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Abstract Background Advances in technology and the scientific understanding of disease processes are presenting new opportunities to improve health through individualized approaches to patient management referred to as personalized medicine. Future health care strategies that deploy genomic technologies and molecular therapies will bring opportunities to prevent, predict, and pre-empt disease processes but will be dependent on knowledge management capabilities for health care providers that are not currently available. A key cornerstone to the potential application of this knowledge will be effective use of electronic health records. In particular, appropriate clinical use of genomic test results and molecularly-targeted therapies present important challenges in patient management that can be effectively addressed using electronic clinical decision support technologies. Discussion Approaches to shaping future health information needs for personalized medicine were undertaken by a work group of the American Health Information Community. A needs assessment for clinical decision support in electronic health record systems to support personalized medical practices was conducted to guide health future development activities. Further, a suggested action plan was developed for government, researchers and research institutions, developers of electronic information tools (including clinical guidelines, and quality measures), and standards development organizations to meet the needs for personalized approaches to medical practice. In this article, we focus these activities on stakeholder organizations as an operational framework to help identify and coordinate needs and opportunities for clinical decision support tools to enable personalized medicine. Summary This perspective addresses conceptual approaches that can be undertaken to develop and apply clinical decision support in electronic health record systems to achieve personalized medical care. In addition, to represent meaningful benefits to personalized decision-making, a comparison of current and future applications of clinical decision support to enable individualized medical treatment plans is presented. If clinical decision support tools are to impact outcomes in a clear and positive manner, their development and deployment must therefore consider the needs of the providers, including specific practice needs, information workflow, and practice environment.

Despite various intervention efforts, college drinking remains a concern, and while personalized normative feedback (PNF) has proven effective, attempts to deliver it in a way that minimizes reactance and maximizes student engagement have been slow to emerge. This study examined the short-term effects of CampusGandr, a mobile gamified PNF intervention for college students. The game took place over 16 weeks (1 round per week) during the fall semester and included weekly PNF on various topics related to college life, including alcohol. Participants (N = 1,143) were recruited from universities in Texas and California and randomized into one of three conditions: no alcohol feedback (NAF), less alcohol feedback (LAF; delivered in 3 rounds), and more alcohol feedback (MAF; delivered in 6 rounds). Number of alcohol and non-alcohol feedback participants viewed was objectively tracked in CampusGandr. Relative to NAF, there were no significant effects for LAF or MAF on descriptive drinking norms or on drinking (any drinks consumed and typical number of drinks per week consumed) one-month post-intervention. However, a significant quadratic effect emerged between the number of alcohol feedbacks viewed and having consumed any drinks, indicating decreased odds of having consumed any alcohol at the follow-up with up to three alcohol feedbacks. Number of alcohol feedbacks viewed was also related to decreases in norms. Thus, despite a lack of evidence for differences in drinking between conditions, findings suggest future research is needed to explore the optimal dosage and timing of alcohol feedback within gamified interventions like CampusGandr., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025. Published by Elsevier Ltd.)

Objective: Previous work has investigated parents' reports of motives for communicating with their young adults about alcohol. While parents' self-reported motives may predict intentions to communicate, young adults' perceptions of their parents' motives may be important for understanding young adults' responses to parent alcohol communication. The present study was conducted to explore college students' perceptions of their parents' motives for alcohol communication and to investigate whether perceptions of these motives predict changes in alcohol consumption and related consequences during the transition to college., Method: First-year college students (N = 306) participated in a longitudinal survey study. Baseline measures at pre-matriculation (T1) included assessments of student perceptions of their parents' motives for alcohol communication and covariates (e.g., perceived peer descriptive drinking norms, parental modeling and alcohol communication, and drinking and consequences). At a 1-month follow-up (T2), students reported on their alcohol use and consequences., Results: Controlling for other predictors of college student drinking, results indicate that for each one-unit increase in perceived parental reactive communication motives, the incidence rate of typical weekly drinking increased by 9%, and heavy episodic drinking (HED) increased by 21%. Conversely, the incidence rate of HED decreased by 27% for each one-unit increase in perceived maternal family history communication motives., Conclusions: These findings suggest that college students' perceptions of their parents' motives for alcohol communication can significantly influence their drinking behavior during the transition to college.

Objective: Although previous research has established that students who perceive that their parents have lower drinking limits on underage drinking consume less alcohol, optimal approaches for effectively communicating these limits are less understood. To address this gap in the literature, the present study examined the effects of hypothetical limit-focused text messages on estimated drinking behavior., Method: Undergraduate college students ( N = 253) completed an online survey in which they were instructed to imagine a scenario in which they were planning to go out at night to an event involving drinking. Participants were randomly assigned to a condition in which they would receive one of four hypothetical text messages from their mother and/or father containing a range of drinking limits. They were then asked to report how much alcohol they would realistically consume on this night if they were and were not obligated to check in with their parent at the end of the night., Results: Hypothetical text messages from mothers and fathers containing lower drinking limits resulted in lower estimated alcohol consumption. A drinking limit of zero resulted in the least amount of expected alcohol consumption, but specifying 1-2 drinks as a limit might produce a similar effect if parents also required their student to check in at the end of the night., Conclusions: Findings from this study provide initial support for future studies to investigate the effects of limit-setting text messages sent from parents on college student drinking as well as the effects of text messages sent from parents requiring that students check in.

Most alcohol intervention research focuses on program efficacy, yet few studies have investigated the acceptability of a program's design and implementation to the target population or adapting existing alcohol interventions to different populations. To address these gaps in the literature, we (1) examined participant responsiveness to and implementation quality of FITSTART+, a web-app delivered parent-based alcohol intervention designed for incoming first-year college students in the United States, and (2) gathered feedback on how this intervention could be adapted to other populations of parents. A sample of U.S. parents of 17-20-year-old first-year college students (N = 109) participated in FITSTART+ during their child's first year of college and completed a survey about parents' responsiveness to the app and its quality. Next, a sample of non-U.S. parents of adolescents aged 13 to 19 (N = 44) participated in one of 11 focus groups in which they briefly explored the app and then discussed how it could be adapted to be applicable and culturally relevant for them and their context. Results revealed that U.S. parents rated the intervention's quality as high and parents were responsive to the web-app's content, but some did not visit one of the most critical aspects of the intervention (i.e., alcohol-related parenting resources). Non-U.S. participants provided a range of suggestions for adapting the intervention to their context, which varied by culture. Results identify areas for improvement, particularly regarding the use of alcohol-related parenting resources, in this intervention and for web-delivered PBIs more broadly., (© 2024. The Author(s).)

Parent communication can be protective against cannabis use among young adults. However, changes in parent-student communication frequency naturally occur during the transition from high school to college. Recent research suggests declines in parent-student communication frequency predict increased drinking and consequences during the first year of college, yet these effects on other risky behaviors are unknown. The current study investigated whether post-matriculation changes in frequency of texting/calling with parents predict cannabis use and simultaneous use of cannabis and alcohol, and whether pre-matriculation cannabis and simultaneous use predict changes in communication. First-year students ( N = 287, 61.3% female, 50.9% White) reported cannabis and simultaneous use pre- and post-matriculation (T1 & T3) and changes in frequency of texting/calling their mother/father per day (T2). Negative binomial hurdle models examined whether T2 changes in communication frequency predicted T3 cannabis and simultaneous use, and logistic regression models examined whether T1 cannabis and simultaneous use predicted T2 changes in communication frequency. Results revealed that increasing (vs. decreasing) frequency of calling with mothers and texting with fathers was protective against cannabis use, whereas increasing frequency of calling with fathers was associated with greater risk of use. Changes in communication did not significantly predict simultaneous use, nor did pre-matriculation cannabis or simultaneous use predict changes in either mode of communication with parents during the college transition. These findings highlight that changes in mother and father communication may be both beneficial and detrimental to cannabis use depending on the parent and mode of communication. Implications for these findings are discussed., Competing Interests: All authors declare that they have no conflicts of interest., (© 2024 Authors et al.)

Objective: This study evaluated FITSTART+, a parent-based intervention (PBI), for preventing risky drinking among first-year college students. Participants: Participants were traditional first-year students aged between 17 and 20. Method: In total, 391 eligible students completed a baseline survey and their parents were then invited to use the FITSTART+ PBI or Control web-applications. 266 students had a parent who created a profile in the app (FITSTART+ PBI, n  = 134; FITSTART+ Control, n  = 132). Additionally, 58 parents randomized to the FITSTART+ PBI did not complete the personalized normative feedback (PNF) component of the intervention. Results: No significant effect on drinking or related consequences was detected between Intervention and Control groups. However, exploratory analyses revealed that completing PNF in the FITSTART+ PBI condition was associated with a greater likelihood of remaining zero on consequences at follow-ups. Conclusion: The PNF component of the FITSTART+ PBI showed potential in preventing risky drinking, warranting further research.

Objective: We examined (a) whether changes in parent-student phone call and text messaging communication during the transition into college are associated with alcohol use and related consequences, and (b) whether pre-matriculation drinking patterns predicted these changes in parent-student communication., Method: First-year students ( n = 246; M age [ SD ] = 17.91 [0.39] years; 61.8% female) participated in a longitudinal survey study as a part of a larger study. Before matriculation (Time 0), participants reported their drinking and whether they experienced alcohol consequences in the past 30 days. Approximately 1 month into their first semester (Time 1), participants reported if the frequency of their calling and texting their parents had decreased, remained the same, or increased since the start of college. Drinking and consequences were then reassessed 4 months later (Time 2). Analytic models evaluated (a) whether a decrease in calling and texting parents, as reported by students (compared with an increase or no change), predicted drinking outcomes, and (b) whether pre-college drinking (compared with nondrinking) predicted changes in communication., Results: Changes in phone calls and texting with mothers and fathers during the first month of college predicted alcohol use and consequences into the second semester. In addition, heavy drinking predicted lower odds of texting frequency with mothers staying the same or increasing., Conclusions: This study underscores that consistent call or text communication with students during their transition into college could serve as a protective factor against alcohol risk. By closely monitoring such communication, parents may be better equipped to identify potential signs of risky drinking behavior in their first-year students.

Background: Depression is prevalent among adolescents and young adults and is associated with experiencing increased negative alcohol-related consequences; thus, it is imperative to identify malleable protective factors for alcohol risks in young adults experiencing elevated depressive symptoms. The current study longitudinally explored the effects of perceived parental alcohol-related discipline on the relationship between depressive symptoms, alcohol use, and negative drinking consequences during the transition into college., Methods: Incoming college students ( N = 272, 63.2% female) completed web-based surveys before (July, T1) and after (October, T2) the transition into college and reported depressive symptoms, perceived alcohol-related discipline, alcohol use, and consequences of drinking experienced in the past 30 days., Results: The moderated mediation model revealed that at above average perceptions of alcohol-related discipline, depressive symptoms were negatively associated with alcohol use, which in turn was associated with experiencing fewer negative consequences of drinking., Limitations: The current study did not measure a diagnosis of major depressive disorder, and therefore our results may differ among clinical populations. In addition, we did not measure other parenting constructs shown to protect students with elevated levels of depressive symptoms from experiencing consequences (i.e., monitoring)., Conclusions: The present findings suggest perceptions of parental alcohol-related discipline measured here (e.g., having a privilege taken away, being scolded or grounded) can be protective against alcohol risks among college students experiencing above average depressive symptoms. Parent-based alcohol interventions administered prior to matriculation should encourage parents of depressed students to clearly communicate consequences for drinking to their child., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Objective: This study explored the burgeoning youth practice of possessing a fake, secondary Instagram account known as a "Finsta" in relation to exposure to alcohol-related content and college drinking., Participants: First-year university students with at least a primary Instagram account ( N  = 296) completed online surveys., Method: Surveys assessed whether participants did or did not have a Finsta pre-matriculation (T1), Instagram alcohol content exposure one month into college (T2), and alcohol use at T1 and near the end of the first year (T3)., Results: Moderated mediation analysis revealed that having a Finsta at T1 was associated with greater exposure to alcohol-related posts at T2 and, for male but not female students, predicted heavier drinking at T3., Conclusion: Findings are consistent with previous results suggesting that males may be more behaviorally impacted by peers' depictions of alcohol use on social media. This carries implications for social media-based intervention efforts targeting first-year students.

While adolescents and underage emerging adults typically obtain alcohol from social sources (e.g., parents, friends, parties), taking alcohol from the home without permission is not well understood. The current study investigated plausible individual characteristics associated with taking alcohol from one's parents' home without permission and associations between taking alcohol and drinking, alcohol consequences, and marijuana use. Two cohorts of alcohol-experienced underage emerging adults (N = 562) completed a web-based survey pre-college matriculation. Participants reported sources of alcohol (friend, mother, father, party, took it from home); drinking; consequences; marijuana use (ever and past 30 days); age of alcohol initiation; symptoms of depression, anxiety, and stress; parental modeling of drinking; and demographic information. Results revealed that taking alcohol was significantly associated with several of the measures examined here (e.g., having obtained alcohol from friends, parents, and parties; earlier age of alcohol initiation; parental modeling of alcohol). Having taken alcohol from the home without permission and obtained it from friends were uniquely associated with increased odds of typical weekly drinking, consequences, and marijuana use in the past 30 days when controlling for all other variables assessed in this study (including drinking, in the consequences and marijuana models). Parent-based interventions targeting adolescents and emerging adults should inform parents of the risks associated with taking alcohol from the home and obtaining it from friends. Further, parents should also be informed that supplying their adolescent with alcohol or modeling drinking may increase the likelihood that they take alcohol from their home., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Previous research has shown a reliable association between social media (SM) use and drinking among college students. However, most studies have investigated SM behaviors (e.g., time spent on a platform, posting frequency) in isolation and on a single site. While some have studied multiple SM behaviors across platforms using person-centered approaches (e.g., latent profile analysis [LPA]), these studies have failed to take alcohol-related SM behaviors into account. This longitudinal study addressed this gap in the literature by using LPA to identify subpopulations of SM users during the college transition (N = 319; 62.1% female) using general (frequency of checking, time spent on, and frequency of posting to Instagram/Facebook/Snapchat; Finstagram ownership) and alcohol-related SM behaviors (posting alcohol, partying, and marijuana content). LPA results revealed three SM user profiles at baseline: low general use with low alcohol-related posting (LGU + LAP), high general use with low alcohol-related posting (HGU + LAP), and high general use with high alcohol-related posting (HGU + HAP). Prospective analyses revealed that HGU + HAP membership was associated with greater descriptive peer drinking norms, alcohol use, and consequences relative to HGU + LAP and LGU + LAP membership. Results suggest that there are distinct patterns of general and alcohol-related SM use during the college transition associated with risky drinking that can inform interventions combating SM-related alcohol risks. These findings illustrate the importance of investigating SM use holistically and suggests studying alcohol-related SM behaviors may reveal differences in individuals' alcohol risk that general SM behaviors might not capture., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Stigma-related stress and inflated perceptions of substance use norms are positioned in the literature as theoretically distinct explanations for disproportionate substance use among sexual minorities. As research has yet to examine how these variables may interact in an intervention context, this study examined the impact of recent experiences with violence and harassment due to sexual minority status (i.e., interpersonal stigma exposure) on the effectiveness of a culturally adapted personalized normative feedback intervention for lesbian, bisexual, and queer (LBQ) women. A sub-sample of 499 moderate-to-heavy drinking LBQ women were randomized to receive personalized normative feedback (PNF) on alcohol use or control topics within a broader digital competition designed to challenge negative LBQ stereotypes. At baseline, recent interpersonal stigma exposure strengthened the relationship between perceived LBQ alcohol-related norms and participants' own alcohol-related behaviors (i.e., consumption and consequences). At follow-up, 3 months later, recent interpersonal stigma exposure moderated the effectiveness of alcohol PNF with substantially less drinking and consequences among participants in the treatment condition reporting recent violence or harassment due to sexual minority status, relative to those reporting no such experiences. Underscoring the utility of PNF for LBQ women and potentially other heavy drinking stigmatized populations, findings suggest that a greater tendency to conform to over-estimated ingroup drinking norms may be another way in which minority status-based violence and harassment contributes to alcohol consumption in stigmatized populations., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Public health researchers are increasingly interested in the potential relationships between social media (SM) use, well-being, and health behavior among adolescents. However, most research has assessed daily SM time via self-report survey questions, despite a lack of clarity around the accuracy of such reports given the current tendency of youth to access SM on multiple electronic devices and cycle between multiple SM platforms on a daily basis (i.e., platform swinging). The current study investigates the potential for systematic reporting biases to skew findings. Three hundred and twenty incoming college students downloaded software on their computers, tablets, and smartphones to track their active use of Facebook, Twitter, Instagram, and Snapchat over a 2-week surveillance period and then self-reported their average daily minutes on each platform immediately after. Larger proportions of students over-estimated than under-estimated their use, with the largest overestimations found on the most heavily used platforms. Females logged significantly more SM time and were less accurate in reporting than were males and, independently, the likelihood of substantial inaccuracies in reporting total SM time and time on most individual platforms increased with each additional SM platform participants reported using. Findings demonstrate that self-reported estimates of SM time among adolescents in the age of SM platform swinging are prone to substantial error and may lead to biased conclusions about relationships between variables. Alternative measurement approaches are suggested to improve the validity of future research in this area.

Parent-based interventions (PBIs) and living at home with one's parents both have been shown to mitigate alcohol risk associated with the first year of college. The current study extends these findings by examining the independent and interactive effects of these two constructs on first-year drinking. The sample included 82 parent-student dyads. Parents were randomized to receive an online PBI that either did (intervention; n = 44) or did not (n = 38) include alcohol-related content in December 2020. Students completed online surveys assessing college residence and drinking (typical weekly and peak) in August 2020 (T1) and February 2021 (T2). Hierarchical zero-inflated Poisson models assessed the main and interaction effects of having a parent in the intervention group (vs control) and living with parents (vs without) on drinking outcomes, controlling for T1 alcohol use. Results revealed that living with parents predicted decreases in typical weekly drinking and having a parent in the intervention predicted decreases in the number of drinks consumed on one's peak drinking occasion at T2. Treatment*residence was also significantly associated with typical weekly drinking in the inflated model. These results suggest that moving out was associated with a greater likelihood of not drinking during a typical week if students had a parent in the intervention and a lower likelihood of not drinking during a typical week if they had a parent in the control application. Together, findings support continued exploration of this online PBI as it appears to reduce peak drinking during the first year of college and reduces the odds of students drinking during a typical week when they move out of their parents' home., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Sexual minority women disproportionately engage in heavy drinking and shoulder the burden of alcohol dependence. Although several intensive interventions are being developed to meet the needs of treatment-seeking sexual minority women, there remains a lack of preventive interventions to reduce drinking and its consequences among women not yet motivated to reduce their alcohol consumption., Objective: We aimed to examine the feasibility and efficacy of reducing alcohol-related risks via personalized normative feedback (PNF) on alcohol use and coping delivered within LezParlay, a social media-inspired digital competition designed to challenge negative stereotypes about lesbian, bisexual, and queer (LBQ)-identified sexual minority women., Methods: Feasibility was assessed by examining engagement with LezParlay outside the context of an incentivized research study, assessing the characteristics of the LBQ women taking part, and examining the competition's ability to derive risk-reducing actual norms as well as levels of acceptability and perceived benefits reported by participants. Intervention efficacy was examined by randomizing a subsample of 499 LBQ alcohol consumers (ie, drinkers) already taking part in the competition to receive sexual identity-specific PNF on alcohol use and coping, alcohol use only, or control topics over only 2 rounds of play. Changes in alcohol use and negative consequences were examined 2 and 4 months after the delivery of treatment PNF., Results: A total of 2667 diverse LBQ women played ≥1 round of LezParlay. The competition attracted large numbers of moderate and heavy drinkers; however, risk-reducing actual norms could still be derived from competition rounds and featured in PNF. Efficacy results revealed that drinkers who received PNF on alcohol use and both alcohol use and coping had similar reductions in their weekly drinks (P=.003; P<.001), peak drinks (P<.001; P<.001), and negative consequences (P<.001; P<.001) relative to those who received PNF on control topics at the 2-month follow-up. However, at the 4-month follow-up, reductions in alcohol consumption outcomes faded among those who received alcohol PNF only (weekly: P=.06; peak: P=.11), whereas they remained relatively robust among those who received PNF on both alcohol use and coping (weekly: P=.02; peak: P=.03). Finally, participants found the competition highly acceptable and psychologically beneficial as a whole., Conclusions: The LezParlay competition was found to be a feasible and efficacious means of reducing alcohol-related risks in this population. Our findings demonstrate the utility of correcting sexual identity-specific drinking and coping norms to reduce alcohol-related risks among LBQ women and suggest that this approach may also prove fruitful in other stigmatized health disparity populations. To engage these populations in the real world and expand the psychological benefits associated with PNF, our findings also point to packaging PNF within a broader, culturally tailored competition designed to challenge negative group stereotypes., Trial Registration: ClinicalTrials.gov NCT03884478; https://clinicaltrials.gov/ct2/show/NCT03884478., International Registered Report Identifier (irrid): RR2-10.2196/24647., (©Sarah C Boyle, Joseph W LaBrie, Bradley M Trager, Lauren D Costine. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 13.05.2022.)

When exposed to complementary features of information across sensory modalities, our brains formulate cross-modal associations between features of stimuli presented separately to multiple modalities. For example, auditory pitch-visual size associations map high-pitch tones with small-size visual objects, and low-pitch tones with large-size visual objects. Preferential, or congruent, cross-modal associations have been shown to affect behavioural performance, i.e. choice accuracy and reaction time (RT) across multisensory decision-making paradigms. However, the neural mechanisms underpinning such influences in perceptual decision formation remain unclear. Here, we sought to identify when perceptual improvements from associative congruency emerge in the brain during decision formation. In particular, we asked whether such improvements represent 'early' sensory processing benefits, or 'late' post-sensory changes in decision dynamics. Using a modified version of the Implicit Association Test (IAT), coupled with electroencephalography (EEG), we measured the neural activity underlying the effect of auditory stimulus-driven pitch-size associations on perceptual decision formation. Behavioural results showed that participants responded significantly faster during trials when auditory pitch was congruent, rather than incongruent, with its associative visual size counterpart. We used multivariate Linear Discriminant Analysis (LDA) to characterise the spatiotemporal dynamics of EEG activity underpinning IAT performance. We found an 'Early' component (∼100-110 ms post-stimulus onset) coinciding with the time of maximal discrimination of the auditory stimuli), and a 'Late' component (∼330-340 ms post-stimulus onset) underlying IAT performance. To characterise the functional role of these components in decision formation, we incorporated a neurally-informed Hierarchical Drift Diffusion Model (HDDM), revealing that the Late component decreases response caution, requiring less sensory evidence to be accumulated, whereas the Early component increased the duration of sensory-encoding processes for incongruent trials. Overall, our results provide a mechanistic insight into the contribution of 'early' sensory processing, as well as 'late' post-sensory neural representations of associative congruency to perceptual decision formation., Competing Interests: Declaration of Competing Interest The authors declare no competing interests., (Copyright © 2021. Published by Elsevier Inc.)

Background: The purpose of this study was to address a dearth in the literature on non-response bias in parent-based interventions (PBIs) by investigating parenting constructs that might be associated with whether a parent volunteers to participate in a no-incentive college drinking PBI. Method: Incoming first-year students (N = 386) completed an online questionnaire that included items assessing plausible predictors of participation in a PBI (students' drinking, perceptions of parents' harm-reduction and zero-tolerance alcohol communication, whether parents allowed alcohol, and changes in parents' alcohol rules). Four months later, all parents of first-year students at the study university were invited to join the PBI, which was described as a resource guide to teach them how to help their student navigate the college transition and prepare them for life at their university. Results: Parents who signed up for the intervention used greater harm-reduction communication than those who did not sign up, were more likely to have allowed alcohol use, and signing up was significantly associated with student reports that fathers became less strict toward drinking after high school. Students' drinking and zero-tolerance communication did not significantly differ between the groups. Conclusion : Results indicate that non-response bias can be an issue when utilizing a real-world, non-RCT recruitment approach to invite parents into a PBI (i.e., non-incentivized, inviting all parents). Findings suggest that more comprehensive recruitment strategies may be required to increase parent diversity in PBIs.

Backround: Research suggests that the social media platforms popular on college campuses may reflect, reinforce, and even exacerbate heavy drinking practices among students. The present study was designed to directly examine: (1) whether exposure to alcohol-related content on social media diminishes the efficacy of a traditional web-based personalized normative feedback (PNF) alcohol intervention among first-year drinkers; and (2) if social media inspired features and digital game mechanics can be integrated into a PNF intervention to combat social media-based alcohol influence and increase efficacy., Method: Alcohol experienced first-year college students (N = 223) completed a pre-survey that assessed exposure to alcohol-related content and social media and were randomized to 1 of 3 web-based alcohol PNF conditions (traditional, gamified only, or social media inspired gamified). One month later, participants' alcohol consumption was reassessed., Results: Among participants who received traditional PNF, social media-based alcohol exposure interacted with pre-intervention drinking such that traditional PNF was less effective in reducing drinking among heavier drinkers reporting greater exposure to alcohol-related social media content. Further, when regression models compared the efficacy of all three conditions, the social media inspired gamified PNF condition was significantly more effective in reducing drinking than was traditional PNF among moderate and heavy drinkers reporting greater exposure to alcohol on social media., Conclusion: Although additional research is needed, these findings suggest that representing the population of students on whom normative statistics are based with social media-like user avatars and profiles may enhance the degree to which alcohol PNF is relatable and believable among high-risk students., (Copyright © 2021. Published by Elsevier B.V.)

Previous research suggests that exposure to alcohol-related content on social media sites (SMSs) may inflate perceptions of drinking norms, thereby increasing drinking among college students and potentially undermining popular social norms-based alcohol interventions. However, prior research on exposure has used subjective measures of alcohol exposure and has focused mostly on Facebook. The current study focused on Instagram, a popular SMS among college students, and utilized objective time tracking and newsfeed sampling methods to rigorously examine the prospective relationship between exposure to alcohol-related Instagram content (ARIC), alcohol cognitions, and drinking. Participants were 309 matriculating college students (M age  = 18.1, SD = 0.26; 62.1% female; 46.9% White/Caucasian; 17.5% Hispanic) who had their Instagram use tracked and newsfeeds sampled via a macro several times during the transition into college (August & September), and completed a baseline survey and two follow-up surveys. A sequential mediation model examined theoretically derived pathways between objective ARIC exposure and alcohol use. Results revealed that objective ARIC exposure during the transition to college was positively associated with drinking at the end of the first year of college, and subjective frequency of ARIC exposure mediated this relationship between objective ARIC exposure and later drinking. Subjective frequency of ARIC exposure also mediated the association between objective ARIC exposure and perceptions of descriptive norms, which, in turn, predicted later drinking. These findings illustrate that greater objective ARIC exposure during the transition into college may increase risky drinking over the first year via increased subjective frequency of ARIC and elevated perceptions of drinking norms. Priority directions for future research are discussed and several novel ways in which social norms-based interventions for first-year students may be enhanced to better combat ARIC-related influences are introduced., (Copyright © 2021. Published by Elsevier Ltd.)

Objective: Previous research has linked social media involvement and alcohol use among college students. However, this literature has been limited by self-report measures of social media use, cross-sectional data, inadequate attention to potential moderators and mediators, and unclear implications for interventions. To improve and extend this work, students' (N = 297) daily time on Facebook, Twitter, Instagram, and Snapchat during the transition into college were assessed objectively and examined as predictors of later drinking., Method: Time spent on social media overall and on each individual platform between August and September were examined as predictors of alcohol consumption in March. Perceptions of peer drinking norms in October were examined as a potential mediator of these relationships, and sex as a potential moderator., Results: Students spent the most daily time on Snapchat, followed by Instagram. The results indicated that among men, but not women, daily social media time during the transition into college predicted second semester drinking. This relationship was mediated by perceptions of same-sex student drinking norms. Analysis of individual platforms revealed that daily time on Snapchat drove the relationships among men., Conclusions: Greater time on social media during the transition to college, and on Snapchat in particular, predicted increases in perceptions of peer drinking norms and, in turn, greater alcohol consumption among men only. These findings carry precise implications for interventions seeking to reduce alcohol-related risks among first-year men and underscore the need for additional research examining developmental factors and social media user experiences that may explain the sex-specific patterns of relationships observed.

Background: Sexual minority women are more likely to drink alcohol, engage in heavy drinking, and experience alcohol-related problems than heterosexual women. However, culturally tailored interventions for this population have been slow to emerge., Objective: This type 1 effectiveness-implementation trial examines the feasibility and efficacy of a gamified, culturally tailored, personalized normative feedback (PNF) alcohol intervention for sexual minority women who psychologically identify as lesbian, bisexual, or queer (LBQ)., Methods: The core components of a PNF intervention were delivered within LezParlay, a fun, social media-inspired, digital competition designed to challenge negative stereotypes about LBQ women and increase visibility. The competition was advertised on the web through social media platforms and collaboration with LBQ community organizations. After 2 rounds of play by a large cohort of LBQ women, a subsample of 500 drinkers already taking part in the competition were invited to participate in the evaluation study. Study participants were randomized to receive 1 of 3 unique sequences of PNF (ie, alcohol and stigma coping, alcohol and control, or control topics only) over 2 intervention rounds. Randomization was fully automated by the web app, and both researchers and participants were blinded., Results: Analyses will evaluate whether PNF on alcohol use reduces participants' drinking and negative consequences at 2 and 4 months postintervention; examine whether providing PNF on stigma-coping behaviors, in addition to alcohol use, further reduces alcohol use and consequences beyond PNF on alcohol alone; identify mediators and moderators of intervention efficacy; and examine broader LezParlay app engagement, acceptability, and perceived benefits., Conclusions: This incognito intervention approach is uniquely oriented toward engaging and preventing alcohol-related risks among community populations of LBQ women who may view their heavy drinking as normative and not in need of change because of the visibility of alcohol use in sexual minority community spaces. Thus, this intervention strategy diverges from, and is intended to complement, more intensive programs being developed to meet the needs of LBQ women already motivated to reduce their consumption., Trial Registration: ClinicalTrials.gov NCT03884478; https://clinicaltrials.gov/ct2/show/NCT03884478., International Registered Report Identifier (irrid): DERR1-10.2196/24647., (©Sarah C Boyle, Joseph W LaBrie. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 16.04.2021.)

Although sexual minority stress remains the dominant perspective for understanding disproportionate substance use among lesbian, gay and bisexual (LGB) populations, social norms are among the most predictive and commonly targeted substance use antecedents in other high-risk groups. This scoping review seeks to bring clarity to the body of norms-focused alcohol, tobacco, and other drug (ATOD) research conducted with LGBs over the past 20 years, identify intervention implications, and present priority directions for future research. Fifty-two peer-reviewed studies published between June 1999 and June 2019 were identified from searches of PubMed, PsycInfo, and Medline databases using combinations of terms related to: social norms; sexual orientation or sexual minority status; and, the use of alcohol, tobacco, and other drugs. A far greater number of studies focused on actual ATOD norms than perceived ATOD norms or discrepancies between actual or perceived norms, illuminating the need for additional research focused on these levels of analysis. Taken together, this literature suggests that: (1) perceived ATOD norms are reliable predictors of LGBs' ATOD use; (2) actual ATOD use norms are low among LGBs participating in representative, population-based survey studies; and, (3) LGBs over-estimate the ATOD use of peers. Thus, intervention strategies including personalized normative feedback, psychoeducation, and social branding may hold promise in reducing LGBs substance use. However, additional research is needed to increase our understanding of injunctive ATOD norms, identify meaningful LGB reference groups, elucidate environmental influences on ATOD norms, and examine relationships between stigma experiences, perceived norms, and ATOD use.

Alcohol-related problems disproportionately impact sexual minority women. Recent research suggests that lesbian-identified women overestimate peer drinking norms and therefore, personalized normative feedback (PNF) may be an appropriate and efficacious intervention strategy for reducing alcohol-related risks in this population. To inform the development and packaging of such interventions, this study examines lesbians' use of the popular social media sites Facebook, Instagram, Snapchat, and Twitter in relation to alcohol consumption, perceptions of peer drinking norms, confidence in normative perceptions, and interest in receiving alcohol PNF. Findings suggest that the lesbians who are most likely to benefit from a PNF alcohol intervention may also be the most readily reached via social media sites. Alcohol interventions that both recruit and deliver PNF via widely used social media platforms such as Facebook and Instagram represent a promising and cost-effective strategy to reduce heavy drinking among lesbians.

Virtual copresence, or the sense of being with others in an online space, is a feeling induced on many apps and websites through user avatars and browsable profile pages. Despite the small/modest effect sizes observed in popular web-based personalized normative feedback (PNF) alcohol interventions for college students, previous research has yet to consider how copresence might boost efficacy. This study builds on previous PNF gamification work to investigate whether specific copresence features (visual and text-based information about peers) increase PNF's ability to reduce alcohol use relative to a standard PNF condition and a gamified PNF condition. Copresence and perceptions of drinking norms (average drinks, peak drinks, and binge episodes) were assessed during a 3-week period following random assignment of college students (N = 235) to 1 of the 4 web-based PNF conditions (Standard PNF, Gamified PNF Only, Gamified PNF + Visual Copresence, and Gamified PNF + Maximum Copresence). These conditions asked the same questions about drinking and delivered identical PNF on alcohol use, but differed in the level of visual and text-based information about peers. Overall, only the gamified condition that featured maximum copresence significantly reduced drinking outcomes relative to standard PNF. However, conditional effects were moderated by pre-intervention drinking. Among heavier pre-intervention drinkers, both gamified conditions that featured copresence significantly improved upon Standard PNF in reducing alcohol use at follow-up. Findings suggest that including social media-like copresence features to visually represent and provide basic information about the peers contributing to the norms can enhance the efficacy of gamified PNF interventions, especially among high-risk heavy drinkers., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objective: Despite its prominence in the health communication literature, psychological reactance has rarely been considered as a factor that may undermine web-based Personalized Normative Feedback (PNF) alcohol interventions for college students. This study built on recent gamification work to examine how chance-based uncertainty, a popular game mechanic associated with motivation and attention in digital games for learning, might be leveraged to reduce the psychological reactance experienced by heavy drinking students receiving alcohol PNF, thereby leading to larger reductions in their alcohol consumption., Method: Psychological reactance, perceptions of norms, and drinking behaviors were assessed during a 3-week period following random assignment of binge drinking students (N = 141, 51% female) into one of four web-based PNF conditions. These conditions asked the same questions about drinking and delivered identical PNF on alcohol use but differed in whether animated slot-machine spinners appeared to select participants' question and feedback topics as well as the number of additional topics (beyond alcohol) on which questions were asked and PNF was delivered., Results: All conditions similarly reduced drinking norms but differed in the degree to which they aroused cognitive reactance and reduced drinking. Relative to a no-spinner alcohol-only condition, increasing chance-based uncertainty by giving question and feedback topics the appearance of being selected by gamelike spinners substantially reduced cognitive reactance, which, in turn, reduced drinking 20 days later. Overall, participants experienced the least cognitive reactance when spinners first selected three question topics and later selected two of these topics to deliver feedback on., Conclusions: Findings suggest that introducing chance-based uncertainty through gamelike spinners, asking questions about multiple topics, and delivering feedback on additional topics unrelated to alcohol together work to reduce the degree to which the task feels like an alcohol intervention overtly aimed at reducing consumption, thereby making the alcohol PNF more effective among heavy drinking students.

Our recent work (Boyle, Earle, LaBrie, & Smith, 2017) showed that the efficacy of personalized normative feedback-based (PNF) college alcohol interventions can be improved through the addition of gamified elements including points, chance, competition, and personal avatars. However, participants in that study were compensated with subject pool credit. In the current study, we piloted an upgraded, smartphone-based version of the game, which was designed to be truly self-sustaining (i.e., engaging enough that students play voluntarily without the presence of external motivators). First-year students were invited to play the game weekly for six rounds, with participants submitting and voting on their own questions each week and receiving a novel type of feedback in addition to standard descriptive PNF: opposite peers' judgments of participants' self-reported drinking behavior, or reflective norms. With no play-based incentives, 222 first-year college students voluntarily played the game, CampusGANDR. ANCOVA models revealed that, relative to participants randomized to receive feedback on control topics during the three intervention rounds, those who received both descriptive and reflective feedback on peer alcohol use had significantly reduced normative perceptions and reduced alcohol use two months post intervention. This was especially true among heavy drinkers. The results suggest that our gamified "GANDR" approach shows promise as a self-sustaining intervention and, further, that high-risk drinkers may benefit disproportionately from this methodology. Thus, self-sustaining interventions represent an encouraging avenue for future research and development and may hold the potential to impact risky college drinking on a large scale., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objective: Examine 1) whether observed social reinforcements (i.e., "likes") received by peers' alcohol-related social media posts are related to first-year college students' perceptions of peer approval for risky drinking behaviors; and 2) whether associations are moderated by students' alcohol use status., Participants: First-year university students (N = 296) completed an online survey in September, 2014., Method: Participants reported their own alcohol use, friends' alcohol use, perceptions of the typical student's approval for risky drinking, and ranked 10 types of social media posts in terms of the relative numbers of "likes" received when posted by peers., Results: Observed social reinforcement (i.e., "likes") for peers' alcohol-related posts predicted perceptions of peer approval for risky drinking behaviors among non-drinking students, but not drinking students., Conclusions: For first-year college students who have not yet initiated drinking, observing peers' alcohol-related posts to receive abundant "likes" may increase perceptions of peer approval for risky drinking.

To make accurate perceptual estimates, observers must take the reliability of sensory information into account. Despite many behavioural studies showing that subjects weight individual sensory cues in proportion to their reliabilities, it is still unclear when during a trial neuronal responses are modulated by the reliability of sensory information or when they reflect the perceptual weights attributed to each sensory input. We investigated these questions using a combination of psychophysics, EEG-based neuroimaging and single-trial decoding. Our results show that the weighted integration of sensory information in the brain is a dynamic process; effects of sensory reliability on task-relevant EEG components were evident 84 ms after stimulus onset, while neural correlates of perceptual weights emerged 120 ms after stimulus onset. These neural processes had different underlying sources, arising from sensory and parietal regions, respectively. Together these results reveal the temporal dynamics of perceptual and neural audio-visual integration and support the notion of temporally early and functionally specific multisensory processes in the brain., (© 2017 The Authors. European Journal of Neuroscience published by Federation of European Neuroscience Societies and John Wiley & Sons Ltd.)

Visual performance of human observers depends not only on the optics of the eye and early sensory encoding but also on subsequent cortical processing and representations. In two experiments, we demonstrated that motion adaptation can enhance as well as impair visual acuity. Observers who experienced an expanding motion aftereffect exhibited improved letter recognition, whereas observers who experienced a contracting motion aftereffect showed impaired letter recognition. We conclude that illusory enlargement and shrinkage of a visual stimulus can modulate visual acuity.

Gamified interventions exploit the motivational characteristics of a game in order to provide prevention information and promote behavior change. Despite the modest effect sizes observed in increasingly popular web-based personalized normative feedback (PNF) alcohol interventions for college students, previous research has yet to consider how gamification might be used to enhance efficacy. This study examines whether a novel, gamified PNF intervention format, which includes a point-based reward system, the element of chance, and personal icons to visually represent users, is more effective in reducing short-term alcohol use than the standard web-based style of PNF currently used on college campuses. Two-hundred and thirty-seven college students were randomly assigned to receive either a standard brief, web-based PNF alcohol intervention or the same alcohol intervention components delivered within a Facebook-connected social game called CampusGANDR (Gamified Alcohol Norm Discovery and Readjustment). In both study conditions participants answered identical questions about their perceptions of peer drinking norms and own drinking and then received the same PNF slides. Two weeks following PNF delivery, participants again reported their perceptions of peers' alcohol use and own drinking. Students in the CampusGANDR condition reported significantly reduced peer drinking norms and alcohol use at the two-week follow-up relative to students who received identical PNF delivered by standard online survey. Further, a mediation model demonstrated that this effect was driven by larger reductions in perceived drinking norms among participants assigned to receive CampusGANDR, relative to control. As web-based PNF is becoming an increasingly universal prevention strategy, findings from this study suggest gamification may represent one method by which intervention efficacy could be substantially improved. The potential methodological and economic benefits associated with gamified PNF interventions are emphasized and directions for future research are discussed., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Studies examining representations of college drinking on social media have almost exclusively focused on Facebook. However, recent research suggests college students may be more influenced by peers' alcohol-related posts on Instagram and Snapchat, two image-based platforms popular among this demographic. One potential explanation for this differential influence is that qualitative distinctions in the types of alcohol-related content posted by students on these three platforms may exist. Informed by undergraduate focus groups, this study examined the hypothesis that, of the three platforms, students tend to use Instagram most often for photos glamourizing drinking and Snapchat for incriminating photos of alcohol misuse and negative consequences. Undergraduate research assistants aided investigators in developing hypothetical vignettes and photographic examples of posts both glamorizing and depicting negative consequences associated with college drinking. In an online survey, vignette and photo stimuli were followed by counterbalanced paired comparisons that presented each possible pair of social media platforms. Undergraduates (N=196) selected the platform from each pair on which they would be more likely to see each post. Generalized Bradley-Terry models examined the probabilities of platform selections. As predicted, Instagram was seen as the most probable destination (and Facebook least probable) for photos depicting alcohol use as attractive and glamorous. Conversely, Snapchat was selected as the most probable destination (and Facebook least probable) for items depicting negative consequences associated with heavy drinking. Results suggest researchers aiming to mitigate the potential influences associated with college students' glamorous and consequential alcohol-related photos posted social media posts should shift their focus from Facebook to Instagram and Snapchat., Competing Interests: Statement 3: Conflicts of Interest All authors declare that they have no conflicts of interest., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Sexual minority stress experiences (e.g. prejudice, victimization, etc.) and peer substance use norms (e.g. peers' frequency of use and quantity consumed) are important correlates of alcohol and drug use in sexual minority populations. The current study incorporates both of these by examining LGB individuals' perceptions of peers' use of alcohol and other drugs to cope with a sexual minority stressor, and whether perceptions of peer coping norms relate to one's own coping-motivated substance use in response to the stressor. Three-hundred and seven sexual minority males and females who identified as gay, lesbian, or bisexual completed an online survey approximately 1month following the Pulse Nightclub Shooting, the deadliest incident of violence against LGBT people in U.S. history, and a stressor experienced within LGB communities throughout the U.S. Results revealed that LGB peers were widely perceived as likely to have coped with alcohol (68%) and drugs (41%) following the Pulse Shooting; however only small proportions of participants themselves reported coping with alcohol (26%) and drugs (7%). Further, multivariate models revealed that even after controlling for other factors including the stress impact of the Pulse shooting, the odds of using alcohol to cope with this event were 15 times greater among participants who held the perception that LGB peers likely used alcohol to cope relative to those who did not share this perception. Similarly, the odds of using drugs to cope with this event were 9 times greater among participants who perceived LGB peers likely to use drugs to cope with Pulse compared to those who did not. Importantly, these findings suggest that personalized normative feedback designed to correct perceptions of peers' coping motivated substance use may have utility as a motivational component in larger interventions seeking to reduce LGBs' substance use., Competing Interests: All authors declare that they have no conflicts of interest., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

A randomized controlled trial tested an interactive normative feedback-based intervention-codenamed "FITSTART"-delivered to groups of 50-100 parents of matriculating college students. The 60-min session motivated parents to alter their alcohol-related communication by correcting normative misperceptions (e.g., about how approving other parents are of student drinking) with live-generated data. Then, tips were provided on discussing drinking effectively. Incoming students (N = 331; 62.2% female) completed baseline measures prior to new-student orientation. Next, at parent orientation in June, these students' parents were assigned to either FITSTART or a control session. Finally, 4 months later, students completed a follow-up survey. Results revealed that students whose parents received FITSTART during the summer consumed less alcohol and were less likely to engage in heavy episodic drinking (HED) during the first month of college. These effects were mediated by FITSTART students' lower perceptions of their parents' approval of alcohol consumption. Further, FITSTART students who were not drinkers in high school were less likely to initiate drinking and to start experiencing negative consequences during the first month of college, where FITSTART students who had been drinkers in high school experienced fewer consequences overall and were significantly more likely to report that they did not experience any consequences whatsoever during the first month of college. Importantly, FITSTART is the first parent-based intervention to impact HED, one of the most well-studied indicators of risky drinking. Thus, interactive group normative feedback with parents is a promising approach for reducing college alcohol risk. (PsycINFO Database Record, ((c) 2016 APA, all rights reserved).)

Background: Prepartying, or drinking before an event where more alcohol may or may not be consumed, has been positioned in the literature as a behavior engaged in by heavy drinkers. However, recent findings suggest that prepartying may confer distinct risks, potentially causing students to become heavier drinkers over time., Objectives: The goals of this study were to disentangle the longitudinal relationships between prepartying, general and episodic alcohol consumption, and alcohol-related consequences by investigating (1) whether prepartying is associated with future consequences above and beyond current alcohol consumption habits and (2) whether augmentations in approval for alcohol and related increases in drinking mediate this relationship., Methods: One-hundred and ninety-five undergraduates completed online questionnaires at baseline, 6 months, and 12 months later., Results: Prepartying frequency was more strongly related to alcohol-related consequences one year later than was overall or episodic drinking. In addition, a path mediation model confirmed our hypothesis that this relationship is due to gradual increases in drinking which occur as a result of more approving attitudes toward alcohol brought on by exposure to prepartying. Conclusion/Importance: Findings suggest a new model for conceptualizing the relationship between prepartying, drinking, and consequences whereby students who get involved in prepartying may witness slow increases in their approval for alcohol use and, as a result, consumption. Importantly, results suggest that the increases in drinking displayed by prepartiers over the course of a year may account for the strong relationship between prepartying and later consequences. Prevention and intervention initiatives may benefit from directly targeting prepartying as a means of tempering risky alcohol use trajectories during one's college tenure.

Despite speculation that peers' alcohol-related content on social media sites (SMS) may influence the alcohol use behaviors of SMS frequenting college students, this relationship has not been investigated longitudinally. The current prospective study assesses the relationship between exposure to peers' alcohol-related SMS content and later-drinking among first-year college students. Among 408 first-year students, total exposure to peers' alcohol-related content on Facebook, Instagram, and Snapchat during the initial 6 weeks of college predicted alcohol consumption 6 months later. The rather robust relationship persisted even after students' and close friends drinking were accounted for, indicating that alcohol references on SMS do not simply reflect alcohol use behaviors that would otherwise be observed in the absence of SMS and be predictive of later alcohol use. Findings also illuminate important gender differences in the degree to which peers' alcohol-related SMS content influenced later drinking behavior as well as psychological mediators of this relationship. Among females, enhancement drinking motives and beliefs about the role of alcohol in the college experience fully mediated the relationship between SMS alcohol exposure and later drinking. Males, however, evidenced a much stronger predictive relationship between SMS alcohol exposure and second semester drinking, with this relationship only partially explained by perceptions of drinking norms, enhancement drinking motives, and beliefs about the role of alcohol in the college experience. Implications of these findings for college drinking prevention efforts and directions for future research are discussed., (Copyright © 2016. Published by Elsevier Ltd.)

This study examines the potential utility of social norms-based approaches to reduce heavy alcohol use in lesbian community settings. In a sample of 278 Southern Californian lesbians recruited from social media networks to complete an online survey, the majority of participants overestimated the quantity of alcohol consumed by their lesbian peers and more frequent lesbian bar attendance was associated with elevated perceptions of how much other lesbians drink. Greater than 90% of participants expressed interest in receiving personalized normative feedback, suggesting that culturally tailored personalized normative feedback interventions focused on correcting perceptions of heavy drinking may be successful in mitigating the alcohol-related risks of lesbians in Southern California, and potentially beyond.

Parental communications about alcohol can have a significant impact on college students' alcohol use; however, it is unclear what types of communication may be most beneficial for reducing alcohol risk, particularly among students who have already initiated alcohol use. The present research examines differences in alcohol use and employment of drinking protective behavioral strategies between pre-college matriculation high school seniors receiving predominantly abstinence parent messaging and students primarily receiving harm-reduction parent messaging. Students who identified as light drinkers were recruited during their last month in high school and completed an online assessment of alcohol use and parent alcohol communication. Analyses revealed that, in comparison to light drinkers who primarily received harm-reduction messaging from parents, light drinkers who received more abstinence messaging reported less frequent alcohol use, lower peak alcohol consumption, and greater use of protective drinking strategies aimed at changing the way they drank and avoiding serious hazards associated with drinking. Findings from this study underscore the utility of messages related to abstinence even for parents who are aware that their children have had previous experiences with alcohol and highlight the need for longitudinal research assessing additional mechanisms associated with message efficacy among light, moderate and heavy drinking students transitioning to college., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Mesangial cells are specialized pericyte/smooth muscle cells that surround and constrain the vascular network within the glomerulus of the kidney. They are derived from the stromal mesenchyme, a progenitor population distinct from nephron stem cells. Whether mesangial cells have a distinct origin from vascular smooth muscle cells (VSMCs) and the pathways that govern their specification are unknown. Here we show that Notch signaling in stromal progenitors is essential for mesangial cell formation but is dispensable for the smooth muscle and interstitial cell lineages. Deletion of RBPjk, the common DNA-binding partner of all active Notch receptors, with Foxd1(tgCre) results in glomerular aneurysm and perinatal death from kidney failure. This defect occurs early in glomerular development as stromal-derived, desmin-positive cells fail to coalesce near forming nephrons and thus do not invade the vascular cleft of the S-shaped body. This is in contrast to other mutants in which the loss of the mesangium was due to migration defects, and suggests that loss of Notch signaling results in a failure to specify this population from the stroma. Interestingly, Pdgfrb-positive VSMCs do not enter the vascular cleft and cannot rescue the mesangial deficiency. Notch1 and Notch2 act redundantly through γ-secretase and RBPjk in this process, as individual mutants have mesangial cells at birth. Together, these data demonstrate a unique origin of mesangial cells and demonstrate a novel, redundant function for Notch receptors in mesangial cell specification, proliferation or survival during kidney development.

Hepatoblastoma, the most common pediatric liver cancer, consists of epithelial mixed embryonal/fetal (EMEF) and pure fetal histologic subtypes, with the latter exhibiting a more favorable prognosis. Few embryonal histology markers that yield insight into the biologic basis for this prognostic discrepancy exist. CBP/P-300 interacting transactivator 1 (CITED1), a transcriptional co-activator, is expressed in the self-renewing nephron progenitor population of the developing kidney and broadly in its malignant analog, Wilms tumor (WT). In this current study, CITED1 expression is detected in mouse embryonic liver initially on post-coitum day 10.5 (e10.5), begins to taper by e14.5, and is undetectable in e18.5 and adult livers. CITED1 expression is detected in regenerating murine hepatocytes following liver injury by partial hepatectomy and 3,5-diethoxycarbonyl-1,4-dihydrocollidine. Importantly, while CITED1 is undetectable in normal human adult livers, 36 of 41 (87.8%) hepatoblastoma specimens express CITED1, where it is enriched in EMEF specimens compared to specimens of pure fetal histology. CITED1 overexpression in Hep293TT human hepatoblastoma cells induces cellular proliferation and upregulates the Wnt inhibitors Kringle containing transmembrane protein 1 (KREMEN1) and CXXC finger protein 4 (CXXC4). CITED1 mRNA expression correlates with expression of CXXC4 and KREMEN1 in clinical hepatoblastoma specimens. These data show that CITED1 is expressed during a defined time course of liver development and is no longer expressed in the adult liver but is upregulated in regenerating hepatocytes following liver injury. Moreover, as in WT, this embryonic marker is reexpressed in hepatoblastoma and correlates with embryonal histology. These findings identify CITED1 as a novel marker of hepatic progenitor cells that is re-expressed following liver injury and in embryonic liver tumors.

The kidney is the body's filter, responsible for the removal of metabolic waste and the excretion or reabsorption of electrolytes to control blood composition and pH balance. The functional unit of this filter is the nephron, whose segmented architecture has been largely conserved in form and function throughout eukaryotic evolution. Not surprisingly, the core developmental pathways that regulate the formation of the nephron have also been conserved. In particular, the Notch signaling pathway functions in both primitive and advanced nephrons to pattern domains required for the kidney's diverse functions. In this chapter, we will discuss the role that Notch plays in directing cell fate decisions during embryonic development of the pronephros and metanephros. We will go on to discuss the later role of Notch signaling as a cyst-suppressor and the consequences of aberrant or absent Notch activity in disease and cancer. The work discussed here highlights the fundamental importance of Notch during development and homeostasis of the kidney and underlies the need for mechanistic understanding of its role towards the treatment of human disease.

The primary excretory organ in vertebrates is the kidney, which is responsible for blood filtration, solute homeostasis and pH balance. These functions are carried out by specialized epithelial cells organized into tubules called nephrons. Each of these cell types arise during embryonic development from a mesenchymal stem cell pool through a process of mesenchymal-to-epithelial transition (MET) that requires sequential action of specific Wnt signals. Induction by Wnt9b directs cells to exit the stem cell niche and express Wnt4, which is both necessary and sufficient for the formation of epithelia. Without either factor, MET fails, nephrons do not form and newborn mice die owing to kidney failure. Ectopic Notch activation in stem cells induces mass differentiation and exhaustion of the stem cell pool. To investigate whether this reflected an interaction between Notch and Wnt, we employed a novel gene manipulation strategy in cultured embryonic kidneys. We show that Notch activation is capable of inducing MET in the absence of both Wnt4 and Wnt9b. Following MET, the presence of Notch directs cells primarily to the proximal tubule fate. Only nephron stem cells have the ability to undergo MET in response to Wnt or Notch, as activation in the closely related stromal mesenchyme has no inductive effect. These data demonstrate that stem cells for renal epithelia are uniquely poised to undergo MET, and that Notch activation can replace key inductive Wnt signals in this process. After MET, Notch provides an instructive signal directing cells towards the proximal tubule lineage at the expense of other renal epithelial fates.

The study of organogenesis in mammals allows investigation of a wide variety of basic cell biological processes in the context of the intact organ. This has become especially important in the age of genetics, as the consequences of gene deletion or mutation in the mouse can be directly linked to human congenital abnormalities. The ability to culture some organs ex vivo during development has emerged as an important tool to understand how tissues are constructed and the signaling pathways that regulate these processes. It has been especially useful in organs that grow via branching morphogenic mechanisms, such as the lung and kidney. Here we demonstrate isolation, ex vivo growth, and fluorescent immunostaining of mouse embryonic day 12.5 (E12.5) kidneys. To demonstrate nephron formation using live imaging, we have isolated and cultured kidneys from mice carrying a green fluorescent protein (GFP) transgene driven by the Hes 1 promoter, which is expressed early in the developing nephron. We also provide a protocol for robust imaging of multiple kidney structures in the whole-mount setting. These techniques serve as a basic platform for the analysis of branching morphogenesis and nephron formation in genetic mouse models or in response to exogenous factors, such as agonists or inhibitors, which can be directly added to the culture medium.

Identification of multipotent cardiac progenitors has provided important insights into the mechanisms of myocardial lineage specification, yet has done little to clarify the origin of the endocardium. Despite its essential role in heart development, characterization of the endocardial lineage has been limited by the lack of specific markers of this early vascular subpopulation. To distinguish endocardium from other vasculature, we generated an NFATc1-nuc-LacZ BAC transgenic mouse line capable of labeling this specific endothelial subpopulation at the earliest stages of cardiac development. To further characterize endocardiogenesis, embryonic stem cells (ESCs) derived from NFATc1-nuc-LacZ blastocysts were utilized to demonstrate that endocardial differentiation in vitro recapitulates the close temporal-spatial relationship observed between myocardium and endocardium seen in vivo. Endocardium is specified as a cardiac cell lineage, independent from other vascular populations, responding to BMP and Wnt signals that enhance cardiomyocyte differentiation. Furthermore, a population of Flk1+ cardiovascular progenitors, distinct from hemangioblast precursors, represents a mesodermal precursor of the endocardial endothelium, as well as other cardiovascular lineages. Taken together, these studies emphasize that the endocardium is a unique cardiac lineage and provides further evidence that endocardium and myocardium are derived from a common precursor.

A number of studies have shown that placental insufficiency affects embryonic patterning of the kidney and leads to a decreased number of functioning nephrons in adulthood; however, there is circumstantial evidence that placental insufficiency may also affect renal medullary growth, which could account for cases of unexplained renal medullary dysplasia and for abnormalities in renal function among infants who had experienced intrauterine growth retardation. We observed that mice with late gestational placental insufficiency associated with genetic loss of Cited1 expression in the placenta had renal medullary dysplasia. This was not caused by lower urinary tract obstruction or by defects in branching of the ureteric bud during early nephrogenesis but was associated with decreased tissue oxygenation and increased apoptosis in the expanding renal medulla. Loss of placental Cited1 was required for Cited1 mutants to develop renal dysplasia, and this was not dependent on alterations in embryonic Cited1 expression. Taken together, these findings suggest that renal medullary dysplasia in Cited1 mutant mice is a direct consequence of decreased tissue oxygenation resulting from placental insufficiency.

CITED1 is the founding member of the CITED family of cofactors that are involved in regulating a wide variety of CBP/p300-dependent transcriptional responses. In the present study, we show that the phosphorylation status of CITED1 changes during the cell cycle and affects its transcriptional cofactor activity. Tryptic mapping and mutagenesis studies identified five phosphorylated serine residues in CITED1. Phosphorylation of these residues did not affect CRM1-dependent nuclear export, but did decrease CITED1 binding to p300 and inhibited CITED1-dependent transactivation of Smad4 and p300. These results suggest that CITED1 functions as a cell cycle-dependent transcriptional cofactor whose activity is regulated by phosphorylation.