific thoughts and feelings about blackouts. We conducted a series of single-gender focus groups (8 groups; 5–8 per group; n = 50, 56% female) with college student drinkers. Questions focused on: (a) their subjective evaluations of blackouts and (b) factors influencing those evaluations (i.e., what determines whether a blackout is perceived as a negative/neutral/positive experience). Verbatim transcripts were content analyzed using applied thematic analysis with NVivo software. Evaluations of blackouts were primarily negative, with some notable positive, neutral and mixed reactions. Influences on blackout evaluations included those demonstrated as influential on broader alcohol consequences in prior work (e.g., normative perceptions, social context). However, some contextual influences on evaluations that may be specific to blackouts included pre-blackout events, the objective severity (extent/length) of memory loss, what participants later learned had happened during the blackout, and whether or not they had expected to blackout. Findings provide insight into why some students are not necessarily concerned with blackout experiences.

OBJECTIVE. Brief Motivational Interventions (BMI) reduce drinking in the short term, but these initial effects often decay. We tested the hypothesis that theory-based email boosters would promote maintenance of change after a BMI. METHOD. Participants were students (N = 568; 72% male) who violated campus alcohol policy and were mandated to participate in an alcohol risk reduction program. Participants provided baseline data, received a BMI, and then completed a 1-month post-BMI survey. Next, they were randomized to receive 12 booster emails that contained either (a) alcohol norms, or (b) structurally equivalent general health information (control). Alcohol consumption and alcohol-related consequences were assessed at baseline, 1-, 3-, 5-, 8-, and 12-months. RESULTS. As expected, we observed significant reductions in both consumption and consequences after the BMI (ps < .01), and groups were equivalent at baseline and at 1-month post-BMI, prior to randomization (ps > .05). Latent growth curve models revealed no condition effects on changes in the latent consumption variable from 1- to 12-month follow-ups (B = .01, SE = .01, p > .05). Unexpectedly, a main effect of the condition emerged for self-reported consequences (B = .03, SE = .01, p = .01); we observed more consequences after boosters containing alcohol norms than general health information. Outcomes were not moderated by sex, consumption at baseline or 1-month, or email exposure, and there was no mediation by descriptive norms, injunctive norms, or peer communication. CONCLUSIONS. Contrary to predictions, email boosters with corrective norms content did not improve outcomes after a BMI.

College students may subjectively evaluate the consequences of drinking in unexpected ways, rating "negative" consequences as neutral or even positive experiences. We previously gathered qualitative evidence for several contextual factors that may influence one's subjective evaluations (e.g., social influences, intoxication level, concurrent positive consequences). The purpose of the present study was to quantitatively investigate whether student evaluations of consequences differ by various contextual factors. We administered an anonymous online survey to 214 college students (76% female, 69% drinkers, 48% heavy drinkers) in return for academic credit, on which they reported how positively or negatively they would evaluate 6 alcohol-related consequences (e.g., vomiting, being rude, blacking out) under different conditions. Paired samples t tests were used to compare evaluation ratings, averaged across consequences, under different hypothetical contextual conditions (e.g., among friends vs. strangers). Out of 16 contextual comparisons, all but one (first-time vs. repeated consequence) revealed significant differences in subjective evaluations; the pattern held in reduced samples of just drinkers or just heavy drinkers. Examples include that consequences were viewed more negatively (a) if occurring at either a party or bar versus alone in one's home/dorm, (b) if friends express concern versus find it funny, (c) if the consequence was expected versus unexpected, and (d) if there are lasting consequences versus none. When using recent consequences in feedback-based interventions to build motivation to change, it may be useful to discuss the context of a consequence and how this influences the perceived aversiveness of that consequence. (PsycINFO Database Record

OBJECTIVE:Brief motivational interventions (BMIs) are currently the most efficacious individual intervention for mandated college students. However, little is known about how BMIs facilitate client language in relation to subsequent changes in alcohol use and problems in mandated student samples. METHOD:The current study used the Motivational Interviewing Skills Code (MISC 2.0; Miller, Moyers, Ernst, & Amrhein, 2003) to code BMI sessions (N = 252) from 2 randomized clinical trials that led to significant reductions in alcohol use and alcohol-related problems in mandated student drinkers. A proportion of change language was calculated for each decile (1st to 10th) of the BMI sessions. RESULTS:Latent class analyses of in-session speech indicated that there were 3 distinct trajectories of change language over the course of the session: high (n = 59), increasing (n = 122), and low (n = 71). Members of the high trajectory group showed higher rates of alcohol-related problems prior to the BMI and members of the low trajectory group were more likely to be male. Six months following the BMI, members of the high and low trajectory groups demonstrated significant reductions in alcohol use and problems, and members of the increasing trajectory group only reduced alcohol-related problems. CONCLUSIONS:Associations among the 3 trajectories of client change language and subsequent reductions in alcohol use and problems partially supported the technical hypothesis of MI efficacy. Client factors as well as the nature of the discussion of personalized feedback may determine the link between in-session client language and subsequent behavior change. (PsycINFO Database Record

The current study tests individual differences in response to a mandated brief motivational intervention (BMI) for college student drinking. Participants consisted of 99 (45% female) students who were referred for violating campus alcohol policy. Within-subject analyses suggest that the BMI led to a significant reduction in frequency of drinking and alcohol-related problems at the 1-month follow-up, with a nonsignificant trend in reduction of quantity of drinking and no difference in maximum level of drinking. However, there was a statistically significant amount of variability in response to the BMI across frequency, quantity, maximum, and alcohol-related problems. Individual differences in self-regulation and the strength of the therapeutic relationship were used to predict variability in change associated with participating in the intervention. Lower levels of self-regulation predicted more alcohol-related problems at 1 month following the BMI. A stronger therapeutic relationship predicted lower frequency, quantity, and maximum level of drinking at 1 month following the BMI. At the 12-month follow-up, there was a significant decay in the efficacy of the intervention, with a statistically significant amount of variability across all outcomes. Lower self-regulation was associated with more problems at 12 months. Individual differences in the therapeutic relationship were not associated with decay of efficacy between 1 and 12 months across any of the outcome variables. Results are consistent with both etiological heterogeneity and common factors models of the efficacy of psychotherapy, and extend these models to explaining outcomes of brief alcohol interventions in students mandated to treatment. (PsycINFO Database Record