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There is a need for integrated treatment approaches that address heavy alcohol use and posttraumatic stress disorder (PTSD) concurrently among Veterans as interactions between heavy drinking and PTSD are frequent. Veteran engagement in specialty mental health services after referral is limited with poorer outcomes following empirically-supported, exposure-based PTSD treatments that do not explicitly address alcohol use. The current project aimed to incorporate two evidenced-based interventions: Brief Motivational Intervention (BMI) with Prolonged Exposure for Primary Care (PE-PC) for Veterans with heavy drinking and PTSD. Delphi methodology was applied to adapt an intervention protocol using subject matter expert (SME) feedback to guide the refinement of a preliminary treatment manual. The newly developed brief intervention (PC-TIME) was then tested in an open trial (n=9) to gather Veteran participant feedback to modify the treatment manual.Two rounds of SME feedback resulted in 80% agreement that manual content was acceptable as-is across all intervention domains. The resulting protocol is a five-session, integrated intervention with session 1 primarily focused on alcohol use reduction and sessions 2-5 consisting of narrative exposure and in-vivo exercises for PTSD symptoms with brief alcohol use check-ins. Open trial results indicated high Veteran acceptance of PC-TIME structure and content, and reductions in heavy drinking and PTSD symptoms. Preliminary data suggest PC-TIME to be a promising approach for treatment of heavy alcohol use and PTSD. A pilot randomized controlled trial is necessary to demonstrate the interventions efficacy with Veterans in a PC setting.

The present work aimed to extend the evidence of the structure validity of the Ruminative Thought Style Questionnaire (RTSQ) 15-item version testing: (1) the structure of two competing models (i.e., four-factor correlated model vs a second-order factor model); (2) the measurement invariance of the final model across four countries (U.S., Spain, Argentina, and the Netherlands) and gender groups (male and female); and (3) the invariance across three assessment waves in a subsample of Spanish youths. Participants were college students (mean age = 20.87, SD = 4.47) from the U.S. (n = 1875; 67.1% of females), Spain (T1, n = 732, 63.9% females; T2, n = 370, 71.6% females: T3, n = 307, 60.6% females), Argentina (n = 368, 65.6% females) and the Netherlands (n = 295, 74.8% females). Confirmatory Factor Analyses supported both correlated factors and second-order factor structure in the whole sample. Due to similar fit indices being observed for both models, and considering the theoretical and practical advantages, we kept the second-order model to examine its invariance across groups and time. Measurement invariance analyses showed that the second-order model was invariant across countries, gender, and over time. Comparisons of the total mean score and the subfacet mean scores (i.e., Repetitive Thoughts, Counterfactual Thoughts, Problem-focused Thoughts, and Anticipatory Thoughts) reveled only small differences across country and gender groups. The present work extends the structural validity evidence of the RTSQ, and provides the first evidence concerning its longitudinal stability across time., Author(s): Verónica Vidal-Arenas [sup.1] , Manuel I. Ibáñez [sup.1] [sup.2] , Jordi Ortet-Walker [sup.1] , Generós Ortet [sup.1] [sup.2] , Laura Mezquita [sup.1] [sup.2] , Adrian J. Bravo, James M. [...]

While there is evidence that histories of adverse childhood experiences (ACEs) are common in university students and are associated with an increased risk of mental health difficulties, current research has limited geographic and cross-cultural representation. Comparing ACEs across diverse contexts using a standardized measure can illuminate geographic and sociocultural similarities or differences in exposure. The present study aimed to assess ACE exposure and its relationship with mental health symptoms in university students from seven countries. We sampled 5945 university students from the United States, Canada, England, South Africa, Spain, Argentina, and Uruguay. Participants completed the Adverse Childhood Experiences International Questionnaire (ACE-IQ) and the Inventory of Depression and Anxiety Symptoms (IDAS). Most participants (94.8%) reported exposure to at least one type of ACE and 61% reported exposure to four or more types. Repeated exposure to at least one ACE was reported by 70.2% and repeated exposure to at least four ACEs was reported by 21.2%. Spanish students had significantly lower ACE exposure than other students. Cumulative ACE exposure was significantly higher among students in lower income countries, but when repeated exposure was considered these differences fell away. For the total sample, cumulative ACE exposure was significantly associated with severity of depression symptoms, anxiety symptoms, and suicidality. Findings indicate that universities globally should be guided by a trauma-informed approach that recognizes students as a psychologically vulnerable group carrying a long-standing burden of childhood adversity., Author(s): Debra Kaminer [sup.1] , Adrian J. Bravo [sup.2] , Laura Mezquita [sup.3] [sup.4] , Angelina Pilatti [sup.5] [sup.6] , Adrian J. Bravo, Christopher C. Conway, James M. Henson, Lee [...]

Individualism and collectivism are dimensions of cultural variation thought to shape differences in emotion regulation tendencies, yet research to date has examined these cultural dimensions as country-level features, emphasizing variability across nations. The present study takes the approach of examining cultural differences within nations as predictors of emotion regulation strategies, shifting the perspective instead to individual differences. This present study aimed to address how individual endorsement of individualism-collectivism (i.e. prioritizing individual versus group goals) and vertical-horizontal attitudes (preference for hierarchy versus equality) are associated with use of emotion regulation strategies (i.e., reappraisal and suppression) among college students from seven countries (n = 5,900; female = 70.80%). Overall, we found that individual differences in individualism-collectivism and vertical-horizontal attitudes had strong connections with young adults' emotion regulation styles. Results of our multivariate (i.e., all variables were simultaneously examined) regression model revealed: a) higher endorsement of horizontal individualism and horizontal collectivism were associated with higher use of reappraisal strategies; b) higher endorsement of horizontal individualism and vertical collectivism were associated with higher use of suppression strategies; while higher endorsement of horizontal collectivism was associated with lower use of suppression strategies. A multi-group model supported the generalizability of these associations across countries. These findings demonstrate the value of approaching cultural differences in emotion regulation from an individual differences framework, and not assuming country-level differences are representative of individuals' affective experiences. Further work is needed examining models within-country to examine cultural variation in individualism vs collectivism compared to country-level norms. [ABSTRACT FROM AUTHOR]

Objective: Undergraduates frequently engage in risky drinking (i.e., drinking alcohol in ways that may result in problems). The reasoned action approach identifies injunctive norms (i.e., perceptions that others approve of risky drinking) as central in predicting engagement in risky drinking. However, research linking injunctive norms and risky drinking is equivocal, possibly because of extensive variability in the operationalization of injunctive norms across studies. This study describes the development and validation of the Perceived Approval of Risky Drinking Inventory (PARDI), designed according to best practice guidelines in questionnaire development. Method: Undergraduate students (N = 1,313) participated in one of the three phases of data collection, including focus group interviews for item generation (n = 31), self-report questionnaires for scale refinement (n = 407), and self-report questionnaires for scale validation (n = 875). Results: Exploratory and confirmatory factor analyses supported a 20-item four-factor solution (Heavy Drinking, Drinking-Related Problems, Coping-Related Drinking, and Sexual-Risk Taking) across the three assessed referent groups (friends, parents, and typical students), all of which present satisfactory estimates of scale score and composite reliability. The results also provided preliminary support for the convergent validity of scores obtained on the PARDI, as demonstrated through correlations with other measures of perceived norms, alcohol use, alcohol-related problems, and coping-motivated drinking. Finally, the results supported the generalizability of the PARDI factor structure by demonstrating its measurement invariance across gender and drinking status (i.e., alcohol use and problems). Conclusions: The PARDI represents a reliable, valid, yet nuanced measure of injunctive norms that can be used to support further theory development and intervention. Public Health Significance Statement: This study provides researchers with a reliable and valid instrument to measure injunctive drinking norms in undergraduate students. This measure is shown to be valid for use in various referent groups (friends, typical students, and parents) and across different groups of respondents (i.e., men and women, heavy and light drinkers). [ABSTRACT FROM AUTHOR]

BackgroundPregaming is a common, high-risk drinking activity among college students that has been largely unchangeable despite targeted intervention approaches. Therefore, identifying profiles of pregamers could enhance understanding of the risks associated with this practice and inform intervention development.MethodsThis study identified subtypes of pregamers in undergraduates (N = 911; 60% female, 42.9% White) attending 3 U.S. universities in 2012. Self-report data assessed recent alcohol use (overall, heavy, and pregaming), pregaming motives, and demographics. Alcohol-related consequences were assessed via the Young Adult Alcohol Consequences Questionnaire.ResultsLatent profile analysis using pregaming-specific indicators assessing motives (e.g., to avoid getting caught) and consumption (e.g., estimated pregaming blood alcohol concentration) yielded 5 unique profiles. Three profiles were characterized by pregaming on 50% or more of all drinking events that differed by pregaming consumption and motives: Instrumental (5.3%; heavy consumption, intoxication-driven motives), Global (16.0%; moderate consumption, indistinct motives), and Risk-averse (18.3%; moderate-to-heavy consumption, negatively reinforcing motives). Two profiles reported lower levels of pregaming: Occasional (32.4%; moderate consumption, indistinct motives) and Infrequent (28.0%; lowest pregaming involvement). Cross-profile differences were then examined for demographics, general drinking and pregaming-specific motives, and alcohol-related consequences. Profile comparisons indicated differences in overall alcohol consumption, ethnicity, gender, current living arrangements, Greek involvement, and a variety of alcohol-related consequences (ps

Despite the promise of incentive-based chronic disease prevention programs, comprehensive evidence on their accessibility among low-income populations remains limited. We adapted Aday and Andersen's framework to examine accessibility and consumer satisfaction within the Medicaid Incentives for the Prevention of Chronic Disease (MIPCD) cross-site demonstration. MIPCD provided 10 states with 5-year grants to implement incentivized chronic disease prevention and management programs for low-income and/or disabled--Medicaid enrolled--Americans. We conducted 36 focus group discussions between July 2014 and December 2015 with Medicaid enrollees participating in the MIPCD programs. We assessed participants' satisfaction by program type (i.e., diabetes prevention, diabetes management, hypertension reduction, smoking cessation, and weight management) related to three components: program enrollment and participation, staff courtesy, and program convenience. Based on Aday and Andersen's framework, we conducted thematic analysis to determine similarities and differences across MIPCD programs by type. Participant feedback confirmed the importance of several features of the Aday and Andersen framework, particularly programs with easy enrollment and participation procedures, courteous and helpful staff, and those that are convenient and flexible for participants. Participants valued programming around the clock via telephone and flexible, in-person hours of operation as well as proximity of the program to reliable transportation. We observed that most participants, despite enrollment and participation barriers, perceived programs as accessible and were willing to engage and continue to participate. This finding may reflect behavior change theory's perspective on personal readiness to change. Individuals in the preparation stage of change can effectively change health habits despite barriers they may encounter. In some cases, personal readiness to change was more impactful than consumer satisfaction at encouraging ongoing participation and perceived access to the programs. Thus, program developers may want to consider individual participant readiness to change and its impact on consumer satisfaction when designing, implementing, and evaluating behavior change initiatives.

The 15-item Distress Tolerance Scale (DTS) is a widely used psychometric measure with evidence generally supporting its reliability and validity. However, limitations related to its ordinal response format and lack of cross-cultural comparisons have yet to be investigated using appropriate methods. The Partial Credit Rasch model was used to evaluate and enhance the psychometric properties of the DTS using responses from 2550 adult participants from the United States of America (USA), England, Canada, South Africa, Spain, and Argentina. The initial poor fit of the DTS to the Rasch model was improved by removing one item and combining locally dependent items into three testlets. These modifications resulted in the best fit of the 14-item DTS to the Rasch model for all the countries in our study, providing evidence of unidimensionality, high reliability and invariance across countries, meditation practice, and gender. Meeting the expectations of the Rasch model permitted the development of ordinal-to-interval conversion algorithms derived from person estimates of the Rasch model. Using the ordinal-to-interval conversion algorithms published in this article, ordinal DTS scores can be transformed into interval-level data, enhancing the precision of this scale for future research and clinical use across people from the six countries in this study and across the English and Spanish versions of the 14-item DTS. [ABSTRACT FROM AUTHOR]

Objective: Young adult women naturalistically engage in sexual assault protective behavioral strategies (SA-PBS) in an effort to reduce their risk of sexual assault. Despite well-documented sociocontextual risks for sexual assault, it remains largely unknown whether and how social contexts influence SA-PBS use. The present study characterized relations of women's alcohol use and interpersonal contexts with SA-PBS engagement across social events, framed according to routine activity theory. Method: Young adult women from a community sample (N = 174) reported their drinking and social events across 27 daily assessments spanning 1 year. Multilevel latent class analyses examined variability in SA-PBS, and multinomial regression tested associations of contextual risks with SA-PBS engagement. Results: Results supported three distinct classes of social events characterized by SA-PBS engagement: (a) no or minimal use of SA-PBS ("no use," 26%), (b) no perceived reason or opportunity to use SA-PBS ("no reason or opportunity," 44%), and (c) any use of SA-PBS ("any use," 30%). Presence of likely offenders (odds ratio [OR] = 4.77, p =.004), absence of capable guardianship (OR = 5.91, p <.001), and greater other's substance intoxication (OR = 1.46, p =.01), as theorized by routine activity theory, increased odds of membership in the "any use" relative to "no use" class. Women's alcohol consumption was not associated with class membership. Conclusions: Women's perceptions of risk in the social environment relate to their likelihood of engaging in SA-PBS. Findings represent an important step toward understanding the social context's role in sexual assault risk and protection. [ABSTRACT FROM AUTHOR]

Students with trauma and posttraumatic stress are disproportionately at risk for heavy drinking and for alcohol-related consequences. Brief motivational interventions (BMIs) have been shown to reduce hazardous drinking in college students, and could serve as a first-line approach to reduce heavy drinking in students with trauma and posttraumatic stress (PTS). Yet the standard BMI format may not adequately address the factors that lead to hazardous drinking in these students. Here, we review the literature on PTS and hazardous drinking in college students, and highlight cognitive (self-efficacy, alcohol expectancies) and behavioral (coping strategies, emotion regulation skills, protective behaviors) factors that may link trauma and PTS to drinking risk. Incorporating these factors into standard BMIs in a collaborative way that enhances their personal relevance may enhance intervention efficacy and acceptability for these at-risk students.

Objective: This study examined how profiles of alcohol use and symptoms of common mental health disorders (depression and posttraumatic stress disorder [PTSD]) influenced the perceived need for and actual seeking of different types of treatment (for alcohol versus psychological distress) in college student drinkers. Participants: Undergraduate students (n = 164) were assessed between September 2009 and August 2015. Methods: We classified students into different symptom profiles using model-based clustering and compared these profiles on a variety of variables. Results: The cluster model yielded three profiles: Low Risk (n = 66), Concomitant (n = 35), and Heavy Drinking (n = 63). Students in these profiles significantly differed in alcohol consumption, alcohol-related cognitions and problems, and perceptions of need and prior engagement in treatment. Conclusion: A variety of strategies can be used to engage students experiencing heavy drinking and/or mental health problems into treatment on campus.

Objective: The Circle of Six (Co6) phone application (app), winner of the White House's "Apps Against Abuse Challenge," seeks to incorporate friends into sexual victimization risk reduction. Despite its growing presence on college campuses, the feasibility/acceptability of the app to college women is unknown. This mixed methods study sought to fill this gap. Participants: College women (n = 44) participated in summer/fall 2015. Methods: Participants completed questionnaires, used the Co6 app for 2 months, and returned to report their experiences. Results: Consistent with the app's aim, women reported greater intentions to help friends versus strangers in sexually aggressive situations. However, app use was low over follow-up. Reasons women gave for not using the app included redundancy with existing smart phone features and discomfort with group messaging. Some saw the app as an emergency only resource. Conclusions: The Co6 app may not meet the real world needs of college women.

Objective: Hooking up is common in college, and has been linked to heavy drinking. Hookups have positive as well as negative consequences, and thus the motivations for hooking up are complex. Yet, little research has focused on these motivations. The present study examined the role that gender and drinking patterns play in the relationship between sexual motivation and penetrative hookups. Participants: Heavy drinking college students (N = 396) completed online surveys between September/October 2009. Method: Sexual motivation, alcohol, and hooking up were assessed. Results: Enhancement motives and drinking frequency predicted more frequent oral and vaginal sex when hooking up, while peer and partner motives predicted anal sex. Men endorsed greater enhancement motives, peer motives, and hookup oral and vaginal sex. For men, coping motives predicted oral and vaginal sex and peer motives predicted anal sex. Conclusions: Results provide greater insight into the reasons why college students engage in penetrative hookups.

Interventions targeting physical activity may be valuable as an adjunct to alcohol treatment, but have been relatively untested. In the current study, alcohol dependent, physically sedentary patients were randomized to: a 12-week moderate-intensity, group aerobic exercise intervention (AE; n=25) or a brief advice to exercise intervention (BA-E; n=23). Results showed that individuals in AE reported significantly fewer drinking and heavy drinking days, relative to BA-E during treatment. Furthermore adherence to AE strengthened the beneficial effect of intervention on alcohol use outcomes. While high levels of moderate-intensity exercise appeared to facilitate alcohol recovery regardless of intervention arm, attending the group-based AE intervention seemed to further enhance the positive effects of exercise on alcohol use. Study findings indicate that a moderate intensity, group aerobic exercise intervention is an efficacious adjunct to alcohol treatment. Improving adherence to the intervention may enhance its beneficial effects on alcohol use.

Early adolescence is a dynamic period for the development of alcohol appraisals (expected outcomes of drinking and subjective evaluations of expected outcomes), yet the literature provides a limited understanding of psychosocial factors that shape these appraisals during this period. This study took a comprehensive view of alcohol appraisals and considered positive and negative alcohol outcome expectancies, as well as subjective evaluations of expected outcomes. Developmental-ecological theory guided examination of individual, peer, family, and neighborhood predictors of cognitive appraisals of alcohol and use. A community sample of 378 adolescents (X-bar age 11.5 years at Wave 1 (W1), 52% female) was assessed annually for 4 years. Longitudinal path analysis suggested that the most robust predictors of alcohol appraisals were peer norms. Furthermore, perceived likelihood of positive and negative alcohol outcomes prospectively predicted increases in drinking. There was limited support for appraisals operating as mediators of psychosocial risk and protective factors.

BackgroundWomen who use antiretroviral therapy (ART) solely for the prevention of mother-to-child transmission of HIV discontinue postpartum. We hypothesized that women discontinuing ART by 6 weeks postpartum ("discontinuers") would have elevated postpartum inflammatory biomarker levels relative to women remaining on ART postpartum ("continuers").MethodsData from HIV-infected pregnant women enrolled in the International Maternal Pediatric Adolescent AIDS Clinical Trials Group P1025 with CD4 counts >350 cells per cubic millimeter before initiating ART or first pregnancy CD4 counts >400 cells per cubic millimeter after starting ART and with available stored plasma samples at >20 weeks of gestation, delivery, and 6 weeks postpartum were analyzed. Plasma samples were tested for highly sensitive C-reactive protein, D-dimer, and interleukin-6. We used longitudinal linear spline regression to model biomarkers over time.ResultsData from 128 women (65 continuers and 63 discontinuers) were analyzed. All biomarkers increased from late pregnancy to delivery, then decreased postpartum (slopes different from 0, P < 0.001). Continuers had a steeper decrease in log D-dimer between delivery and 6 weeks postpartum than discontinuers (P = 0.002).ConclusionsIn contrast to results from treatment interruption studies in adults, both ART continuers and ART discontinuers had significant decreases in the levels of D-dimer, highly sensitive C-reactive protein, or interleukin-6 postpartum. Continuation was associated with a more rapid decline in D-dimer levels compared with discontinuation.

The objective of this review is to provide an update on existing research examining alcohol-related consequences among college students with relevance for individual-based interventions. While alcohol-related consequences have been a focus of study for several decades, the literature has evolved into an increasingly nuanced understanding of individual and environmental circumstances that contribute to risk of experiencing consequences. A number of risk factors for experiencing alcohol-related consequences have been identified, including belonging to specific student subgroups (e.g., Greek organizations) or drinking during high-risk periods, such as spring break. In addition, the relationship between students' evaluations of both negative and positive consequences and their future drinking behavior has become a focus of research. The current review provides an overview of high-risk student subpopulations, high-risk windows and activities, and college students' subjective evaluations of alcohol-related consequences. Future directions for research are discussed and include determining how students' orientations toward consequences change over time, identifying predictors of membership in high-risk consequence subgroups and refining existing measures of consequences to address evolving research questions.

Alcohol expectancies, defined as a person's beliefs about the effects of drinking, can influence alcohol consumption and help predict problem drinking in college students. However, there are concerns that current expectancy measures do not adequately capture mandated student expectations about alcohol use. This study examined the correspondence of 412 self-generated expectancies from mandated students (n=64) to items on the Brief Comprehensive Effects of Alcohol (B-CEOA; Ham, Stewart, Norton, & Hope, 2005). Self-generated expectancies were reviewed by raters who attempted to match each expectancy with a single B-CEOA item based on the qualitative essence of each statement. Most mandated student expectancies were not represented by the B-CEOA. All expectancies were then classified into 6 categories based on themes and categories from the alcohol expectancy literature. Mandated student expectancies emphasized the physiological aspects of drinking, whereas the B-CEOA assesses expectancies about intrapersonal factors. The findings suggest the B-CEOA may exclude alcohol expectancies that are important and relevant to this population. Self-generated alcohol expectancies from the target population should be considered when developing or administering expectancy questionnaires.

Background: It is important to identify students who would benefit from early interventions to reduce harmful drinking patterns and associated consequences. the Brief Young Adult Alcohol Consequences Questionnaire (B-YAACQ) could be particularly useful as a screening tool in university settings. Objectives. The present study examined the utility of the B-YAACQ to distinguish among students at-risk for problematic alcohol use as measured by the AUDIT. Objectives: The present study examined the utility of the B-YAACQ to distinguish among students at-risk for problematic alcohol use as measured by the AUDIT. Methods: A sample of 6382 students (mean age=20.28, SD=3.75, 72.2% females) from seven countries (i.e., U.S., Canada, South-Africa, Spain, Argentina, Uruguay, England) completed the B-YAACQ, the AUDIT and different measures of alcohol use. Results: ROC analyses suggested that a cutoff score of 5 maximized the YAACQ's discrimination utility to differentiate between students at low versus moderate/high risk in the total sample and across countries (except in Canada, where the cutoff was 4). In addition, a cutoff of 7 differentiated between students at low/moderate versus high risk in the total sample, while cutoffs of 10, 9, 8 and 7 differentiate between students at low/moderate versus high risk in Uruguay, U.S and Spain (10), Argentina (9), England (8), and Canada and South-Africa (7), respectively. Students classified at the three risk levels (i.e., low, moderate and high) differed in age (i.e., a younger age was associated with higher risk) and drinking patters (i.e., higher drinking frequency, quantity, binge drinking and AUDIT and B-YAACQ scores in the higher risk groups). Conclusions: This study suggest that the B-YAACQ is a useful tool to identify college students at-risk for experiencing problematic patterns of alcohol use. [ABSTRACT FROM AUTHOR]

Objective: Non-alcohol drug (NAD) use and its associated consequences remain a prevalent problem among young adults. Both positive and negative affect play etiological roles in NAD. The perception of one's ability to refuse a drug in different situations (drug refusal self-efficacy) could be an important mediator between such affect and NAD outcomes (use and consequences). This study examined mediational pathways from affect to NAD use and NAD-related consequences via drug refusal self-efficacy. We also examined the moderating role of normative perceptions of peer NAD involvement. Method: Across three time points (September, February, April) of their first college year, students (N = 355) completed an online self-report questionnaire to assess affect, refusal self-efficacy, NAD use frequency, NAD-related problems, and peer norms. Data were analyzed using longitudinal structural path models. Results: Refusal of self-efficacy for situations involving negative affect significantly mediated the relationship between negative affect and NAD use but not consequences, supporting a negative reinforcement pathway. Greater perceptions of peer drug use moderated the mediated negative reinforcement pathway. No significant pathways were found for the refusal self-efficacy positive reinforcement pathways. Conclusions: This study provides support for a negative reinforcement pathway to NAD use in which refusal self-efficacy plays an important mechanistic role. These findings may have implications for intervention, as targeting refusal self-efficacy for those with NAD use and addressing peer influences could be helpful in reducing NAD risk. Replication of these findings and extension using daily assessment and more fine-grained assessment of individual NAD types will be important next steps. [ABSTRACT FROM AUTHOR]

Background: Much of the evidence underlying guidelines for producing accessible information for people with aphasia focuses on client preference for particular design features. There is limited evidence regarding the effects of these features on comprehension. Aims: To examine the effects of specific design features on text comprehension. It was hypothesized that font style, letter case and supporting images would all have a significant impact on people with aphasias' ability to comprehend text. Methods & Procedures: Participants (N = 9) read 35 paragraphs and selected the most appropriate word or phrase from a choice of four to finish the final sentence. Reading comprehension was assessed in three conditions: font style, letter case and text with a supporting image. One-way analyses of variance (ANOVAs) with Bonferroni post-hoc tests were used to test the effect of each design feature on reading comprehension. Outcomes & Results: People with aphasia comprehended significantly more written information when presented in sans-serif font than in a serif style (p = 0.01) and when presented in lower case than in upper case (p = 0.03). The inclusion of a single supporting image to illustrate a paragraph of text did not have a significant effect on comprehension. Conclusions & Implications: This research supports the premise that font style and letter case have a significant effect on text comprehension, but that illustrating a paragraph of text with a single image may not significantly improve comprehension when text is written at a low readability level. Although it is critical to produce accessible information, improving comprehension is only one rationale for modified text presentation and therefore these results must be viewed in the context of other recommendations.

Prior work has suggested a paradoxical positive relationship between the risk behavior alcohol use and the health behavior exercise, particularly in young adults. Though seldom tested, different theoretical perspectives exist on the mechanisms that may explain the positive relationship. The aims of this study were to test theorized mechanisms of association, including common causes shared by both behaviors (e.g., personality, motives, affective), compensatory processes such as exercising to compensate for calories from alcohol consumption, and methodological confounds (e.g., between vs. within subject effects) in a college sample (N = 132; 56.3% male; 76% Caucasian; M.sub.age = 19.15, SD = 0.99) using a cross-sectional design and time line follow back methods. A positive, between-subjects association between alcohol and exercise was found and explained by exercising to compensate for calories of alcohol consumption, enhancement motives, and physical activity enjoyment. However, we also observed a significant and negative within-subjects association between the two constructs, suggesting that, on a given day, individuals who exercise more tended to drink less. Furthermore, individuals who exercised more during the week tended to have declines in weekend drinking over time. Results suggest a complex relationship between exercise and alcohol use among young adults, and highlight the importance of distinguishing between and within subject processes, as well as the temporal ordering of the two behaviors. Implications are discussed in regard to theory, prevention, and intervention., Author(s): Ana M. Abrantes [sup.1] [sup.2] , Matthew D. Scalco [sup.2] [sup.3] , Sara O'Donnell [sup.3] , Haruka Minami [sup.4] , Jennifer P. Read [sup.3] Author Affiliations: (1) Butler Hospital, [...]