Are social norms the best predictor of outcomes among heavy-drinking college students?

Using e-mail boosters to maintain change after brief alcohol interventions for mandated college students: A randomized controlled trial

OBJECTIVE

Brief motivational interventions (BMIs) reduce drinking in the short term, but these initial effects often decay. We tested the hypothesis that theory-based e-mail boosters would promote maintenance of change after a BMI.

METHOD

Participants were students (N = 568; 72% male) who violated campus alcohol policy and were mandated to participate in an alcohol-risk-reduction program. Participants provided baseline data, received a BMI, and then completed a 1-month post-BMI survey. Next, they were randomized to receive 12 booster e-mails that contained either (a) alcohol norms or (b) structurally equivalent general health information (control). Alcohol consumption and alcohol-related consequences were assessed at baseline, 1, 3, 5, 8, and 12 months.

RESULTS

As expected, we observed significant reductions in both consumption and consequences after the BMI (ps < .01), and groups were equivalent at baseline and at 1-month post-BMI, prior to randomization (ps > .05). Latent growth curve models revealed no condition effects on changes in the latent consumption variable from 1- to 12-month follow-ups (b = .01, SE = .01, p > .05). Unexpectedly, a main effect of the condition emerged for self-reported consequences (b = .03, SE = .01, p = .01); we observed more consequences after boosters containing alcohol norms than general health information. Outcomes were not moderated by sex, consumption at baseline or 1 month, or e-mail exposure, and there was no mediation by descriptive norms, injunctive norms, or peer communication.

CONCLUSIONS

Contrary to predictions, e-mail boosters with corrective norms content did not improve outcomes after a BMI. (PsycINFO Database Record

Geographic and Individual Associations with PrEP Stigma: Results from the RADAR Cohort of Diverse Young Men Who have Sex with Men and Transgender Women

Increasing the uptake of pre-exposure prophylaxis (PrEP) to prevent HIV acquisition among at-risk populations, such as young men who have sex with men (YMSM), is of vital importance to slowing the HIV epidemic. Stigma and negative injunctive norms, such as the so called "Truvada Whore" phenomenon, hamper this effort. We examined the prevalence and types of PrEP stigma and injunctive norm beliefs among YMSM and transgender women and associated individual and geospatial factors. A newly created measure of PrEP Stigma and Positive Attitudes was administered to 620 participants in an ongoing longitudinal cohort study. Results indicated lower stigma among White, compared to Black and Latino participants, and among participants not identifying as male. Prior knowledge about PrEP was associated with lower stigma and higher positive attitudes. PrEP stigma had significant geospatial clustering and hotspots were identified in neighborhoods with high HIV incidence and concentration of racial minorities, whereas coldspots were identified in areas with high HIV incidence and low LGBT stigma. These results provide important information about PrEP attitudes and how PrEP stigma differs between individuals and across communities.

Students Who Limit Their Drinking, as Recommended by National Guidelines, Are Stigmatized, Ostracized, or the Subject of Peer Pressure: Limiting Consumption Is All But Prohibited in a Culture of Intoxication

There is an unquestionable need to address drinking patterns in subcultures where excessive drinking is normative. Regulatory bodies advocate moderating alcohol consumption but it is unclear whether individuals have agency to do so, particularly when excessive consumption is the norm. This study aimed to address this gap by examining student’s perceptions of limiting consumption, as recommended by government guidelines, in one university in New Zealand. Using a qualitative social science approach, university students surveyed and interviewed their heavy-drinking peers (n = 201) to investigate perceptions of 3 drinking behaviors (Heavy, Moderation, and Abstinence). Thematic analysis revealed that students who drink heavily are labeled positively and viewed as sociable (Dr Froth, Liver of Steel, Trooper, Champion, Hero, Good Alcoholic, popular, a friend). Students who limit drinking, on the other hand, were viewed similar to those who abstain, labeled using explicit, emotive, and derogative terminology (eg, Fag, Vagina, Grandma, Weirdo, Coward, Killjoy) and excluded, ostracized, or the subject of peer pressure. They were also expected to provide a justification for moderating their drinking (eg, being an athlete, broke). Although individuals who moderated their consumption were perceived to have strong willpower and maturity (eg, self-aware, brave, sophisticated), these positive attributes were mentioned less frequently and involved less emotive language than were labels linking moderation to a negative social identity. The method employed in this study provided a frank insight into a student culture of intoxication and the barriers facing students who try to drink in moderation. Our findings reveal that limiting consumption, even occasionally, threatens students’ social identity and inclusion in the student drinking culture. These results suggest that individualistic harm minimization strategies are unlikely to be effective. Instead, the findings underscore the need to develop alternative cultures emphasizing extracurricular activities which may facilitate students’ agency to go against the norm and moderate their drinking.

Reducing Heavy Episodic Drinking, Incapacitation, and Alcohol-Induced Blackouts: Secondary Outcomes of a Web-Based Combined Alcohol Use and Sexual Assault Risk Reduction Intervention

Heavy episodic drinking, alcohol-induced blackouts, and incapacitation are associated with sexual assault among college women. Therefore, reducing heavy episodic drinking, alcohol-induced blackouts, and incapacitation among college women may reduce sexual assault victimization risk. The current study examined the indirect effect of a combined alcohol use and sexual assault risk reduction program on sexual assault severity through heavy episodic drinking, alcohol-induced blackouts, and incapacitation ( n = 264). An alcohol use reduction program, sexual assault risk reduction program, and combined alcohol use and sexual assault risk reduction program were compared with a control condition. The sexual assault risk reduction content reduced alcohol-induced blackouts and incapacitation, and the combined alcohol use and sexual assault risk reduction program reduced alcohol-induced blackouts. Only incapacitation was associated with reduced sexual assault severity at follow-up. Reducing incapacitation and alcohol-induced blackouts is possible with a brief, web-based intervention, and reducing incapacitation may be one viable strategy within larger sexual assault prevention programming efforts.

Impact of exposure to alcohol marketing and subsequent drinking patterns among youth and young adults

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the impact of exposure to any form of alcohol marketing, compared to less exposure or no exposure, on alcohol consumption patterns among youth and young adults up to and including the age of 25 years (we want to be able to look at potential dose response relationships at different levels of exposure).

Understanding women's stories about drinking: implications for health interventions

Alcohol consumption poses significant health and safety risks to women. Understanding why women drink and how they experience drinking is the first step in creating efficacious interventions and effective social support programs. Presented here is a qualitative study examining stories women told about drinking on a blog: drinkingdiariesk.com. Eighty-nine stories categorized as 'in-depth, personal and insightful essays' were analysed and four narratives were identified about women's drinking in different stages in their lives: youth (narrative of good girl and narrative of bad girl), adulthood (narrative of pleasure) and old age (narrative of sin). Women constructed their relationships with alcohol in these different life stages, conforming to or rebelling against traditional gender roles. The narratives about drinking among young women and older women were inflicted with adultism and ageism. Practically, this study pointed out the specific stereotypes surrounding younger and older women with a drinking problem, which could inform future intervention campaigns about women's drinking.

Increasing Chance-Based Uncertainty Reduces Heavy Drinkers' Cognitive Reactance to Web-Based Personalized Normative Feedback

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.

Mediators and Moderators of a Personalized Feedback Alcohol Intervention for Nonstudent Emerging Adult Drinkers

BACKGROUND

The main objective of this study was to test proposed mediators and moderators of a personalized feedback alcohol intervention (PFI) on alcohol use. Data for the current investigation came from an earlier randomized controlled trial of a PFI targeted for nonstudent heavy drinkers between 18 and 25 years.

METHODS

Participants were 164 (65.9% men) drinkers recruited from the community. They were randomly assigned to either a single-session PFI or an assessment-only (AO) control group. Follow-up assessments at 1 and 3 months were included for analysis.

RESULTS

Perceived drinking norms mediated the intervention effect on quantity, frequency, and peak drinking; 2 dimensions of protective behavioral strategies (PBS) mediated the intervention effect on peak drinking; and drinking to cope motives did not mediate any drinking outcomes. Of the moderating factors examined (i.e., norms, PBS, drink to cope motives, age, gender), only PBS related to serious harm reduction moderated intervention impact. Specifically, for those high in serious harm reduction PBS at baseline, postintervention reductions in drinking were stronger for the PFI group compared to AO.

CONCLUSIONS

Overall, findings highlight the importance of correcting misperceived drinking norms and addressing the use of specific PBS in brief interventions. The knowledge gained from this study represents an important step toward minimizing drinking-related harms that are disproportionately experienced by those with lower educational attainment.

Working memory moderates the association between perceived norms and heavy episodic drinking among college students

Heavy episodic drinking (4+/5+ drinks/occasion for females/males) is highly prevalent among college students and is influenced by social factors. Among these social risk factors, perceived peer drinking norms have been shown to significantly predict heavy episodic drinking across a number of studies. However, there is little known about which students may be most and least susceptible to these influences or why individual differences may moderate the impact of norms on heavy drinking. Recent work has suggested self-control may be an important individual difference factor in this regard. Working memory (WM) is a central component of self-control that has been shown to buffer the effect of social influence variables. This study examined whether WM, as measured by memory span tasks, moderates the relationship between perceived drinking norms and alcohol use among college students reporting one or more past month drinking occasions (n = 98). Hierarchical linear regression analyses were used to examine whether WM significantly moderated the relationship between perceived norms and heavy drinking episodes (HDEs) as well as number of drinking days in the past month. Analyses revealed a significant WM x norms interaction for both drinking indices. Simple slopes analyses suggested a buffering effect of WM as higher perceived norms predicted more HDEs and drinking days at low (-1SD) and mean WM scores but not high (+1SD) WM. These results suggest WM serves as a protective factor for the influence of norms such that individuals high in WM may be more able to inhibit the impact of norms on alcohol use.

In pursuit of a self-sustaining college alcohol intervention: Deploying gamified PNF in the real world

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.

What "likes" have got to do with it: Exposure to peers' alcohol-related posts and perceptions of injunctive drinking norms

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.

The relative strength of attitudes versus perceived drinking norms as predictors of alcohol use

Social cognitive factors such as perceived norms and personal attitudes toward alcohol consumption are reliable predictors of alcohol use and related problems. The current study aimed to evaluate the relative importance of one's attitude toward alcohol use as a unique and important predictor of drinking related outcomes when directly compared to perceived descriptive and injunctive norms. Participants were mandated students (n=568; 28% female) who violated a campus alcohol policy and received a Brief Motivational Intervention. Analyses included the use of linear regression for prospective predictions to evaluate the relative importance of predictors which included perceived descriptive norms and injunctive norms, and attitudes toward moderate and heavy alcohol use. Overall, the results indicate that one's attitude toward heavy alcohol use is a stronger predictor of drinks per week, binge frequency, as well as alcohol related problems when directly compared to norms. Thus, the findings of the current study provide a compelling rationale for incorporating attitudes in the development and refinement of intervention strategies.

Resistance to peer influence moderates the relationship between perceived (but not actual) peer norms and binge drinking in a college student social network

INTRODUCTION

Adolescent and young adult binge drinking is strongly associated with perceived social norms and the drinking behavior that occurs within peer networks. The extent to which an individual is influenced by the behavior of others may depend upon that individual's resistance to peer influence (RPI).

METHODS

Students in their first semester of college (N=1323; 54.7% female, 57% White, 15.1% Hispanic) reported on their own binge drinking, and the perceived binge drinking of up to 10 important peers in the first-year class. Using network autocorrelation models, we investigated cross-sectional relationships between participant's binge drinking frequency and the perceived and actual binge drinking frequency of important peers. We then tested the moderating role of RPI, expecting that greater RPI would weaken the relationship between perceived and actual peer binge drinking on participant binge drinking.

RESULTS

Perceived and actual peer binge drinking were statistically significant predictors of participant binge drinking frequency in the past month, after controlling for covariates. RPI significantly moderated the association between perceptions of peer binge drinking and participant's own binge drinking; this association was weaker among participants with higher RPI compared to those with lower RPI. RPI did not interact with the actual binge drinking behavior of network peers.

CONCLUSIONS

RPI may function to protect individuals from the effect of their perceptions about the binge drinking of peers, but not from the effect of the actual binge drinking of peers.

Educational differences in alcohol consumption and heavy drinking: An age-period-cohort perspective

BACKGROUND

Low socioeconomic status (SES) has been associated with lower alcohol consumption, but also with heavier drinking. To explain this contradictory relationship, we examined SES differences in drinking patterns from an age-period-cohort (APC) perspective.

METHODS

Data are from seven waves of the U.S. National Alcohol Surveys from 1979 to 2010. As a proxy for SES, educational attainment was used. Past-year alcohol volume was calculated from frequency (never-to-every day) and usual quantity (1-2, 3-4, or 5-6 drinks). Past-year frequency of heavy episodic drinking was labelled as total days of 5+ drinks. Gender-stratified APC fixed-effects models were conducted controlling for demographics and adjusting for survey design and weights.

RESULTS

Significant APC effects by education were found, but the direction varied by alcohol measure. Education and total volume were positively associated across APC. Cross-over effects for age occurred with a positive education-heavy drinking relationship in young adulthood and negative relationship in mid-adulthood. Cohort-by-education effects showed greater heavy drinking among less educated women in 1956-60 cohort and more educated men and women in younger cohorts (post-1976).

CONCLUSIONS

Higher SES is consistently associated with total volume across age, period, and cohort, but less consistently with heavy drinking. While there are currently significant intervention efforts to reduce heavy drinking in young adulthood, our study suggests the need for age-specific strategies targeting lower-SES groups in mid-adulthood and cohort-specific strategies for lower-SES women in the baby boomer cohort and higher-SES men and women in younger birth cohorts.

Vietnamese medical students and binge drinking: a qualitative study of perceptions, attitudes, beliefs and experience

OBJECTIVES

To explore the perceptions, attitudes, beliefs, and experiences related to Vietnamese medical students' binge drinking.

DESIGN

A qualitative study comprising semi-structured focus groups/interviews with medical students and semi-structured interviews with key informants. Thematic analysis of data.

SETTING

Participants were a convenience sample of usual volunteers from a medical university in Viet Nam.

PARTICIPANTS

19 medical students from year 1 to 6 and 4 key informants agreed to participate in the study.

RESULTS

The study found participants believe medical students drink less than other students and are not binge drinkers yet they experience and/or witness many binge drinking occasions among medical students. Participants consider alcohol use as culturally acceptable in Vietnamese society and a way for medical students to create and improve relationships with their friends, teachers, or work colleagues. Group affiliation and peer pressure to drink excessive alcohol are identified among medical students, especially male students.

CONCLUSION

The culture of drinking behaviour was explored among medical students in Viet Nam. This study reveals a dichotomy between the belief of not being binge drinkers and the experience of many binge drinking occasions among medical students. This tension suggests future research about binge drinking behaviour of Vietnamese medical students is required.

Information about peer choices shapes human risky decision-making

Humans frequently make choices that involve risk for health and well-being. At the same time, information about others’ choices is omnipresent due to new forms of social media and information technology. However, while past research has shown that peers can exert a strong influence on such risky choices, understanding how information about risky decisions of others affects one’s own risky decisions is still lacking. We therefore developed a behavioral task to measure how information about peer choices affects risky decision-making and call it the social Balloon Analogue Risk Task (sBART). We tested this novel paradigm in a sample of 52 college young adults. Here we show that risky decisions were influenced in the direction of the perceived choices of others – riskier choices of others led to riskier behavior whereas safer choices of others led to less risky behavior. These findings indicate that information about peer choices is sufficient to shape one’s own risky behavior.

Transitions into young adulthood: Extent to which alcohol use, perceived drinking norms, and consequences vary by education and work statuses among 18-20year olds

INTRODUCTION

With many young adults pursuing post-secondary education and many working, understanding the importance of education and work roles on alcohol use are of developmental and clinical importance. Utilizing a sample of 18-20year-olds transitioning from adolescence to young adulthood, the current study examined how social role statuses in education (i.e., not in school, 2-year students, 4-year students) and work status (i.e., unemployed, employed part-time, employed full-time) were associated with alcohol use, alcohol-related consequences, and perceived drinking norms.

METHOD

Participants were 18-20year old young adults (54% female) participating in a one-time online survey about alcohol use and sexual behavior. Regression models were conducted to examine associations between school status and work status with alcohol related outcomes.

RESULTS

Individuals who were unemployed had a significantly lower likelihood of any heavy episodic drinking (HED) in the past month, consumed fewer drinks per week, and experienced fewer alcohol-related consequences compared to individuals who worked full-time. Individuals who worked part-time consumed fewer drinks per week and had lower perceived drinking norms compared to individuals who worked full-time. No significant associations were found for alcohol use and consequences by education status.

DISCUSSION

Working full-time is a risk factor for HED, greater weekly drinking and negative alcohol-related consequences when compared to young adults who are unemployed, and to a lesser extent with young adults working part-time. Workplace interventions may be one approach to reach heavy drinking young adults.

The Role of Norms in Marijuana Use Among American Indian Adolescents

American Indian adolescents residing on reservations report high levels of marijuana use. Understanding the relationships between normative mechanisms and marijuana use in this group can be especially important in designing effective strategies to prevent use. Participants were 3446 students identifying as American Indian in grades 7-12 across four academic years (2009-2012) from 45 schools. Multilevel logistic analysis was used to examine the relationships between lifetime, last month, and frequent marijuana use and measures of the normative environment. Descriptive and injunctive norms were distinctly and directly associated with all measures of marijuana use, with family injunctive norms showing a strong relationship to use (0.49 < OR < 0.58 for a 9th grade student). Family injunctive norms moderated the relationship between descriptive norms and lifetime and last month use (OR = 0.79 and 0.82, respectively), with higher family disapproval associated with a weaker relationship between descriptive norms and use. Anticipatory socialization was positively related to all measures of marijuana use, with the relationship stronger for lifetime and last month use than for frequent use (OR = 1.88, 1.74, and 1.30, respectively). A contextual variable of descriptive norms was related to lifetime and last month use (OR = 1.66 and 1.51, respectively) but not frequent use. These findings reinforce the importance of parental norms in reducing the likelihood of using marijuana. In addition, prevention strategies that increase the perception that healthy behaviors not involving marijuana use are an enjoyable way to socialize may be more effective in preventing occasional marijuana use.

Prototype Willingness Model Drinking Cognitions Mediate Personalized Normative Feedback Efficacy

Personalized normative feedback (PNF) interventions have been shown to be efficacious at reducing college student drinking. Because descriptive norms have been shown to mediate PNF efficacy, the current study focused on examining additional prototype willingness model social reaction cognitions, namely, prototypes and willingness, as mediators of intervention efficacy. We expected the PNF interventions to be associated with increased prototype favorability of students who do not drink, which would in turn be associated with decreased willingness to drink and subsequently, less drinking. The current study included 622 college students (53.2% women; 62% Caucasian) who reported one or more heavy drinking episodes in the past month and completed baseline and three-month follow-up assessments. As posited by the framework of the prototype willingness model, sequential mediation analyses were conducted to evaluate increases in abstainer prototype favorability on willingness on drinking, and subsequently willingness to drink on drinking behavior. Mediation results revealed significant indirect effects of PNF on three-month drinking through three-month prototypes and willingness, indicating that the social reaction pathway of the prototype willingness model was supported. Findings have important implications for PNF interventions aiming to reduce high-risk drinking among college students. Study findings suggest that we should consider looking at additional socially-based mediators of PNF efficacy in addition to perceived descriptive norms.

Design and feasibility testing of a novel group intervention for young women who binge drink in groups

BACKGROUND

Young women frequently drink alcohol in groups and binge drinking within these natural drinking groups is common. This study describes the design of a theoretically and empirically based group intervention to reduce binge drinking among young women. It also evaluates their engagement with the intervention and the acceptability of the study methods.

METHODS

Friendship groups of women aged 18-35 years, who had two or more episodes of binge drinking (>6 UK units on one occasion; 48g of alcohol) in the previous 30 days, were recruited from the community. A face-to-face group intervention, based on the Health Action Process Approach, was delivered over three sessions. Components of the intervention were woven around fun activities, such as making alcohol free cocktails. Women were followed up four months after the intervention was delivered.

RESULTS

The target of 24 groups (comprising 97 women) was recruited. The common pattern of drinking was infrequent, heavy drinking (mean consumption on the heaviest drinking day was UK 18.1 units). Process evaluation revealed that the intervention was delivered with high fidelity and acceptability of the study methods was high. The women engaged positively with intervention components and made group decisions about cutting down. Twenty two groups set goals to reduce their drinking, and these were translated into action plans. Retention of individuals at follow up was 87%.

CONCLUSIONS

This study successfully recruited groups of young women whose patterns of drinking place them at high risk of acute harm. This novel approach to delivering an alcohol intervention has potential to reduce binge drinking among young women. The high levels of engagement with key steps in the behavior change process suggests that the group intervention should be tested in a full randomised controlled trial.

Testing competing models of injunctive and descriptive norms for proximal and distal reference groups on alcohol attitudes and behavior

INTRODUCTION

Injunctive norms represent perceptions regarding the extent that others approve of a behavior, whereas descriptive norms represent perceptions of the extent that others engage in a behavior. This study evaluated competing path models, varying in the representation of injunctive and descriptive norm constructs, to forecast alcohol attitudes and use.

METHODS

College students (N=326) answered questions about their normative perceptions regarding three relevant reference groups (typical students, friends, and parents) in the form of alcohol injunctive and descriptive norms. Personal alcohol attitudes (approval) and usage were assessed one month later.

RESULTS

The path analysis model arranged by injunctive versus descriptive found that injunctive norms explained attitudes, but descriptive norms contributed to behavior. In the path analysis model of constructs organized by reference groups, friend and parent norms uniquely contributed to attitudes, but typical student, friend, and parental norms contributed to use. Finally, the comprehensive model based on each reference group combination with injunctive and descriptive norms (e.g., typical student injunctive) determined that friend injunctive norms and parent injunctive norms uniquely forecasted alcohol attitudes, whereas typical student injunctive norms, typical student descriptive norms, and friend descriptive norms forecasted behavior.

CONCLUSIONS

A novel contribution of the study is the scrutiny of competing models of alcohol norms using the same multifaceted measures. Disparate implications emerge about the role of subjective norms as a function of the approach to compute the constructs. The most nuanced insights were obtained in the final comprehensive model involving the representation of norms at the finest level of specificity.

Descriptive and injunctive norms of waterpipe smoking among college students

INTRODUCTION

Smoking tobacco via a waterpipe (WP) is on the rise, particularly among college students. One reason for this may be normative perceptions of WP tobacco smoking (WTS) among this population. The current study examined the perceived and actual descriptive and injunctive norms of WTS among a college student sample.

METHODS

Participants were 894 college students enrolled at a large, Midwestern university. Participants completed measures of WTS frequency and quantity and perceived/actual descriptive and injunctive norms of WTS.

RESULTS

Over one-third of the sample reported ever trying WTS, while only 2% reported current (past month) use. When comparing ever and never WP smokers, ever smokers reported greater perceived peer approval of WTS. Both males and females overestimated WTS frequency of same-sex students at their university.

DISCUSSION

The current study is one of the first to investigate descriptive and injunctive norms of WTS among college students. Students who report WTS are more likely to overestimate descriptive norms of WTS among their peers, suggesting corrective normative feedback regarding actual use by peers may be an important target for WTS intervention among college students. Future research should investigate the temporal association between normative perceptions and WTS behaviors among college students.

Sexual Minority Disparities in Substance Use Willingness Among Youth

BACKGROUND

Disparities in substance use have been observed in sexual minority youth, but less is known about willingness to use substances, an important precursor to actual use.

OBJECTIVE

The goal of this study was to examine willingness to use cigarettes, alcohol, and marijuana among sexual minority youth compared to their non-sexual minority counterparts using both cross-sectional and longitudinal data.

METHODS

The present study drew on two waves (Times 1 and 2; 6 months apart) of data collected during high school as part of a prospective study of substance use initiation and progression in Rhode Island. At Time 1, participants (N = 443) ranged in age from 15 to 20 years (M age = 16.7 years, 26.6% sexual minority, 59.5% female, 72.0% White). Participants self-reported their sexual identity and attraction, lifetime use of alcohol, cigarettes and marijuana, and cigarette, alcohol, and marijuana use willingness (i.e., if offered by a best friend or group of friends).

RESULTS

In cross-sectional multivariate regression models, sexual minority youth were more likely to report willingness to use cigarettes (p <.05) and marijuana (p <.01) compared to their non-sexual minority counterparts. Longitudinal multivariate regression models revealed that sexual minorities were only significantly more likely to report cigarette willingness at Time 2 compared to their non-sexual minority counterparts (p <.01). There were no significant differences in alcohol use willingness in multivariable cross-sectional or longitudinal models by sexual minority status.

CONCLUSIONS

Sexual minority youth reported more willingness than non-sexual minority youth to use substances offered by peers; however, longitudinal analyses revealed that peers appear to play a role only in willingness to smoke cigarettes for these youth, and thus peer influence may be a contributing factor in explaining tobacco-related disparities among sexual minority youth. Given that stigma and peer groups may a particular risk factor for tobacco among sexual minority youth, our findings highlight the importance of prevention programs such as social marketing approaches that correct social norms, reduce stigma, and provide refusal-skills training to reduce tobacco-related disparities among sexual minorities.

The Epidemiology of Binge Drinking Among College-Age Individuals in the United States

Rates of alcohol consumption continue to be a concern, particularly for individuals who are college age. Drinking patterns have changed over time, with the frequency of binge drinking (consuming four/five or more drinks for women/men) remaining high (30% to 40%). Young adults in the college age range are developmentally and socially at higher risk for drinking at binge levels. Changes in autonomy, parental control, norms, and attitudes affect binge drinking behaviors. This article reviews those changes, as well as the individual and environmental factors that increase or decrease the risk of participating in binge drinking behaviors. Risk factors include risky drinking events (e.g., 21st birthdays), other substance use, and drinking to cope, while protective factors include religious beliefs, low normative perceptions of drinking, and use of protective behavioral strategies. Additionally, this article discusses the physical, social, emotional, and cognitive consequences of consuming alcohol at binge levels. Alcohol policies and prevention and intervention techniques need to incorporate these factors to reduce experiences of alcohol-related problems. Targeting policy changes and prevention and intervention efforts toward young adults may increase effectiveness and prevent both short- and long-term consequences of binge drinking.

Reward System Activation in Response to Alcohol Advertisements Predicts College Drinking

OBJECTIVE

In this study, we assess whether activation of the brain's reward system in response to alcohol advertisements is associated with college drinking. Previous research has established a relationship between exposure to alcohol marketing and underage drinking. Within other appetitive domains, the relationship between cue exposure and behavioral enactment is known to rely on activation of the brain's reward system. However, the relationship between neural activation to alcohol advertisements and alcohol consumption has not been studied in a nondisordered population.

METHOD

In this cross-sectional study, 53 college students (32 women) completed a functional magnetic resonance imaging scan while viewing alcohol, food, and control (car and technology) advertisements. Afterward, they completed a survey about their alcohol consumption (including frequency of drinking, typical number of drinks consumed, and frequency of binge drinking) over the previous month.

RESULTS

In 43 participants (24 women) meeting inclusion criteria, viewing alcohol advertisements elicited activation in the left orbitofrontal cortex and bilateral ventral striatum-regions of the reward system that typically activate to other appetitive rewards and relate to consumption behaviors. Moreover, the level of self-reported drinking correlated with the magnitude of activation in the left orbitofrontal cortex.

CONCLUSIONS

Results suggest that alcohol cues are processed within the reward system in a way that may motivate drinking behavior.

How acceptable are intoxicated behaviors? Discrepancy between personal versus perceived approval

INTRODUCTION

College students report high rates of binge drinking yet they reliably endorse elevated perceptions of drinking by their peers. However, the drinking norms literature offers little insight into how college students think about behaviors exhibited while intoxicated. This study aims to determine (a) if the predicted self-other differences (SODs) are seen among college students with respect to approval of intoxicated behaviors and (b) whether gender and race/ethnicity moderate these differences. We hypothesized that students would perceive others as more approving of intoxicated behaviors than they were themselves, resulting in significant SODs. We also predicted that women would have larger SODs relative to their male counterparts, and minority students would have larger SODs relative to their white counterparts.

METHODS

Participants (N=233, 63% female) were recruited from an introductory psychology course at a large public northeastern university. They completed online surveys that assessed demographics, and responded to a list of intoxicated behaviors with ratings of personal approval and perceived peer approval.

RESULTS

Perceived others' approval ratings exceeded personal approval ratings for 42 of the 44 different intoxicated behaviors. Women had significantly higher SODs relative to men and differed on personal approval. Non-white students had significantly higher SODs relative to white students, and differed both on personal approval and perceptions of others' approval of intoxicated behaviors.

CONCLUSIONS

Consistent SODs were observed in the approval of intoxicated behaviors. These findings may help to inform normative feedback interventions by revealing the potential for normative pressure, especially for non-white students.

Personality, marijuana norms, and marijuana outcomes among college students

Based on the high prevalence of marijuana use among college students, we examined distal and proximal antecedents to marijuana-related outcomes in this population. Specifically, we examined three marijuana-related perceptions (descriptive norms, injunctive norms, and internalization of college marijuana use culture) as potential mediators of the associations between four personality traits (impulsivity, sensation seeking, hopelessness, and anxiety sensitivity) and marijuana-related outcomes (marijuana use, negative marijuana-related consequences). In a large sample of college student marijuana users (n=2129), our path analysis revealed marijuana-related perceptions to significantly mediate the associations between personality and marijuana-related outcomes. Specifically, internalization of college marijuana use culture mediated the effects of both impulsivity and sensation seeking on marijuana-related outcomes. Not only do our findings suggest the importance of distinct types of marijuana-related norms in predicting marijuana involvement, but also the possibility that such normative beliefs could be targeted as part of personality-tailored interventions.

Peer norms and susceptibility mediate the effect of movie alcohol exposure on alcohol initiation in adolescents

Movie alcohol exposure is a known and consistent predictor of adolescent alcohol use initiation and escalation. Nearly 90% of the top U.S. movies contain alcohol content. Social-cognitive theory posits reciprocal links among environmental influences (e.g., movie alcohol exposure), social-cognitive processes (e.g., perceived norms, susceptibility, alcohol outcome expectancies), and behavior (alcohol use), but these links have been tested in only 1 direction. In the current study, we assessed movie alcohol exposure, alcohol cognitions, and alcohol initiation among adolescents (N = 1,023; 52% female, mean age = 13.7 years) in 4 annual survey waves. Cross-lagged panel models tested bidirectional relations between cognitions and movie alcohol exposure. Finally, we tested bidirectional mediation effects in the prospective prediction of alcohol initiation. Movie alcohol exposure prospectively predicted increases in descriptive norms, injunctive norms, and susceptibility but not positive or negative alcohol outcome expectancies. All factors predicted subsequent alcohol initiation. Close friend injunctive and descriptive norms, peer descriptive norms, and susceptibility mediated the effect of earlier movie alcohol exposure on subsequent alcohol initiation. Movie alcohol exposure mediated the effect of earlier close friend descriptive norms on subsequent alcohol initiation. Movie alcohol exposure and social-cognitive processes are interrelated facets that impact alcohol initiation. Permissive cognitions infrequently predicted higher subsequent exposure to movie alcohol. Clinical and preventative implications of this work are discussed. (PsycINFO Database Record

Acculturative stress as a moderator of the effect of drinking motives on alcohol use and problems among young adults

BACKGROUND

Research has demonstrated a strong relationship between drinking motives and alcohol use among young adult populations. Further, there is substantial evidence of the association between psychosocial stressors and greater alcohol consumption. In the present study, we examined whether acculturative stress would moderate the relationship between major drinking motives and alcohol use behaviors and alcohol-related problems, and whether this relationship differs by racial/ethnic group.

METHOD

Six hundred diverse undergraduate students (mean age=21.50, SD=2.46; 82.8% female; 40.2% White/Caucasian) completed a series of measures, including demographic information, alcohol use/alcohol problems, and acculturative stress.

RESULTS

Findings showed varying patterns in the moderating effect of acculturative stress on the relationship between drinking motives and alcohol consumption and alcohol-related problems, particularly for self-identified Hispanic, Black, and Asian students. Stronger drinking motives were associated with greater alcohol consumption and alcohol-related problems, and this relationship was stronger among Asian and Hispanic students who reported higher levels of acculturative stress. For Black students, greater acculturative stress was observed to weaken the relationship between coping, enhancement, and conformity motives and alcohol drinking frequency.

CONCLUSIONS

Results are discussed in terms of incorporating acculturative stress in the development of tailored alcohol use interventions for vulnerable young adults, such as certain ethnic minority and immigrant groups. Clinical implications include screening for acculturative stress in primary care and counseling centers and early intervention programs to identify young adults who may be at-risk for or currently experiencing alcohol problems.

Cross-cultural examination of college drinking culture in Spain, Argentina, and USA: Measurement invariance testing of the College Life Alcohol Salience Scale

OBJECTIVE

Perceptions about what is "normal" drinking in college, measured by the College Life Alcohol Salience Scale (CLASS; 15 items), have been robustly associated with elevated levels of problematic alcohol use, yet the role of these beliefs has not been studied outside the U.S. The present work examined measurement invariance of the CLASS across sex, drinker status, and in individuals from three different countries (i.e., U.S., Argentina, Spain). Additional goals were to evaluate differences on the CLASS (i.e., latent mean differences) as a function of sex, drinker status and country and to compare construct validity (i.e., correlations with alcohol variables) across sex and different countries.

METHOD

A large sample of 1841 college students enrolled in universities from the U.S., Spain and Argentina completed, via an online survey, a battery of instruments that assess college alcohol beliefs, drinking motives, alcohol consumption and alcohol-related negative consequences.

RESULTS

We found that a shortened 12-item version of the CLASS to be invariant across sex and drinker status, but only metric invariance was found across countries. As expected, men and drinkers showed significantly higher scores on the CLASS than women and non-drinkers, respectively. Bivariate correlations between CLASS scores and drinking outcomes strongly supported criterion-related validity of this measure across multiple countries and sex with differing strengths in relationships with alcohol-related constructs.

CONCLUSIONS

Taken together, perceptions of the centrality of alcohol to the college experience appear to be an important target for college student alcohol interventions across various cultures and countries, especially for male college student drinkers.

The impact of normative perceptions on alcohol consumption in military veterans

BACKGROUND AND AIMS

Perceptions of both descriptive norms (prevalence of drinking) and injunctive norms (others' approval of drinking) relate to alcohol consumption, but mechanisms for these associations have received little attention, especially in military samples. This study tested the direct and indirect associations between perceived descriptive and injunctive norms on drinking through personal attitudes (i.e. personal approval) in a veteran sample.

DESIGN

Data were collected as part of a longitudinal randomized controlled alcohol intervention study. The study involved two time-points: baseline/intervention (time 1) and 1-month follow-up (time 2).

SETTING

A national sample of veterans was recruited from Facebook to participate in an online study between June and October 2015.

PARTICIPANTS

Data included responses of 621 adult military veterans (age 18-34; 83% male).

MEASURES

Respondents reported on their weekly alcohol consumption (primary outcome), perceptions of typical drinking and approval by other same-gender veterans. Covariates included gender, intervention condition and combat experience.

FINDINGS

Regression results found no significant effects of perceived descriptive or injunctive norms on time 2 drinking when accounting for the effects of personal attitudes, time 1 drinking and covariates. However, mediation analyses found support for personal attitudes as a mediator of the relationship between perceived descriptive norms and time 2 drinking [indirect effect = 0.003, standard deviation (SD) = 0.001, P = 0.001] and between perceived injunctive norms and time 2 drinking (indirect effect = 0.004, SE = 0.001, P < 0.001).

CONCLUSIONS

Attitudes to drinking appear to mediate the association between descriptive and injunctions norms about alcohol and subsequent level of alcohol consumption in US military personnel.

Positive expectancies mediate the link between race and alcohol use in a sample of Native American and Caucasian college students

BACKGROUND

Though abundant research suggests that Native Americans report high rates of alcohol use and related consequences, little research has examined drinking patterns among Native American college students. It is possible that drinking rates for this group may differ from their non-college counterparts and also from those of Caucasian college students. The aim of this study was to examine whether alcohol use differs between Native American and Caucasian college students, and specifically whether alcohol expectancy effects mediate the relationship between race and drinking.

METHOD

Participants were 43 Native American and 87 Caucasian college students who reported on their positive and negative expectancy effects and past-6-month drinking.

RESULTS

Caucasians reported drinking significantly more alcohol and holding stronger positive expectancies. Bootstrapping mediational analysis with 95% confidence intervals indicated that positive but not negative expectancy effects mediated the relationship between race and past-6-month drinking.

CONCLUSIONS

This preliminary research is the first to examine expectancy effects as mediators of the relationship between Native American and Caucasian race and drinking. Further understanding of the differences in positive expectancy effects between groups may have important implications for prevention and treatment of alcohol use among Native American college students.

Perceived Importance of Marijuana to the College Experience Scale (PIMCES): Initial Development and Validation

OBJECTIVE

Internalization of college substance use culture refers to the degree to which an individual perceives the use of that substance to be an integral part of the college experience. Although there is a growing literature characterizing this construct for alcohol, the present study describes the development and validation of a new measure to assess the internalization of the college marijuana use culture, the Perceived Importance of Marijuana to the College Experience Scale (PIMCES).

METHOD

We recruited a large, diverse sample (N = 8,141) of college students from 11 participating universities. We examined the psychometric properties of the PIMCES and evaluated its concurrent validity by examining its associations with marijuana-related outcomes.

RESULTS

A single-factor, eight-item PIMCES demonstrated good model fit and high internal consistency (Cronbach's α = .89) and was correlated with marijuana user status, frequency of marijuana use, marijuana consequences, and injunctive norms.

CONCLUSIONS

Overall, the PIMCES exhibits sound psychometric properties. The PIMCES can serve as a possible mediator of the effects of personality and other factors on marijuana-related outcomes and may be a promising target for marijuana interventions.

Descriptive drinking norms in Native American and non-Hispanic White college students

OBJECTIVE

College students tend to overestimate how much their peers drink, which is associated with higher personal alcohol use. However, research has not yet examined if this phenomenon holds true among Native American (NA) college students. This study examined associations between descriptive norms and alcohol use/consequences in a sample of NA and non-Hispanic White (NHW) college students.

METHOD

NA (n=147, 78.6% female) and NHW (n=246, 67.8% female) undergraduates completed an online survey.

RESULTS

NAs NHWs showed similar descriptive norms such that the "typical college student," "typical NA student," and "typical NHW student" were perceived to drink more than "best friends." "Best friends" descriptive norms (i.e., estimations of how many drinks per week were consumed by participants' best friends) were the most robust predictors of alcohol use/consequences. Effect size estimates of the associations between drinking norms and participants' alcohol use were consistently positive and ranged from r=0.25 to r=0.51 across the four reference groups. Negative binomial hurdle models revealed that all descriptive norms tended to predict drinking, and "best friends" drinking norms predicted alcohol consequences. Apart from one interaction effect, likely due to familywise error rate, these associations were not qualified by interactions with racial/ethnic group.

CONCLUSIONS

We found similar patterns between NAs and NHWs both in the pattern of descriptive norms across reference groups and in the strength of associations between descriptive norms and alcohol use/consequences. Although these results suggest that descriptive norms operate similarly among NAs as other college students, additional research is needed to identify whether other norms (e.g., injunctive norms) operate similarly across NA and NHW students.

A descriptive analysis of where and with whom lesbian versus bisexual women drink

Purpose

Sexual minority women (SMW) are at increased risk for alcohol use disorders and related problems. Social context (e.g., where and with whom one drinks) has been identified as an important factor associated with drinking behavior, but little is known about social context among SMW. An improved understanding of social context among SMW has the potential to inform efforts to reduce problematic drinking and its consequences in this high-risk population.

Methods

We examined where and with whom SMW drink in a national sample recruited via social media (N = 1,057).

Results

SMW reported more frequent drinking in private locations (compared to public locations), with friends and romantic partners (compared to family members and strangers), and in locations with both heterosexuals and sexual minorities (compared to mostly or exclusively sexual minorities). Additionally, lesbians reported more frequent drinking in bars and in locations with more sexual minorities compared to bisexual women.

Conclusion

Interventions to reduce problematic drinking among SMW may benefit from addressing social context.

Alcohol use from adolescence through early adulthood: an assessment of measurement invariance by age and gender

BACKGROUND AND AIMS

Studies on alcohol use and related constructs rarely test for measurement invariance to assess the reliability and validity of measures of alcohol use across different subpopulations of interest or ages. This failure to consider measurement invariance may result in biased parameter estimates and inferences. This study aimed to test measurement invariance of alcohol use across gender and age using a US nationally representative sample to inform future longitudinal studies assessing alcohol use.

DESIGN

The National Longitudinal Study of Adolescent to Adult Health, a school-based, nationally representative longitudinal study conducted in 1994-95, 2001-02 and 2008.

SETTING

All regions within the United States; participants were selected via a clustered sample design from 80 high schools that represented the national population.

PARTICIPANTS

Youth and young adults aged 13-31 years who had valid data on all three alcohol items within wave: 18 923 from wave 1; 14 315 from wave 3; and 14 785 from wave 4.

MEASUREMENTS

Alcohol use measurement models were constructed using past-year general drinking frequency, heavy episodic drinking frequency and average quantity when drinking. Configural (factor structure), metric (factor loadings) and scalar (item intercepts) measurement invariance models were tested by gender and for each year of age from 13 to 31 years.

FINDINGS

All models passed the threshold for configural invariance. Comparisons between males and females demonstrated metric (and usually scalar) non-invariance for most ages beyond middle adolescence. Nearly all 1- and 2-year contrasts passed metric invariance. Scalar non-invariance was most prevalent in age comparisons between late adolescence and early adulthood, particularly for tests using 2-year age increments.

CONCLUSIONS

Studies that do not account for the effects of gender and age on the measurement of alcohol use may be statistically biased.

Peer alcohol behavior moderates within-level associations between posttraumatic stress disorder symptoms and alcohol use in college students

Self-medication theory (SMT) posits that individuals exposed to trauma and resulting posttraumatic stress symptoms (PTSD) are at risk for heavy drinking and associated negative consequences. Close peer alcohol use is also a powerful predictor of alcohol involvement in college, particularly influencing those with greater negative affect. As individuals with PTSD may rely on peers for support, peer drinking behaviors are possibly putting them at further risk for greater alcohol use and resulting consequences. To test self-medication processes, the present study examined the relationship between weekday PTSD symptoms, weekend alcohol behavior, and the influence of both emotionally supportive peer and other friend drinking behavior by investigating: (a) whether weekday PTSD symptoms predicted subsequent weekend alcohol use and consequences; and (b) whether the relationship between weekday PTSD symptoms and weekend alcohol behavior was moderated by various drinking behaviors of one's peers. Trauma-exposed heavy-drinking college students (N = 128) completed a baseline assessment and 30 daily, Web-based assessments of alcohol use and related consequences, PTSD symptoms, and peer alcohol behavior. Results directly testing SMT were not supported. However, friend alcohol behavior moderated the relationship between weekday PTSD and weekend alcohol behavior. Findings highlight the importance of peer drinking as both a buffer and risk factor for problematic drinking and provide useful information for interventions aimed at high-risk drinkers. (PsycINFO Database Record

Not all drinking events are the same: Exploring 21st birthday and typical alcohol expectancies as a risk factor for high-risk drinking and alcohol problems

Alcohol expectancies are a central construct in understanding college student typical alcohol use. However, to our knowledge, there is no research addressing how alcohol expectancies for specific events (i.e. 21st birthday) are different from expectancies regarding typical drinking. We examine the extent to which 21st birthday alcohol expectancies differ from general alcohol expectancies and how 21st birthday expectancies are associated with actual alcohol use and consequences experienced on 21st birthdays, above and beyond expectancies for typical drinking. Participants were college students (N=585; 54% women) who were turning 21 within a week, and intended to drink 4/5 (female/male) drinks on their birthday. All negative expectancies (impairment, risk and aggression, negative self-perception) and positive expectancies (social, liquid courage, sex) except tension reduction were significantly greater for 21st birthday drinking than for typical drinking. While 21st birthday expectancies were not uniquely related to actual birthday drinking, several positive and negative 21st birthday expectancy subscales were associated with 21st birthday drinking-related consequences, even when controlling for typical drinking expectancies. Expectancy challenge interventions aimed specifically at these subscales may be effective at attenuating alcohol-related consequences that result from 21st birthday drinking.

Interaction between the ADH1B*3 allele and drinking motives on alcohol use among Black college students

BACKGROUND

Black young adults have lower rates of alcohol use than other racial groups. Genetic factors may protect against drinking. Specifically, the ADH1B*3 allele is present almost exclusively in Black populations and has been protective against alcohol use and alcohol use disorder. The protective effects of the ADH1B*3 allele, however, may differ as a function of alcohol-promoting cognitions.

OBJECTIVES

The current study examined whether ADH1B*3 moderated relations of drinking motives with alcohol consumption among Black college drinkers.

METHODS

Participants were 241 undergraduate students of self-identified Black race (mean age = 20 years; 66% female) who reported consuming alcohol at least once in the past 30 days.

RESULTS

ADH1B*3 was not significantly associated with drinking motives or drinking behaviors. However, significant, albeit small, interaction effects of ADH1B*3 with drinking motives on drinking behavior were found; the presence of an ADH1B*3 allele protected against greater drinking quantity among students with high social motives (incidence rate ratio [IRR] = 0.95, 95% CI [0.92, 0.99]) and against frequent drinking among students with low coping motives (IRR = 1.06, 95% CI [1.01, 1.11]).

CONCLUSION

These findings represent a novel demonstration of genetic modulation of alcohol-related cognitions within Black college drinkers, although replication is needed. Results represent an initial step toward better characterizing individual differences in associations of drinking motives with drinking behavior, with potential implications for interventions aimed at motivational processes in alcohol use.

Detecting Drinking Episodes in Young Adults Using Smartphone-based Sensors

Alcohol use in young adults is common, with high rates of morbidity and mortality largely due to periodic, heavy drinking episodes (HDEs). Behavioral interventions delivered through electronic communication modalities (e.g., text messaging) can reduce the frequency of HDEs in young adults, but effects are small. One way to amplify these effects is to deliver support materials proximal to drinking occasions, but this requires knowledge of when they will occur. Mobile phones have built-in sensors that can potentially be useful in monitoring behavioral patterns associated with the initiation of drinking occasions. The objective of our work is to explore the detection of daily-life behavioral markers using mobile phone sensors and their utility in identifying drinking occasions. We utilized data from 30 young adults aged 21-28 with past hazardous drinking and collected mobile phone sensor data and daily Experience Sampling Method (ESM) of drinking for 28 consecutive days. We built a machine learning-based model that is 96.6% accurate at identifying non-drinking, drinking and heavy drinking episodes. We highlight the most important features for detecting drinking episodes and identify the amount of historical data needed for accurate detection. Our results suggest that mobile phone sensors can be used for automated, continuous monitoring of at-risk populations to detect drinking episodes and support the delivery of timely interventions.

Binge drinking: Health impact, prevalence, correlates and interventions

OBJECTIVE

Binge drinking (also called heavy episodic drinking, risky single-occasion drinking etc.) is a major public health problem. This paper provides an overview of recently published evidence concerning the definition and measurement, prevalence rates, health impact, demographic and psychosocial correlates of, and interventions for, binge drinking.

DESIGN

Narrative review.

RESULTS

Mostly occurring among young people at weekends, binge drinking increases the risk of both acute (e.g. injuries) and long-term negative consequences (e.g. alcohol disorders). Binge drinkers tend to be extrovert, impulsive and sensation-seeking. Stress, anxiety, traumatic events and depression are also related to binge drinking. Both alcohol-related behaviour of parents and general parenting (e.g. parenting styles, monitoring) are also important. Other major risk factors for binge drinking are frequently spending time with friends who drink, and the drinking norms observed in the wider social environment (e.g. school, community, culture). Emergency departments, birthday parties, fraternities and the workplace serve as settings for interventions; these are increasingly delivered via digital and mobile technology. There is evidence of small-sized effects across approaches (brief interventions, personalised normative feedback, protective behavioural strategies etc.) and populations.

CONCLUSION

A more consistent terminology, investigating multi-level influences and identifying the most effective intervention components are challenges for future research.

The role of perceived injunctive alcohol norms in adolescent drinking behavior

Peers have a major influence on youth during adolescence, and perceptions about peer alcohol use (perceived norms) are often associated with personal drinking behavior among youth. Most of the research on perceived norms among adolescents focuses on perceived descriptive norms only, or perceptions about peers' behavior, and correcting these perceptions are a major focus of many prevention programs with adolescents. In contrast, perceived injunctive norms, which are personal perceptions about peers' attitudes regarding the acceptability of behaviors, have been minimally examined in the adolescent drinking literature. Yet correcting perceptions about these perceived peer attitudes may be an important component to include in prevention programs with youth. Using a sample of 2493 high school-aged youth (mean age=17.3), we assessed drinking behavior (past year use; past month frequency, quantity, and peak drinks), drinking consequences, and perceived descriptive and injunctive norms to examine the relationships of perceived injunctive and descriptive norms on adolescent drinking behavior. Findings indicated that although perceived descriptive norms were associated with some drinking outcomes (past year use; past month frequency; past month quantity; peak drinks), perceived injunctive norms were associated with all drinking outcomes, including outcomes of consequences, even after controlling for perceived descriptive norms. Findings suggest that consideration of perceived injunctive norms may be important in models of adolescent drinking. Prevention programs that do not include injunctive norms feedback may miss an important opportunity to enhance effectiveness of such prevention programs targeting adolescent alcohol use.

PNF 2.0? Initial evidence that gamification can increase the efficacy of brief, web-based personalized normative feedback alcohol interventions

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.

Evaluations and Perceptions of Others' Evaluations of Negative Alcohol-Related Consequences Predict Negative Alcohol-Related Consequences Among College Drinkers

OBJECTIVE

A key assumption when assessing alcohol-related problems is that these problems are considered negative. A growing literature suggests that college drinkers do not perceive all measured consequences to be negative. Research has established the impact of others' beliefs on personal beliefs and behaviors. The purpose of this study was to assess the effect of perceptions of others' evaluations (POE) of consequences on one's own evaluations and subsequent experiences of consequences.

METHOD

A sample of 885 heavy drinking college students participated in a longitudinal study. Participants reported the number of alcoholic drinks consumed per week, experiences of alcohol-related problems, evaluations of those consequences, and perceptions of how typical university students evaluate those consequences. A moderated mediation of POE on negative alcohol-related consequences via evaluations of consequences at differing levels of alcohol consumption was conducted, with gender, baseline consequences, and intervention effects being controlled for.

RESULTS

Results indicated that POE had no direct effect on subsequent consequences. However, an indirect effect was found through evaluations of consequences, such that there was a positive association between both POE and evaluations of consequences, and evaluations of consequences and subsequent consequences. Average weekly drinking moderated the association between POE and evaluations of consequences, such that the association between POE and evaluations of consequences was stronger for those who drank more heavily.

CONCLUSIONS

Results are consistent with social cognition processes, such as pluralistic ignorance, and suggest that POE and evaluations of consequences should be considered in the construction of interventions targeting heavy-drinking college students.