The influence of context in the subjective evaluation of "negative" alcohol-related consequences

Do hypothetical evaluations of alcohol related consequences change over time? Examining the influence of past and ongoing consequences

OBJECTIVE

Despite experiencing alcohol-related consequences, college students continue to drink at high rates. Hypothetical evaluations of alcohol-related consequences (i.e., evaluations of where potential/hypothetical consequences lie on a spectrum from extremely positive to extremely negative) may contribute to the maintenance of drinking patterns among students. The purpose of the present study was to describe hypothetical evaluations in a sample of students mandated to an alcohol intervention, examine changes over time, and investigate the influence of both baseline and time-varying experienced consequences.

METHOD

This study was a secondary data analysis from a longitudinal randomized controlled trial. Participants were 474 mandated students (Mage = 18.65; 55.5 % male, 77.6 % White). Students completed an initial baseline assessment of demographics, alcohol use, consequences, and hypothetical evaluations, and 3-month and 9-month follow-up assessments that included hypothetical evaluations and experienced consequences.

RESULTS

Hierarchical linear modeling (HLM) analyses revealed significant change in hypothetical evaluations over time such that they became less negative. A piecewise model demonstrated that this change happened between baseline and 3-month, with no additional change between 3-month and 9-month. The experience of consequences at baseline did not significantly moderate changes in either time interval. Time-varying consequences also had no significant effect on same-timepoint hypothetical evaluations.

CONCLUSIONS

This study is the first to examine changes in hypothetical evaluations over time among mandated college students. Counter to expectations, hypothetical evaluations became less negative at 3-month follow-up. Though preliminary, findings add to the understanding of hypothetical evaluations of alcohol-related consequences.

Perceived helpfulness of alcohol protective behavioral strategies and consequence severity: A person-centered analysis

Objective: College students report high rates of alcohol use and negative alcohol-related consequences (ARC). Many studies document that protective behavioral strategy (PBS) use is negatively associated with ARC. Few studies examine consequence severity and PBS helpfulness, both of which may provide nuance to this relationship. Participants and method: The current study used latent profile analysis to examine variability in PBS use, PBS helpfulness, ARC count, and ARC severity patterns among college students (n = 1156). We identified latent profiles and differences in alcohol use and drinking motives across profiles. Results: Three profiles best represented the data: (1) high PBS/low consequences, (2) moderate PBS/moderate consequences, (3) low PBS/high consequences. Conclusions: College students endorsing stronger drinking motives might be less likely to use and select helpful PBS and might experience more severe ARC. Results suggest that simple modifications to common measures can add depth of understanding and nuance to the examination of alcohol-related behaviors.

Effects of social drinking context on subjective effects, affect, and next-day appraisals in the natural environment

BACKGROUND

Drinking commonly occurs in social settings and may bolster social reinforcement. Laboratory studies suggest that subjective effects and mood are mechanisms through which the social context influences alcohol consumption. Ecological momentary assessment (EMA) may be useful for extending these findings to the natural environment. This pre-registered secondary analysis of EMA data investigated the influence of the social environment on: (1) stimulating and sedating subjective effects of alcohol, (2) contentedness and negative affect, and (3) next-day evaluations of the drinking occasion.

METHODS

Nontreatment seeking adults reporting past-month heavy drinking (N = 131; Mage = 28.09; 42% female) completed 7 days of EMA (in the morning, at random, and following drinking prompts), which included questions on their social context (drinking in the presence of known others or alone), contemporaneous stimulating and sedating effects, contentedness and negative affect, alcohol consumption, and next-day evaluations of a prior day's drinking event (how satisfying/pleasant was drinking). We used multi-level models in SAS 9.4 M7 software to examine relations among the variables.

RESULTS

Contemporaneous subjective effects (stimulating or sedating), negative affect, and contentedness did not significantly depend on the social context. For next-day evaluations of pleasure/satisfaction from drinking, context effects were dependent on consumption totals. As the total number of standard drinks consumed increased, recollections of pleasure/satisfaction were higher when drinking had occurred with others, relative to alone. At lower consumption totals, next-day evaluations did not appear to depend on social context.

CONCLUSIONS

When reported contemporaneously, subjective effects and affect do not appear dependent upon the presence of known others. However, heavier drinking events, relative to lighter drinking events, are appraised more favorably the following day when occurring within social contexts.

Event-level risk for negative alcohol consequences in emerging adults: The role of affect, motivation, and context

OBJECTIVE

Decades of research has found support for the motivational model of alcohol use, such that positive/negative affect are indirectly associated with drinking behavior through drinking motives. However, research on event-level drinking motives is in its nascent stage, and studies have yet to consider how drinking context plays a role in the motivational pathway to both event- and person-level drinking behavior. Therefore, the present study seeks to test whether drinking context mediates the effect of affect and motivation on drinking outcomes at both the event- and person-level.

METHOD

Data for this Stage 1 Registered Report will come from a recently completed ecological momentary assessment (EMA) study in emerging adults. The study collected data on 131 emerging adults, of whom 107 reported event-level social and solitary drinking during the EMA period. Multilevel structural equation modeling will be used to test whether predrinking affect is associated with predrinking motives, and whether drinking context (social vs. solitary drinking) mediates the effect of drinking motives on drinking outcomes. Models will parse within-/between-person variance, allowing the present study to test whether drinking context serves as a mechanism of risk in the motivational model at the event-level, or solely at the between-person level. Findings will inform personalized interventions and motivational models of drinking behavior. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Beyond mediators: A critical review and methodological path forward for studying mechanisms in alcohol use treatment research

Understanding how treatments for alcohol use disorder (AUD) facilitate behavior change has long been recognized as an important area of research for advancing clinical care. However, despite decades of research, the specific mechanisms of change for most AUD treatments remain largely unknown because most prior work in the field has focused only on statistical mediation. Statistical mediation is a necessary but not sufficient condition to establish evidence for a mechanism of change. Mediators are intermediate variables that account statistically for the relationship between independent and dependent variables, whereas mechanisms provide more detailed explanations of how an intervention leads to a desired outcome. Thus, mediators and mechanisms are not equivalent. To advance mechanisms of behavior change research, in this critical review we provide an overview of methodological shortfalls of existing AUD treatment mechanism research and introduce an etiologically informed precision medicine approach that facilitates the testing of mechanisms of behavior change rather than treatment mediators. We propose a framework for studying mechanisms in alcohol treatment research that promises to facilitate our understanding of behavior change and precision medicine (i.e., for whom a given mechanism of behavior change operates and under what conditions). The framework presented in this review has several overarching goals, one of which is to provide a methodological roadmap for testing AUD recovery mechanisms. We provide two examples of our framework, one pharmacological and one behavioral, to facilitate future efforts to implement this methodological approach to mechanism research. The framework proposed in this critical review facilitates the alignment of AUD treatment mechanism research with current theories of etiologic mechanisms, precision medicine efforts, and cross-disciplinary approaches to testing mechanisms. Although no framework can address all the challenges related to mechanisms research, our goal is to help facilitate a shift toward more rigorous and falsifiable behavior change research.

Examination of the Sexual and Negative Dating Inventory (SANDI) Among Sexual and Gender Minorities: An Analysis of Psychometrics and Outcomes

ObjectiveAdverse sexual experiences (ASE), including sexual violence, sexual risk behaviors, and regretted sex, are highly prevalent among sexual and gender minorities (SGM) compared to cisgender and heterosexual individuals. Research indicates ASEs are associated with increased mental health symptomatology and decreased subsequent protective behavior use. The Sexual and Negative Dating Inventory (SANDI) measures dating and sexual protective strategies and includes five factors: Location Sharing, Assertiveness, Self-Protection, Risk Reduction and Privacy. SANDI total scores are linked to lower ASEs in heteronormative samples. Method: SANDI was previously validated in a sample of n = 1,289 college students. Data were examined from n = 313 (24.28%) SGM individuals at baseline, and n = 95 at one-month follow-up. Individuals were 19.70 (2.98 SD) years old, and 25% were non-white. Model fit was adequate for SGM: χ2(484) = 1729.621, p < .001, CFI = .947, RMSEA = .063 (90% CI = .060, .066), SRMR = .048. Results: Non-cisgender men and non-heterosexual individuals endorse using more of the SANDI at the factor level. Using logistic regression, SANDI was not associated with history of sexual violence or sexual violence over the next month. SANDI is inversely associated with history of sexual risk and prospectively associated with less sexual risk over the next month. Negative binomial regression analyses showed SANDI was not associated with a history of regretted sex; however, SANDI was moderately associated with decreased regretted sex over the next month. Conclusion: Findings highlight the importance of dating and sexual protective behaviors across dimensions of gender and sexual orientation.

Shame and guilt for alcohol-related transgressions and hazardous drinking among male and female college students

Objective: Shame and guilt are often present prior to and consequent to alcohol use among college students. Little is known about the propensity to experience these emotions in the context of transgressions that occur while drinking alcohol. We examined the association between shame and guilt propensity for alcohol-related transgressions with hazardous drinking, and the role of gender in these relationships. Participants: College student drinkers (N = 130; Mage=19.39; 68% females; 86% White) from a Mid-south college. Methods: An online confidential survey included measures of hazardous drinking, guilt and shame propensity, and guilt and shame propensity specific to alcohol-related transgressions. Results: Our preliminary findings suggest that experiencing guilt (but not shame) after alcohol-related transgressions was related to less hazardous drinking when controlling for general guilt and shame propensity for male and female students. Conclusions: Targeting components of guilt (e.g., reparative behaviors) after alcohol-related transgressions may help to reduce problematic drinking among college students.

Do Alcohol Consequences Serve as Teachable Moments? A Test of Between- and Within-Person Reciprocal Effects From College Age to Adulthood

OBJECTIVE

Several studies find between-person reciprocal relations between adolescent/college drinking and positive expectancies. However, drinking and expectancies from college into adulthood are largely unstudied, as are within-person associations. During these age periods, negative alcohol consequences may represent "teachable moments" via expectancy change. The current study tested the reciprocal effects of drinking, negative consequences, and expectancies from college age to adulthood.

METHOD

Using data from a longitudinal study focused on familial alcohol disorder, age bands were created to model effects from college age (18-22) to young adulthood (23-28) and adulthood (29-34). Participants (N = 420) reported on their drinking, negative consequences, and expectancies across three waves (1995-2010).

RESULTS

Negative consequences did not predict negative expectancies, but the random intercepts of the two were highly related. Young adult negative consequences predicted a within-person increase in adult heavy drinking. A within-person increase in college age negative expectancies indirectly predicted a within-person decrease in adult negative consequences through reduced young adult drinking, whereas within-person increases in college age positive expectancies indirectly predicted a within-person increase in adult negative consequences through heavier young adult drinking.

CONCLUSIONS

Findings suggest that negative consequences were related to trait-level negative expectancies, even though prospective effects were not observed. Findings also suggest that college age negative expectancies were protective against future use and consequences, and this effect was unique to college age.

Qualitative examination of simultaneous alcohol and cannabis use reasons, evaluations, and patterns among heavy drinking young adults

Use of alcohol and cannabis together so their effects overlap (simultaneous use) is common among college students and associated with numerous negative consequences. The aim of this study was to gain insight into college students' recent simultaneous use events in order to inform future studies (i.e., generate hypotheses, inform measures/assessments of simultaneous use, and identify factors influencing simultaneous use). Qualitative interviews of simultaneous use experiences among heavy drinking college students (n = 38) were conducted to better understand reasons for simultaneous use, evaluations of simultaneous use events, and patterns of substance use during simultaneous use events. Findings indicated that students' reasons for simultaneous use included traditional four-factor motive types (i.e., social, conformity, enhancement, and coping), cross-fading motives, harm reduction motives (e.g., to drink less), and reactive/situational reasons (e.g., because it was offered/available). There was variability in participants' subjective evaluations of how positive versus negative simultaneous use events were and how this compared to single-substance events. Evaluation of simultaneous use events depended on patterns of use, external and internal context, and consequences experienced. Additionally, patterns of simultaneous use including order of substances, timing of using each substance, and quantities of substances used were highly variable across participants. Notably, participants endorsed patterns of use they perceived to reduce negative consequences during simultaneous use events. Further research on reasons for simultaneous use and patterns of use may help identify simultaneous use occasions that result in greater risk; identification of high-risk simultaneous use occasions and evaluation of these occasions can then help inform targeted interventions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

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

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

Unplanned vs. planned drinking: Event-level influences of drinking motives and affect

OBJECTIVE

Problematic alcohol involvement in college students remains a public health concern and identifying factors that promote this consequential behavior as it occurs in daily life is critical. Recent work has found that whether a drinking event is unplanned vs. planned has implications for the risk of negative consequences, though less work has identified fine-grained predictors of these two types of drinking occasions.

METHOD

The present study examined drinking motives and positive and negative affect as predictors of unplanned vs. planned drinking in a sample of college students who completed 28 days of ecological momentary assessment (N = 96; 72% White; 52% female). We examined drinking motives reported at two points: (1) in real-time upon initiating drinking and (2) after one day of retrospection (collected at the daily diary report assessing the prior day). Positive and negative affect were both assessed in real-time. Generalized linear mixed-effects models disentangling within- and between-person effects were leveraged.

RESULTS

Drinking "to get high, buzzed, or drunk" - when retrospectively reported for prior-day drinking - exhibited within-person associations with planned drinking, relative to unplanned drinking. This same effect was marginally significant when ascertained in real-time. Individuals with more frequent retrospective endorsement of the motive "to make the day/night more fun" reported more planned drinking. Higher real-time positive affect, but not negative affect, was marginally associated with planned drinking.

CONCLUSIONS

Our findings provide preliminary support that enhancement motives and higher positive affect are related to planned drinking, which may inform the development of momentary interventions.

Using Demand Curves to Quantify the Reinforcing Value of Social and Solitary Drinking

BACKGROUND

Young adults typically drink in social settings and report high levels of episodic heavy drinking despite a range of adverse consequences. Behavioral economics posits that this may reflect a reinforcer pathology in which alcohol is overvalued relative to other reinforcers. Theoretically, the value of alcohol is related to both the direct pharmacological effects of alcohol (euphoria, sedation) and the associated social reinforcement, but to date no studies have differentiated the value of social vs. solitary drinking. The current study examines two modified hypothetical alcohol purchase tasks (APTs), one explicitly social and one explicitly solitary, in order to quantify the reward value of social vs. solitary drinking and to determine whether there are unique clinical correlates of solitary alcohol demand.

METHODS

Participants were young adults (N = 274, Mage  = 25.15, SD = 4.10) recruited from Mturk and from a university subject pool. Participants completed a solitary and social APT, in addition to measures of alcohol consumption and problems.

RESULTS

Participants reported significantly greater demand in the social APT compared to the solitary APT across all demand indices. Elevated solitary and social demand were associated with elevated levels of alcohol use and problems. Using a residualized change approach, solitary demand amplitude (maximum consumption and expenditure) and persistence (price sensitivity) contributed additional variance above and beyond their social APT composite counterparts in predicting typical drinks per week and the self-care, academic/occupational, and physical dependence subscales of the YAACQ.

CONCLUSIONS

The presence of peers increases alcohol demand compared to a solitary scenario, and greater relative solitary drinking demand may be a risk factor for greater alcohol consumption and problems.

Physical Disorders are Associated with Health Risk Behaviors in Chinese Adolescents: A Latent Class Analysis

It is known that health risk behaviors (HRBs) can lead to a variety of physical and mental health problems among adolescents, but few studies have paid attention to the relationship between latent classes of HRBs and adolescent diseases. The purpose of this study was to use latent class analysis (LCA) to clarify the potential subgroups of HRBs (smoking, drinking, screen time, non-suicidal self-injuries, suicidal behaviors, and unintentional injuries) and examine the association between the subgroups of HRBs and physical disorders (diarrhea, fever, cough, and vomiting) with multiple logistic regression analysis, in Chinese adolescents. Self-reported HRBs and physical disorders were used to evaluate 22,628 middle school students in six cities of China, from November 2015 to January 2016, based on a multistage stratified cluster sampling approach. The prevalence of diarrhea, fever, cough, and vomiting was 23.5%, 15.9%, 50.6%, and 10.7%, respectively. We identified four latent classes of HRBs by LCA, including low-risk class, moderate-risk class 1 (smoking, drinking, and screen time), moderate-risk class 2 (non-suicidal self-injuries and suicidal behaviors, unintentional injuries), and high-risk class (smoking, drinking, screen time, non-suicidal self-injuries, suicidal behaviors, and unintentional injuries), which were 64.0%, 4.5%, 28.8% and 2.7% of participants, respectively. Compared to the low-risk class, all other classes showed higher risk for these physical disorders (P < 0.01 for each). In particular, the high-risk class had the highest risk (diarrhea (odds ratio (OR) = 2.628, 95% confidence interval (CI) 2.219 to 3.113), fever (OR = 3.103, 95% CI 2.591 to 3.717), cough (OR = 2.142, 95% CI 1.805 to 2.541), and vomiting (OR = 3.738, 95% CI 3.081 to 4.536). In conclusion, these results indicated that heterogeneity exists in HRBs, and subgroups of HRBs were correlated to the occurrence of common physical disorders in Chinese adolescents. Therefore, multiple HRBs rather than single factors should be considered for the prevention of common physical disorders in schools.

Alcohol demand assessed daily: Validity, variability, and the influence of drinking-related consequences

BACKGROUND

Alcohol demand, typically assessed at the trait-level, via single administration, reflects individualized alcohol value. We examined correspondence between baseline trait-level and daily brief measures of alcohol demand, and whether demand changes day-to-day in response to recent drinking-related consequences. Understanding whether consequences influence demand fluctuations may provide insight into when demand can be reduced in the context of intervention.

METHODS

Heavy drinking college students (n = 95, age 18-20, 52% female) completed a baseline 14-item alcohol purchase task (APT). Observed demand indices were: intensity (consumption at zero cost), O_max (maximum expenditure), and breakpoint (cost whereby consumption is suppressed to zero). Participants subsequently completed 28 daily reports including a 3-item APT (one item corresponding to each baseline index) and prior day drinking and consequences.

RESULTS

Intraclass correlations revealed within-person variability (i.e., day-to-day change) across daily demand indices. In hierarchical linear models (HLM), each daily demand index was significantly predicted by its corresponding baseline full APT index, when all three baseline indices were entered, suggesting convergent validity of the daily measure. Lower day-level intensity was predicted by more prior day negative consequences, controlling for several day- and person-level variables in HLM. Recent positive consequences did not impact intensity, and daily O_max and breakpoint were not predicted by any tested day- or person-level variables.

CONCLUSIONS

APT indices collected daily map on well to traditional single-administration APT metrics and change in response to recent consequences. Intensity demonstrated the greatest within-person variability, the strongest association with its corresponding full APT index, and theoretically-consistent prediction by negative consequences of drinking.

Posting Post-Blackout: A Qualitative Examination of the Positive and Negative Valence of Tweets Posted after "Blackout" Drinking

Alcohol-induced memory loss (i.e., blackout) is a consequence of drinking that is both common and associated with additional negative outcomes. The goal of the present study was to use publicly available Twitter data to better understand cognitions and emotions following blackouts. Tweets containing key terms (e.g., "black out") were collected over 4 days in 2018. Using NVivo software, we coded all post-blackout Tweets for valence (positive, negative, neutral). Within each valence category, we reviewed Tweets to identify themes. Among Tweets coded with a positive valence, themes included pride in blacking out, pride in ability to function despite blackouts, blackouts as a shared social experience, and overall positive views of a drinking experience despite blackouts. Among Tweets coded with a negative valence, themes included the experience of other negative consequences on blackout nights, blackouts as unexpected/unplanned, blackouts as motivator of change, and blackout-related negative emotions. Additionally, Tweeters expressed pride in avoiding blackouts during drinking events. Findings provide insight into why not all individuals describe blackouts negatively, by analyzing specific statements made in a public forum following a blackout. Such insight may inform interventions targeting those who report this risky outcome of drinking, including those that could be delivered via social media.

The relationship between unplanned drinking and event-level alcohol-related outcomes

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

Self-fulfilling prophecies: Documentation of real-world daily alcohol expectancy effects on the experience of specific positive and negative alcohol-related consequences

Alcohol expectancies are consistently associated with alcohol use in cross-sectional and longitudinal studies. However, little research has examined whether alcohol expectancies on specific drinking occasions are associated with reported consequences on those days, particularly when controlling for the amount of alcohol consumed, thus differentiating the extent to which reported consequences may have resulted from alcohol or an "expectancy effect." This study examined consequence-specific daily expectancy effects. College students (N = 342; mean age 19.7 [standard deviation (SD) = 1.25], 52.9% female) participated in a longitudinal measurement burst study. During four 2-week intervals, participants used mobile phones to respond to 3 surveys per day via automated telephone interviews. The results showed that on days when college students had higher-than-average expectancies for specific subjective positive consequences (e.g., feeling more relaxed, being in a better mood), they were more likely to report experiencing those same consequences as a result of their alcohol use that day, even after controlling for how much they actually drank on that day. The same held true for subjective interpersonal negative consequences (e.g., becoming aggressive, rude, or obnoxious; embarrassing oneself), but not for less subjective physical/cognitive negative consequences (e.g., having a hangover, vomiting, getting hurt/injured, forgetting). The results suggest that one's expectations about the particular effects of alcohol tend to be self-fulfilling for subjective effects of alcohol even when they are not directly tied to the physiological effects of alcohol. The findings underscore the important role of alcohol expectancies, particularly the expectation of subjective positive social and tension-reduction/relaxation effects, in understanding problematic alcohol use. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Secondary effects of myPlaybook on college athletes' avoidance of drinking games or pregaming as a protective behavior strategy: A multisite randomized controlled study

RATIONALE

Student-athletes are at risk for engaging in drinking games and pregaming. Research suggests that brief motivational and alcohol education intervention approaches designed to reduce harmful drinking behaviors may not be effective in lowering students' participation in drinking games or pregaming.

METHOD

We evaluated the effects of myPlaybook (a student-athlete-specific web-based alcohol intervention) on student-athletes' avoidance of drinking games and pregaming over a 4-month period. Seventy-three NCAA member institutions were randomly assigned to the treatment condition or a no-intervention control. Student-athletes at these schools (N = 2449) completed assessments at baseline, 1-, and 4-months post-intervention. At each assessment, participants indicated how often they used each of several harm prevention strategies when they drank in the past month including "avoided drinking games" and "avoided drinking before going out (i.e., pregaming or pre-drinking)."

RESULTS

Controlling for gender and race/ethnicity, treatment condition was not associated with change in avoidance of drinking games and pregaming between baseline and either follow-up. Athletic season did not moderate treatment effects on avoidance of either behavior. We found no evidence that myPlaybook, a general alcohol-reduction intervention, is efficacious in influencing student-athletes' avoidance of drinking games or pregaming as a protective strategy.

CONCLUSIONS

Findings from the present study as well as other research suggest that general alcohol-focused interventions may not have secondary effects on reducing students' participation in drinking games and pregaming and as such, more specific targeted interventions should be investigated.

How do college students subjectively evaluate "blackouts"?

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