What Is Pregaming and How Prevalent Is It Among U.S. College Students? An Introduction to the Special Issue on Pregaming

Sexual Violence Victimization and Pregaming Protective Behavioral Strategies Among College Students

BACKGROUND

Sexual violence is a major public health concern that has a detrimental impact on mental health, physical health, and academic performance. College students represent a population that is at an increased risk of experiencing sexual violence. Alcohol use, and more specifically, heavy drinking during pregaming events, is associated with increased risk of sexual violence. Studies have demonstrated that protective behavioral strategies have effectively reduced heavy drinking and the risk of alcohol-related consequences, including sexual violence victimization.

OBJECTIVES

This study aims to examine the association between experiences of sexual violence in college and subsequent use of pregaming protective strategies.

RESULTS

Data from 468 college students (67% female, 33% male) were analyzed. Over 42% of participants reported experiencing sexual violence in college. While adjusting for pregaming frequency and sex, results revealed that those who reported experiencing sexual violence in college were significantly less likely to use pregaming protective behavioral strategies compared to those without such experiences. Specifically, survivors of sexual violence were less likely to report using the protective behavioral strategies of minimizing intoxication, as well as behaviors related to safety and familiarity (e.g., using a designated driver after pregaming).

CONCLUSIONS

The findings have important implications for interventions aimed at empowering survivors of sexual violence. Future research should focus on understanding survivor's motives and mechanisms to use pregaming protective behavioral strategies to reduce the risk of re-victimization.

A daily-level examination of willingness to pregame, blackout, and hook up across drinking days: Associations with respective behavioral outcomes among adolescents and young adults

Research indicates general willingness to drink (i.e., "How willing are you to drink tonight?") fluctuates day-to-day and is associated with daily-level drinking. However, it is unknown whether willingness to engage in specific alcohol-related behaviors is associated with actual engagement in those behaviors above and beyond general willingness to drink at the daily level. The present study examined whether daily-level willingness to engage in specific behaviors (i.e., pre-gaming, blacking out, hooking up) predicted engaging in those respective behaviors on drinking days above and beyond one's general willingness to drink. Participants included adolescents and young adults who were part of a longitudinal ecological momentary assessment (EMA) study on cognitions and alcohol use. Participants (N = 675; 43 % male) who reported drinking on weekend days (i.e., Friday and Saturday [N = 3,727 days]), were included. The study involved a 3-week EMA burst design with bursts occurring quarterly over 12 months. Multilevel logistic regressions indicated on drinking days when participants reported being more willing than their own average to pre-game (OR = 1.77, p <.001), black out (OR = 1.46, p <.05), or drink before hooking up (OR = 1.68, p <.001), they were more likely to pregame, black out, and hook up, respectively, whereas general willingness to drink was not associated with any outcomes at the daily level.Results suggest willingness to engage in specific behaviors may be essential to target in prevention programming in comparison to general willingness to drink when aiming to reduce specific risk behaviors.

Examining the Factor Structure and Correlates of Motives to Drink Before Attending a Virtual Social Event During COVID-19 Among University Students

Background: Many university students pregame or drink before a social event. Pregaming carries some risk due to its link to heavy drinking. During the COVID-19 pandemic, there was limited access to many drinking venues (e.g., bars/clubs). Moreover, universities shifted to a virtual format and imposed restrictions on in-person gatherings resulting in the reliance on virtual platforms for class instruction, meetings, and social events. The pandemic facilitated changes in students' drinking behaviors, stress levels, and how they maintained social contact with others. Thus, it is conceivable that during an academic pandemic year, students may have engaged in the act of drinking before attending a virtual social event. Objectives: In the present study, we examined the factor structures/item loadings of the Pregaming Motives Measure-Virtual (PGMM-V) among students (N = 283; Mage = 21.38; women = 69.3%; White = 45.4%, Hispanic = 40.8%) from seven universities who completed an online questionnaire (Spring/Summer-2021). Items from the original Pregaming Motives Measure (Bachrach et al., 2012) were modified to reflect motives to drink before attending a virtual social event. Results: We found evidence for a 2-factor structure model of the PGMM-V which includes social/enhancement and social ease/stress. Bivariate correlations indicated that social/enhancement and social ease/stress were (a) positively associated with frequency of drinking and alcohol consumption prior to attending virtual social events, and (b) general drinking motives (social/enhancement/coping) that align with these motives. Conclusions: The PGMM-V is a promising instrument that could be used in future research designed to understand students' pregaming behaviors for virtual social events as the use of such platforms are increasingly relied upon for social engagement.

Associations Between Alcohol and Cannabis Use and Pain Among College Student-Athletes

Background: Pain motivates alcohol and cannabis use, with evidence that pain catastrophizing (i.e., ruminative exaggeration of pain) mediates these associations. Student-athletes represent a unique population who engage in riskier substance use, experience more substance-related consequences, and are more likely to develop chronic pain compared to non-athletes. Objectives: This study examined relationships between pain, catastrophizing, alcohol and cannabis use and consequences. Student-athletes from two Division I universities (N = 549; 51% female) completed a cross-sectional survey. Moderated mediation tested the conditional indirect effect of pain catastrophizing on associations between pain and alcohol- and cannabis- use and consequences, separately, with sex moderating the a and b paths. Results: There was a significant direct effect between pain and alcohol-related consequences (b = 0.11, p = .008). Pain and pain catastrophizing were positively associated in all four models (bs = 0.68-0.72, ps <.001), and this relationship was stronger among female than male athletes. No other direct or conditional indirect effects were observed. Conclusions: Student-athletes experiencing pain report more alcohol-related consequences, and pain catastrophizing may be particularly relevant for student-athletes with greater pain. Future research should examine other factors proposed by theoretical models, such as negative affect, while focusing on athletes with more significant pain (e.g., injured athletes).

An Examination of Pregaming Behavior and Motives among Sexual and Gender Minority College Students

Introduction: Pregaming is a popular but high-risk drinking behavior common among college students. Although sexual and gender minority (SGM) college students are a vulnerable population with regards to hazardous alcohol use and alcohol consequences, there is currently limited research investigating the pregaming behavior of this group. The present study aimed to (1) examine mean level differences in pregaming behaviors and motives between SGM and non-SGM college students and (2) explore how SGM status was associated with pregaming behaviors and if SGM status moderated the association between motives and pregaming behaviors. Methods: The sample consisted of 485 college student drinkers in the US, with 19% (n = 93) identifying as SGM. All participants completed measures of past 30-day pregaming frequency and quantity (yielding a total pregaming drinks outcome) and drinking consequences experienced on pregaming days. Results: SGM participants consumed significantly fewer pregaming drinks than non-SGM participants, but did not significantly differ on alcohol-related consequences or drinking motives. The pregaming motive of intimate pursuit moderated the association between SGM status and total pregaming drinks, such that non-SGM participants with high intimate pursuit motives drank the heaviest. Conclusions: Our findings suggest that SGM students consume significantly fewer pregaming drinks than their non-SGM counterparts. However, they may be at a similar risk of experiencing pregaming consequences as non-SGM students. SGM students were less susceptible to the effect of intimate pursuit motives on pregaming drink consumption. This study offers support for past research regarding the effects of certain pregaming motives on pregaming drink consumption and consequences.

A Reexamination of Drinking Motives in Young Adults: The Development and Initial Validation of the Young Adult Alcohol Motives Scale

This study reexamined the factor structure of drinking motives using 205 unique items from 18 drinking motives scales with the inclusion of social tension reduction motives, which have been largely neglected in the literature. A new scale was created and compared with the Drinking Motives Questionnaire-Revised (DMQ-R) to predict alcohol use/problems. Young adults (N = 1,049) completed questionnaires assessing drinking motives and alcohol use/problems. A subset (N = 368) of participants completed a 6-month follow-up. Hierarchical factor analyses informed the creation of a four-factor (i.e., coping, social, enhancement, and social tension reduction) scale (i.e., the Young Adult Alcohol Motives Scale [YAAMS]). In general, the YAAMS performed similarly to the DMQ-R in predicting concurrent and prospective alcohol consumption (i.e., typical drinking quantity and frequency) and alcohol problems (i.e., Alcohol Use Disorder Identification Test [AUDIT] and Brief Young Adult Alcohol Consequences Questionnaire [B-YAACQ] scores), but there were some notable differences, including that the novel social tension reduction scale of the YAAMS was particularly relevant in predicting drinking frequency in those with social anxiety. Results suggest that drinking motives can be described by multiple factor structures and predict alcohol-related outcomes.

A national study on pregaming motives, frequency, consumption, and negative alcohol consequences among university students in the United States

BACKGROUND

Pregaming, or drinking before going out, is a commonly practiced risky behavior. Drinking motives are well-established predictors of alcohol use and negative alcohol consequences. Given the influence of context on drinking practices, motives specific to pregaming may affect pregaming behaviors and outcomes above and beyond general drinking motives. Thus, we examined how pregaming motives are related to pregaming behaviors and negative alcohol consequences.

METHODS

Using data from two national cross-sectional online studies, the current study included undergraduates who pregamed at least once in the past month (n=10,200, Mage=19.9, women=61%, white=73.6%; 119 U.S. universities). Participants completed assessments of demographics, general drinking motives, pregaming motives, pregaming frequency/consumption, and negative alcohol consequences. Data were analyzed using hierarchical linear models accounting for nesting of participants within sites.

RESULTS

When controlling for demographic factors and general drinking motives, interpersonal enhancement motives and intimate pursuit motives were positively associated with pregaming frequency, pregaming consumption, and negative alcohol consequences. Situational control motives were negatively associated with pregaming consumption and negative alcohol consequences. Barriers to consumption motives were negatively associated with pregaming frequency but positively associated with negative alcohol consequences.

CONCLUSIONS

Students who pregame to make the night more fun or to meet potential dating partners appear to be at particular risk for negative alcohol consequences. Motives may be modifiable, particularly via cognitive/behavioral strategies. Findings suggest that specific motives may be appropriate intervention targets when trying to reduce pregaming behaviors and negative alcohol consequences.

Women who pre-game: A study of stress and alcohol use in female collegiate predrinkers

Introduction: This study examined the relationship between stress and pre-gaming (i.e., drinking prior to going out to an event) in female college students. Methods: Thirty-four female college students were grouped as pre-gamers or non-pre-gamers based on self-reported drinking patterns. They completed surveys about alcohol use and mental health and provided a set of salivary cortisol samples upon waking, 30 min later, and at 10am on the same day. Results: Pre-gamers and non-pre-gamers did not differ on demographics or psychosocial variables. Pre-gamers reported riskier drinking overall and had greater endorsement of social, coping, and enhancement drinking motives. Pre-gamers also had lower cortisol levels 30 min after waking and exhibited attenuated CAR. Conclusions: Female collegiate pre-gamers may differ from their peers not only in terms of alcohol consumption and drinking motives, but also on attenuated CAR, a physiological biomarker associated with stress dysregulation and vulnerability to addictive behaviors.

Longitudinal examination of high-risk drinking contexts: Daytime drinking, pregaming, and drinking games linked to high-risk alcohol use and negative consequences in young adults

BACKGROUND

The contexts in which young adults drink alcohol play a salient role in alcohol-related outcomes and negative consequences at an event-level, but less is known about longitudinal risks. We collected longitudinal monthly data across 2 years on (a) daytime drinking, (b) pregaming/pre-partying, and (c) playing drinking games. We then examined associations between drinking in these contexts and within-person variability in alcohol consumption, consequences, and simultaneous alcohol and marijuana (SAM) use in a given month. We also examined the extent to which drinking in these contexts predicted hazardous drinking (using Alcohol Use Disorders Identification Test (AUDIT) scores) at a distal follow-up timepoint, controlling for baseline AUDIT scores.

METHOD

A community sample of 759 young adults (Mage  = 21.1 years; 56.4% female) completed monthly surveys for 24 consecutive months and a distal 30-month follow-up. Multilevel models estimated within- and between-person associations between drinking context frequencies (daytime drinking, pregaming, drinking games) and alcohol-related outcomes (weekly consumption, consequences, SAM use). A single-level negative binomial regression tested associations between drinking context frequency averages across a two-year period and changes in AUDIT scores from baseline to a follow-up 2.5 years later.

RESULTS

Over 75% of the sample of non-abstaining young adults reported drinking in each of the three contexts at least once during the 24-month period. Within-persons, young adults reported greater consumption, more negative consequences, and increased likelihood of SAM use during months that they drank in these contexts more often than usual. Each context was associated with negative consequences, even when controlling for alcohol use frequency. More frequent daytime drinking and pregaming, but not drinking games, were associated with increases in AUDIT scores at the 30-month follow-up, suggesting that there are potential long-term risks of drinking in these contexts.

CONCLUSIONS

Findings suggest that daytime drinking, pregaming, and playing drinking games are high-risk contexts in terms of month-to-month and long-term risks. Additional research is needed on the various contexts in which young adults drink alcohol and the extent to which contextual factors interact with one another to amplify/reduce risks and harms.

Prologue to the special issue on predrinking and drinking game behaviors among adolescents and young adults in the United States and across the globe: Definitions and overview of prevalence rates

Predrinking and drinking games (DGs) are common risky drinking practices among adolescents and young adults in many different countries around the world. However, most studies on these behaviors have been conducted with university student samples in a limited number of countries. Despite the risks of negative alcohol-related consequences associated with predrinking and DGs, these activities are quite prevalent among young people. In this prologue, we provide definitions for predrinking and DGs and an extensive overview of the known prevalence rates of predrinking and DGs among young people around the world. This special issue addresses known gaps in the literature by including articles which (a) use differing methodologies to examine predrinking or DGs behavior, (b) consider psychosocial and contextual factors that influence these behaviors, and (c) examine young people's perceptions of alcohol policies and interventions. Taken together this Special Issue offers an international view on how and why young people around the world engage in these risky drinking practices, and potential ways to address these behaviors.

"It Breaks the Ice": A Qualitative Examination of Drinking Game Motives, Harms and Protective Behavioral Strategies among University Students in Australia

Background: Most research on drinking games (DG) behaviors and cognitions has been conducted among university students from the United States. Understanding why DGs are played, consequences and protective behavioral strategies (PBS) to reduce negative consequences is needed among Australian students. Objectives: In Australia, five focus groups (n=3-8) were held with 27 university students (63% female) aged 18-24 years who had played a DG in the past month. The study aimed to identify motives for playing DGs, consequences and adoption of PBS. Results: Four themes were identified: (1) social lubrication and conformity: playing to fit in; (2) community and camaraderie (perceived social benefits of DGs); (3) a means to an end (where getting drunk/predrinking was the goal and avoidance of PBS was prevalent); and (4) it is not a levelled playing field, which highlights that the risks are not equal for everyone. Conclusions: The interplay between DG motives, PBS and associated harms was identified. Expanding measurement of pre-existing DG motives and PBS is recommended, as well as the potential of DG motives to inform proposed interventions.

A mobile-based pregaming drinking prevention intervention for college students: study protocol for a randomized controlled trial

BACKGROUND

Pregaming is a high-drink context popular among college students that often leads to elevated blood alcohol levels and negative consequences. Over 15 years of research studies have demonstrated that pregaming represents one of the riskiest known behaviors among college students, yet no pregaming-specific interventions have been developed to help prevent this behavior. General brief interventions for students do not reduce pregaming behavior and may not be appropriate, as they do not help students develop skills unique to the pregaming context that could help them drink less. We developed a brief, mobile-based intervention that is proposed to prevent heavy drinking during pregaming for college students, with the ultimate goal that behavioral reductions in this risky practice will ultimately affect global drinking and prevent consequences.

METHODS/DESIGN

The intervention, Pregaming Awareness in College Environments (PACE), was developed by combining two innovations to facilitate behavior change: (1) a mobile-based application that increases accessibility, is easy and engaging to use, and broadens the reach of the intervention content and (2) personalized pregaming-specific intervention content with harm reduction and cognitive behavioral skills proven to be mechanisms preventing and reducing heavy drinking among college students. After a develop and beta-test phase, we propose to test the efficacy of PACE in a preliminary randomized controlled trial with 500 college students who pregame at least once per week. Pregaming, general drinking, and alcohol-related consequences outcomes will be examined in the immediate (2 weeks post-intervention) and short-terms (six and 14-week post-intervention). We will also evaluate moderator effects for age, sex, and heaviness of drinking to allow for more refined information for a planned larger test of the intervention to follow this initial trial of PACE.

DISCUSSION

This pregaming intervention clinical trial, if found to be efficacious, will culminate with an easily-disseminated mobile-based intervention for college student drinkers. It has the potential to reach millions of college students, perhaps as a clinical tool used by college counseling centers as an adjunct to formal care or as a preventive tool for first-year students or other high-risk groups on campus.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier NCT04016766.

Increased Risk for Sexual Violence Victimization on Drinking Days Involving Pregaming

Alcohol consumption has been associated with increased risk for sexual violence victimization and perpetration. Pregaming, a popular activity among college students that involves heavy and quick drinking prior to going out for the night and often results in high blood alcohol levels (BALs), may convey increased risk for sexual violence-potentially due to greater likelihood of contact with intoxicated perpetrators and significantly impaired victim ability to consent or resist. Yet no published work has evaluated whether there is increased risk for victimization on drinking days that involve pregaming. Using a sample of 390 college student drinkers who completed a past 30-day Timeline Followback, we examined heavy drinking behavior, estimated BALs, and experience of sexual violence victimization during 1,899 drinking days, of which 30% involved pregaming. After controlling for demographics, we found that participants drank approximately two more drinks and reached significantly higher BALs on drinking days where they pregamed as compared to drinking days where they did not pregame. Nearly 6% of drinking days that included pregaming involved sexual violence victimization, compared to about 2% of drinking days where pregaming did not occur. Participants were at 2.71 times the odds of experiencing sexual violence, primarily unwelcomed comments and nonconsensual sexual touching, during drinking days with pregaming. This study represents a first step toward greater understanding of the sexual violence and pregaming link, but future research assessing perpetrator behavior and context-specific factors (e.g., amount consumed by victims and perpetrators, location of sexual violent events and peers present) are needed.

Prepartying and incapacitated rape: Is drinking a risk factor or an outcome?

BACKGROUND

Incapacitated rape (IR) is common in college and has been linked to heavier post-assault drinking and consequences, including blackouts. Following IR, college students may adjust their drinking in ways meant to increase perceived safety, such as enhancing situational control over one's drinks through prepartying, which is drinking before going out to a main social event. Although it is possible that prepartying could influence risk related to IR, it is unclear whether or how prepartying and IR are associated.

METHODS

To address these gaps, we examined prepartying as both a risk factor and a consequence of IR, including the reasons for prepartying. Across two studies (Study 1 N = 1074; Study 2 N = 1753) of college women and men, we examined associations between IR and prepartying motives, alcohol consumption, and alcohol-related blackouts.

RESULTS

Within the cross-sectional Study 1, negative binomial regressions revealed that having a history of IR was associated with more alcohol consumption and blackouts when prepartying. In a multivariate model, past-year IR was associated with preparty motives related to interpersonal enhancement, intimate pursuit, and barriers to consumption, but not situational control. Within the prospective Study 2, a path model revealed that preparty drinking was a prospective predictor of IR in the following year, but past-year IR did not predict subsequent prepartying.

CONCLUSIONS

Findings revealed a robust link between recent history of IR and prepartying regardless of gender. Prepartying was a prospective risk factor for subsequent IR. Although more research in this area is needed, addressing prepartying in alcohol interventions may contribute to the prevention of negative outcomes, including sexual assault.

Playing Drinking Games as a Typical Form of Prepartying among Young Adults

Prepartying, or drinking prior to going out, and playing drinking games (DG) can increase young adults' risk of heavy alcohol consumption. In the present study, we examined whether playing DG as a typical form of prepartying can increase alcohol consumption risk when compared with prepartying alone or with friends, and whether the type of DG played while prepartying can increase this risk. Participants consisted of young adults from Amazon's Mechanical Turk (N = 482, M_age=22.56, 44.2% women, 74.3% White, 62.7% were current college students) who played a DG within the past month and completed an anonymous online survey about their prepartying and DG behaviors. Results indicated that team games (e.g. beer pong) are the most commonly played type of DG while prepartying. Controlling for alcohol use on drinking occasions when DGs were not played, gender, and college status, those who played DG as a form of prepartying (n = 163) consumed more alcohol while prepartying than those who prepartied alone or with friends. Finally, those who played card games (e.g. Kings) while prepartying also consumed more preparty drinks than those who do not typically play card games. Implications for prevention and intervention as well as future research directions are briefly discussed.

Pre-game drinking among young adults and its association with positive and negative alcohol consequences

BACKGROUND

Pre-gaming, or drinking before going out, is common among young adults and associated with heavier drinking and negative consequences. However, findings have been mixed as to whether a unique, day-level association between pre-gaming and negative consequences exists independent of alcohol intake. It is also unknown whether young adults experience more positive consequences of alcohol use on days they engage in pre-gaming. This study tested day-level associations between pre-gaming and positive and negative consequences, controlling for same-day alcohol intake, as well as whether these associations were moderated by person- and day-level variables.

METHODS

Participants were 148 young adult heavy drinkers (M_age = 20.30, SD_age = 1.45, 57.4% female) who reported past-month simultaneous alcohol and marijuana use. For up to 14 consecutive days, participants completed electronic surveys asking about their drinking behaviors and consequences the previous day.

RESULTS

Prior to adjusting for alcohol intake, Poisson multilevel models showed that participants reported more negative and positive consequences on days they pre-gamed and those who reported pre-gaming more often throughout the study also experienced more negative and positive consequences overall. After controlling for alcohol intake, a positive, day-level association between pre-gaming and positive consequences remained. There was no evidence of moderation of study associations by person- or day-level variables.

CONCLUSION

The unique association between pre-gaming and positive consequences may help explain why pre-gaming is linked with heavy drinking and other risky behaviors as positive consequences have been shown to reinforce such behaviors. Findings suggest pre-gaming may be a useful intervention point for alcohol reduction programs.

Day drinking among college students and its association with risky substance use behaviors

BACKGROUND

Day drinking, or drinking during the daytime, is a term used colloquially in the media and among college students based on anecdotal evidence. Drinking at tailgate parties, generally thought to be a type of day drinking, tends to be particularly heavy and to achieve levels comparable to drinking on holidays and special occasions. The objective of this study was to assess how many and how often students day drink and whether day drinking days (i.e., days drinking began before 4:00 p.m.) were associated with heavy drinking, legal intoxication, negative alcohol-related consequences, and three risky substance use behaviors.

METHODS

We conducted a longitudinal daily diary study of college students who were followed for their first seven semesters of college. The analytic sample includes 7,633 drinking days nested with 619 student drinkers. We used logistic and Poisson multilevel models to test associations between day drinking days and substance use outcomes and negative consequences.

RESULTS

Approximately 50% of drinkers drank durinng the day at least once, and day drinking occurred on 9% of drinking days. Greek organization participants reported significantly more day drinking days than non-participants. Day drinking days were characterized by heavy drinking as evidenced by strong, positive associations between day drinking and drinking to heavy episodic drinking (HED) and high-intensity drinking (HID) thresholds on a given day. In contrast, students were less likely to reach legal intoxication and experienced fewer negative alcohol-related consequences on day drinking days than days on which drinking began in the evening or nighttime. Students who reported day drinking more often throughout the study also reported having more days of drinking at the HED and HID thresholds and playing drinking games and mixed alcohol with energy drinks more frequently.

CONCLUSIONS

Day drinking was common among this sample of college students. Findings suggest that day drinking days may be characterized by heavy drinking and may be a behavior most typically engaged in by heavy drinkers, including members of Greek organizations.

Pregaming on Alcohol Products among Male College Students in Puducherry-Mixed-Methods Study

Background:

There are some risky practices such as preloading or pregaming which exist among college students. When students pregame, compared with drinking episodes when they do not, they consume a greater number of drinks and have higher blood alcohol concentrations.

Objectives:

(1) To explore the perceptions about pregaming among male college students in Puducherry. (2) To study the prevalence of pregaming among current alcohol users.

Materials and Methods:

A sequential exploratory mixed-method study (Qualitative-Focus Group Discussion [FGD] to explore pregaming followed by Quantitative-self-administered questionnaire [survey]) was conducted among 450 male engineering college students by simple random sampling.

Results:

The prevalence of pregaming among current alcohol users was 66.7%. Among all occasions, the students were involved in pregaming mostly on birthdays 92.5% and marriages 92.5% followed by college cultural events 90%. All of the students 100% wanted to pregame for anticipated alcohol cost problems, 100% pregamed for fun and 87.5% easy conversations with the opposite sex and majority 66.6% had the intention to quit pregaming among current users.

Conclusion:

The prevalence of pregaming is high among current users however, the majority of them had the intention to quit this behavior. Counselors and health care professionals working in alcohol de-addiction centers should specifically question pregaming and its associated symptoms. Tailor-made interventions should be promoted to target the concept of pregaming-related consequences of alcohol addiction.

Participation in Drinking Games and Predrinking Among University Students in Argentina, Australia, Canada, and New Zealand

AIMS

The limited existing research on drinking games and predrinking among university students in Argentina, Australia, Canada, and New Zealand suggests that participation in these risky drinking practices is relatively widespread among this population. Drinking norms and alcohol use can vary across countries and in different regions of the globe. The measurement of drinking games and predrinking participation between studies also differs, making cross-country comparisons difficult. The present study explored differences in past month participation in drinking games and predrinking among university students from a large public university in Argentina, Australia, Canada, and New Zealand.

METHODS

The data analytic sample consisted of 1134 university students (ages 18-25, Mage = 20.2 years; 72.6% women) from Argentina (n = 349), Australia (n = 280), Canada (n = 262), and New Zealand (n = 243) who reported weekly alcohol consumption. Students completed a confidential survey on drinking attitudes and behaviors.

RESULTS

Controlling for age, gender, and weekly drink consumption, there were no cross-country differences in past month participation in predrinking. In contrast, university students from Canada and New Zealand were more likely to have played a drinking game in the past month than students from Australia and Argentina.

CONCLUSIONS

The present finding suggest that university students from Argentina, Australia, Canada, and New Zealand are equally likely to participate in predrinking regardless of country; however, the likelihood of playing drinking games differs as a function of country site.

A Proposal for a Taxonomy of Pre-Loading

Background: Pre-loading of alcohol and other drugs has become a prevalent start to nights out in many countries. Studies into pre-loading have been using different operational definitions and descriptions, leading to confusion and debate in the research literature. Purpose/Objective: We wish to propose a full taxonomy so that research into preloading, of any substances, can be specific and standardized. Methods: We address this problem by analyzing (1) terminology used throughout the literature, (2) the evolving nature of this phenomenon, and (3) the operational components comprising this substance use practice. Additionally, we provide a context and rationale for how we view pre-loading in relation to the broader event-level session. Results: Our results propose a full operational definition and taxonomy of pre-loading to be used, and built upon, by researchers. We also provide a visual representation of pre-loading within an event-level session and provide a method to facilitate consistency across cultures. Conclusions: We propose that this system will lead to greater specificity and higher reliability in the interpretation of research results.

Protective Behavioral Strategies and Alcohol Use While Pregaming: The Moderating Role of Depression and Anxiety Symptoms

The study evaluated the moderating role of anxiety and depression symptoms on the association between subscales on the Protective Behavioral Strategies for Pregaming (PBSP) scale (safety and familiarity, setting drink limits, pacing drinking, and minimizing intoxication) and alcohol consumption during pregaming. Methods: Participants were 359 traditional age undergraduate college students (M = 20, SD = 1.37; 61.7% female; 61.2% White) who reported pregaming in the past year. All participants completed measures through an online survey which evaluated PBSP, depression and anxiety symptoms, and alcohol use during pregame events in the past month. Results: Among students with high depression symptoms, the more frequent use of PBSP to minimize intoxication was not associated with alcohol consumption levels, whereas among those with low depression symptoms, higher use of PBSP to minimize intoxication was associated with higher alcohol consumption. Among those with high anxiety symptoms, the more frequent use of PBSP to minimize intoxication was associated with lower alcohol consumption at pregaming events, whereas among those with low anxiety symptoms, the use of this PBSP was associated with higher alcohol consumption. The more frequent use of PBSP related to safety and familiarity among those with high anxiety symptoms was unrelated to alcohol consumption during pregaming, whereas among those low in anxiety symptoms, the more frequent use of this PBSP was associated with lower alcohol consumption. Conclusion: The findings begin to inform clinical care and intervention techniques aimed at reducing harm associated with risky drinking practices among a vulnerable subset of college students.

Multifaceted impulsivity as a moderator of social anxiety and cannabis use during pregaming

Individuals may drink or use cannabis to cope with social anxiety, and drinking or using cannabis prior to social situations (e.g., pregaming) may be a way to limit the experience of anxiety when entering social settings. However, theoretical and empirical work has reported mixed associations between social anxiety and substance use, specifically alcohol and cannabis. Little work has looked at how other variables, such as impulsivity (a central component to high risk drinking such as pregaming), may shed light onto these mixed findings. College students who reported past year pregaming (n = 363) completed self-report surveys. Supporting prior work, we found that social anxiety was associated with fewer pregaming days, even among those high in sensation seeking. However, those reporting higher social anxiety also reported higher cannabis use during pregaming, specifically among those who reported high sensation seeking and high positive urgency. Results suggest specific facets of impulsivity may affect the association between social anxiety and cannabis use during high risk drinking events.

Comparison of Pregaming Alcohol Use and Consequences by Season Status and Sex in College Student Athletes

As student athletes exhibit unique alcohol use patterns based on being in- versus out-of-season and biological sex, we aimed to explore student athlete (N = 442) alcohol use, pregaming behaviors, and associated negative outcomes. Results suggest being out-of-season and male are positively associated with negative alcohol-related consequences, and male athletes report greater numbers of pregame specific alcohol-related consequences than female athletes (p < .05). Female athletes indicated significantly higher estimated blood alcohol concentrations than male athletes on pregaming nights. No differences emerged between in- and out-of-season athletes on pregame consequences. Results suggest that further emphasis on the role season status and sex has on pregaming behaviors and experiencing negative outcomes may be an important next step toward enhancing prevention and intervention approaches.

Development of a Measure to Assess Protective Behavioral Strategies for Pregaming among Young Adults

Background: Although most young adults drink alcohol, there are specific drinking contexts that are associated with increased risk for alcohol-related consequences. One such drinking context is pregaming, which typically involves heavy drinking in brief periods of time and has consistently been linked to consequences within the pregaming event itself, on a night after pregaming, and in the long-term. Intervention efforts that specifically target this risky behavior are needed, but these efforts need to be informed by empirical work to better understand what behaviors young people engage in that can protect them from pregaming-related harms. Purpose: We designed this study to create a measure of protective behavioral strategies that young people use before, during, and after pregaming to inform future intervention work. Methods: We tested an item pool with 363 young adult college students who engaged in pregaming in the past year and conducted exploratory factor analysis to develop a 19-item Protective Behavioral Strategies for Pregaming (PBSP) scale, which featured four subscales of safety and familiarity, setting drink limits, pacing strategies, and minimizing intoxication. Results: Each subscale negatively and significantly correlated with measures of alcohol use and consequences, though subscales differed in their associations with specific pregaming outcomes and by sex. Conclusion: This initial exploratory examination of the PBSP scale's psychometric properties suggests that use of protective behavioral strategies used specifically during pregaming events may protect young people from heavy drinking and harms. More research with the PBSP scale is encouraged to determine its practical utility as a clinical and assessment tool with young people.

Pregaming among Latina/o emerging adults: Do acculturation and gender matter?

Among ethnic minority groups, Latina/o emerging adults are most likely to engage in pregaming, a risky drinking practice. This study examined how U.S. acculturation and enculturation are associated with pregaming and the extent to which gender moderates this relation in a sample of 312 Latina/o emerging adults (18 - 25 years of age). Results indicated that men consumed more alcohol when pregaming than women, but there were no gender differences in pregaming frequency. Results also showed that lower levels of U.S. acculturation were associated with greater alcohol consumption while pregaming for men, but not women. Gender did not moderate the association between acculturation and pregaming frequency. This study highlights the need to account for gender when examining sociocultural determinants of high risk drinking behaviors such as pregaming among Latina/o emerging adults.

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.

Pregaming: A Field-Based Investigation of Alcohol Quantities Consumed Prior to Visiting a Bar and Restaurant District

BACKGROUND

Investigations examining the association between pregaming, or the consumption of alcohol prior to attending a social gathering or drinking establishment, and blood alcohol concentrations have primarily relied on estimations (i.e., Widmark equation), rather than objective biologic samples, such as breath alcohol concentration (BrAC).

OBJECTIVES

The current study assessed: (1) pregaming, using quantity-based measures, among a sample of college and non-college affiliated bar patrons, (2) associations between pregaming intensity/status and participant intoxication (BrAC), and (3) whether participants who pregamed were more likely to identify as a hazardous drinker.

METHODS

548 bar patrons provided data on the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and a single pregaming item assessing quantity of alcohol consumed prior to visiting a bar/restaurant district in 2015. BrAC samples were collected post interview. We used hierarchical linear regression models, respectively, to assess whether pregaming significantly impacted BrAC and whether presence of hazardous drinking predicted pregaming behavior.

RESULTS

After controlling for sex, race/ethnicity, age, student status, and Greek affiliation, the linear regression model explained 32.3% (R² = .323) of the variance of BrAC levels (F(12) = 21.162, p < .001), with 4.30% of the variance explained solely by pregaming (β = 0.014; p < .001). The linear regression model to assess if harzardous drinking behavior (AUDIT-C) significantly predicted pregaming explained 31.2% (R² = .312) of the variance of pregaming behavior (F(18) = 13.276, p < .001), with 4.2% of the variance explained solely by AUDIT-C scores (β = 0.280; p < .001).

CONCLUSION

Findings further highlight pregaming as a harmful risk behavior linked to elevated levels of hazardous drinking and intoxication.

Toward the prevention of alcohol use disorders: Overdrinking (unintentional binge drinking) in a community sample

Approximately 64,000,000 people in the United States report binge drinking at least once in the past month. Unlike overeating and oversleeping, "overdrinking"-defined as drinking more than a person intends to drink-does not exist in the literature. Terms such as binge and problem drinking do not consider the intent of the drinker. The results of this pilot study suggest that most people drink more than they intend to drink. Moreover, they also report often being surprised that they overdrank. Smartphones may help overdrinkers be less often surprised by overdrinking and may prevent drinkers from developing an alcohol use disorder.

Heterogeneity of Pregamers by Consumption and Reinforcement Reasons: A Latent Profile Analysis

BACKGROUND

Pregaming is a common, high-risk drinking activity among college students that has been largely unchangeable despite targeted intervention approaches. Therefore, identifying profiles of pregamers could enhance understanding of the risks associated with this practice and inform intervention development.

METHODS

This study identified subtypes of pregamers in undergraduates (N = 911; 60% female, 42.9% White) attending 3 U.S. universities in 2012. Self-report data assessed recent alcohol use (overall, heavy, and pregaming), pregaming motives, and demographics. Alcohol-related consequences were assessed via the Young Adult Alcohol Consequences Questionnaire.

RESULTS

Latent profile analysis using pregaming-specific indicators assessing motives (e.g., to avoid getting caught) and consumption (e.g., estimated pregaming blood alcohol concentration) yielded 5 unique profiles. Three profiles were characterized by pregaming on 50% or more of all drinking events that differed by pregaming consumption and motives: Instrumental (5.3%; heavy consumption, intoxication-driven motives), Global (16.0%; moderate consumption, indistinct motives), and Risk-averse (18.3%; moderate-to-heavy consumption, negatively reinforcing motives). Two profiles reported lower levels of pregaming: Occasional (32.4%; moderate consumption, indistinct motives) and Infrequent (28.0%; lowest pregaming involvement). Cross-profile differences were then examined for demographics, general drinking and pregaming-specific motives, and alcohol-related consequences. Profile comparisons indicated differences in overall alcohol consumption, ethnicity, gender, current living arrangements, Greek involvement, and a variety of alcohol-related consequences (ps < 0.01).

CONCLUSIONS

Overall, pregaming is a very heterogeneous behavior among college students in that some students utilize this drinking practice as a means to mitigate risk and others use it to promote intoxication. Results suggest that distinguishing pregamers by consumption as well as motives can facilitate the development of more tailored intervention approaches for students who engage in this high-risk practice.

Using the Solid Research Base on Pregaming to Begin Intervention Development: An Epilogue to the Special Issue on Pregaming

The pregaming research to date, up to and including the innovative studies included in this special issue, has centered on defining the behavior, learning which students may be most at-risk for pregaming, exploring which contexts may be most risky for pregaming, and quantifying the function of pregaming so that individual-level programs can be developed to target the risky practice. Although there is room for continuing to expand and refine our understanding of pregaming, much of the formative work has been conducted-primarily by the researchers highlighted in this special issue. Now it is time to use the understanding we have of this risky behavior to develop and empirically test programs specifically directed toward reducing or eliminating the behavior, not just at the individual level, but by targeting the social, cultural, economic, environmental, and policy level factors that sustain the behavior in the population. This may include targeting the behavior directly through use of techniques that are shown to be effective for young adult behavior change, but this may also require broadening beyond the psychological literature and utilizing expertise from other domains to affect behavior change.