A Test of the Theory of Planned Behavior in the Prediction of Alcohol-Induced Blackout Intention and Frequency

Associations among sexual assault history, alcohol use, blackouts, and blackout intentions among college women

Background: Links between alcohol-induced blackouts and sexual assault (SA) are understudied. We tested whether: (1) history of blackouts, past 30-day blackouts, and past 30-day blackout intentions would be higher among women with histories of SA relative to women without; (2) baseline history of blackouts, past 30-day blackouts, and blackout intentions would predict an increase in SA severity (i.e., a continuous variable that considers SA tactic type and assault frequency) at a one-year follow-up. Methods: 1721 undergraduate women completed a baseline survey and 313 completed the follow-up. Results: Women with SA history had 2.10 higher odds of history of blackouts, 1.47 higher odds of past 30-day blackout during "one" drinking episode, 1.78 higher odds of blackout during a "few" drinking episodes, 3.21 higher odds of blackout during "most/all" drinking episodes, and 1.54 higher odds of blackout intentions in the last 30-days. Longitudinally, history of blackouts and past 30-day blackouts at baseline were associated with an increase in SA severity at follow-up, when peak drinks were not controlled. Conclusion: Longitudinal findings provide some evidence that lifetime history of blackouts and past 30-day blackouts are significant predictors of an increase in SA severity at follow-up and therefore an essential target for interventions.

Does it really matter that I do not remember my night? Consequences related to blacking out among college student drinkers

BACKGROUND

Alcohol-induced blackouts (AIBs) are experienced frequently by college student drinkers and are more likely to occur on days with high-intensity drinking (HID; 8+ for females/10+ for males) than non-HID days. Research suggests that AIBs are associated with experiencing other alcohol-related consequences (ARCs), including more serious ARCs (SARCs; e.g., legal and sexual consequences), but we do not know whether individuals experience more ARCs and more SARCs on occasions when they black out than when they do not black out. This study examines the associations between AIBs and the total number of both ARCs and SARCs.

METHODS

Students (N = 462, 51.7% female, 87.7% White, Mage  = 20.1) were assessed across 6 weekends via e-surveys (80%-97% response rate). Multilevel models were used to test for main effects, controlling for drinking (HID or estimated blood alcohol concentration; eBAC) and sex.

RESULTS

Drinking days when an AIB was experienced were associated with more total ARCs (b = 3.54, 95% CI: 3.10, 3.99) and more SARCs (b = 0.77, 95% CI: 0.60, 0.95) per day than non-AIB days. The more frequently a person experienced an AIB, the more total ARCs (b = 5.33, 95% CI: 4.40, 6.25) and SARCs (1.05, 95% CI: 0.80, 1.30) they reported on average.

CONCLUSION

Alcohol-induced blackout days were associated with higher levels of harm than non-AIB days, even at the same levels of drinking. Interventions that focus on reducing the occurrence of AIBs and factors that contribute to them, in addition to reducing alcohol consumption, may help reduce total harm associated with drinking among college students.

Alcohol-induced blackouts among college student drinkers: A multilevel analysis

OBJECTIVE

To identify factors (manner of drinking, combined alcohol and other substance use, physiology) that are associated with alcohol-induced blackouts (AIBs) over and above estimated blood alcohol concentration (eBAC).

METHODS

Students (N = 462, 51.7 % female, 87.7 % White, Mage = 20.1) were assessed across 6 weekends via e-surveys (80-97 % response rate). eBAC was calculated using standard number of drinks, drinking duration, sex, and weight. Three-level multilevel models (days, weeks, persons) were conducted to test for main effects, controlling for eBAC.

RESULTS

Protective behavioral strategies (PBS) were associated with decreased odds of AIBs on the daily (OR = 0.64, 95 % CI: 0.53, 0.77), weekly (OR = 0.84, 95 % CI: 0.72, 0.98), and person-levels (OR = 0.62, 95 % CI: 0.51, 0.74). Combined cannabis with alcohol was associated with increased odds of AIBs on the weekly (OR = 2.13, 95 % CI 1.13, 4.07) and person-levels (OR = 3.56, 95 % CI 1.60, 7.93). People who more frequently played drinking games (OR = 1.41, 95 % CI: 1.12, 1.77), pregamed (OR = 1.55, 95 % CI: 1.19, 2.03), and showed higher tolerance (OR = 1.22, 95 % CI: 1.08, 1.37) showed increased risk of AIBs, over and above eBAC levels.

CONCLUSION

We identified a number of daily-, weekly-, and person-level factors that uniquely contribute to the prediction of AIBs even at equivalent eBACs. Many of these factors were behavioral, suggesting that they may serve as malleable prevention targets for AIBs in college student drinkers.

The Relationship between Drunkorexia, Alcohol, and Blackouts Among College Students: An Exploratory Study

College drinkers commonly report blacking out (i.e., alcohol-induced amnesia), and those who drink with the intention to blackout are at risk for harmful consequences. Drunkorexia (i.e., restriction of calories on planned drinking days) is a high-risk behavior potentially associated with blacking out. Informed by the Theory of Planned Behavior (TPB), this study explores blackout experiences and intentions to blackout association with drunkorexia. College students (n=2335) who primarily identified as female and White participated via an online survey. Participants received a $3 coupon for completion of the study. Consistent with the literature, 40% and 60.7% participants reported experiencing blackouts and drunkorexia respectively in the last year. Informed by the TPB, a structural equation model assessed if more frequency blackout experiences (IV) related to drunkorexia behaviors (DV1) and alcohol behaviors (DV2), and if there was a significant indirect effect through blackout intention. The model fit the data well (CFI=.98, TLI=.95) and suggests that more frequent blackout experiences relate to more drunkorexia experiences (R²=.04) and higher levels of alcohol consumption (R²=.44). In addition, the relationship between blackout experiences and drunkorexia flows through intentions to blackout (i.e., a significant indirect effect). Findings are consistent with TPB, which suggests intentions predict health behavior. Future interventions should consider modifying intentions and other possible TPB constructs to minimize high risk alcohol consumption and drunkorexia behaviors.

Planned versus unplanned drinking and cannabis use: Do facets of trait impulsivity influence daily risk?

OBJECTIVE

Planned and unplanned substance use have been examined as predictors of heavier alcohol and cannabis use and problems at the between-person level. However, it remains unclear whether planned versus unplanned use is riskiest at the day-level, and for whom. The present study tested whether day-level planned versus unplanned alcohol and cannabis use were associated with higher alcohol and cannabis consumption and negative consequences that day and whether two impulsive traits, lack of premeditation and positive urgency, moderated associations.

METHOD

Young adults (N = 409; 50.9% female) completed five bursts of daily surveys, each consisting of a morning and afternoon report across 14 consecutive days. During a baseline session, participants reported their impulsivity (UPPS-P). During afternoon surveys, participants reported their plans to use alcohol/cannabis that night. During morning surveys, participants reported number of drinks consumed/hours spent high yesterday and negative consequences experienced.

RESULTS

Planned drinking days were associated with a greater number of drinks and negative consequences, whereas planned cannabis use days were associated with more hours spent high but not negative consequences. In the drinking quantity model, there was a significant interaction for planned versus unplanned drinking by positive urgency. Planned drinking was associated with heavier alcohol consumption across levels of positive urgency; however, unplanned drinking was associated with heavier consumption for individuals with higher (vs. lower) levels of positive urgency.

CONCLUSIONS

Day-level planned drinking and cannabis use are important factors to target in just-in-time interventions. However, interventions focused on planned and unplanned drinking may be particularly effective for individuals with higher levels of positive urgency. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Examining Attitude, Norms, and Intentions as Predictors of Prospective Change in Alcohol-Induced Blackouts

OBJECTIVE

Alcohol-induced blackouts are a marker of risk such that they are strong independent predictors of experiencing other adverse alcohol-related social and health effects. Existing work informed by the Theory of Planned Behavior suggests that several of the constructs contained within it, such as perceived norms, personal attitudes toward consumption, and drinking intentions, are reliable predictors of alcohol use, related problems, and blackout experiences. However, research to date has not examined these theoretical antecedents as predictors of change in the occurrence of alcohol-induced blackout. The current work aimed to evaluate descriptive (the rate a behavior occurs) and injunctive (the approval of a behavior) norms, attitudes toward heavy drinking, and drinking intentions as predictors of the prospective change in experiencing a blackout.

METHOD

Using existing data from two samples (Sample 1: N = 431, 68% male; Sample 2: N = 479, 52% male), students mandated to complete an alcohol intervention completed surveys at baseline and 1- and 3-month follow-ups. Latent growth curve models evaluated perceived norms, positive attitude toward heavy drinking, and drinking intention as prospective predictors of the change in blackout over 3 months.

RESULTS

Across both samples, descriptive and injunctive norms and drinking intentions were not significantly predictive of the change in blackout. Only attitude toward heavy drinking significantly predicted prospective change (the slope factor) in blackout in both samples.

CONCLUSIONS

Given the strong association between heavy drinking attitudes and change in blackout, attitudes may represent an important and novel target for prevention and intervention efforts.

Recent alcohol-induced blackouts among heavy drinking college students: A qualitative examination of intentions, willingness, and social context

One-third to half of emerging adult drinkers report experiencing alcohol-induced blackouts in the past year, and blackouts increase the risk for negative consequences. Qualitative methods provide valuable tools for scientific inquiry, allowing for in-depth understanding of lived experiences. The goal of the present study was to gain insight into emerging adults' recent blackout experiences. One hundred heavy drinking college students (age 18-20) completed a baseline survey, 28 days of ecological momentary assessment (EMA) of their alcohol use and consequences, and a follow-up interview. A subset of 37 (46% female, 13.5% Hispanic/Latinx, 54% non-Hispanic ethnicity/White race) endorsed a blackout (forgot what they did during or after drinking) and were interviewed regarding their recent blackout experience. A semi-structured interview guide focused on several key questions regarding intentions and/or willingness to black out, how friends reacted to their blackout, and social norms for blacking out. A priori as well as emergent themes were generated from review of coded data. Qualitative themes included: blackouts are often unintentional, heavy drinking young adults express willingness to black out, friends react in a variety of ways to blackouts, and blackouts are perceived as common and acceptable. Data provide insight into the phenomenology of blackouts among college students, revealing that although college students may not intend to, they are often willing to black out. Future qualitative studies on blackouts among non-college-attending emerging adults are warranted. Such work can inform theory and future survey studies to better understand this high-risk behavior. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Thinking about drinking: Acculturation and alcohol-related cognitions among college-bound Latinas

Objective: This study examined acculturation with positive alcohol expectancies (PAE) and alcohol use intentions among college-bound Latinas using a bidimensional (ie U.S. acculturation/enculturation) and bidomain (ie behaviors/values) acculturation framework. Participants: A total of 298 Latina young adults between 18 and 20 years old were included in this analysis. Methods: Data were collected the summer before participants began college for the first time. We used an online survey to assess acculturation, PAE, and alcohol use expectancies. Results: Path analyses showed that U.S. acculturation values were related to more PAE and alcohol use intentions. U.S. acculturation behaviors were related to more alcohol use intentions, and the pathway was moderated by PAE. There was also an interaction between U.S. acculturation and enculturation behaviors predicting alcohol use intentions. Conclusion: This study sheds light on how acculturating Latina young women think about alcohol use prior to beginning college, which is an opportune window for targeted prevention programs.

Assessing alcohol use in situ: Correlates of self-report vs. objective alcohol consumption

Associations between self-report and objective measurement of young adult alcohol use are weakened by excessive consumption levels; therefore, associations between correlates of alcohol use and consumption likely also differ by alcohol measurement. This study examined the extent to which correlates of heavy drinking measured via self-report are also indicators of heavy drinking measured objectively. Data were collected from 164 bar patrons (54% male; 73% White, 12% Black, 15% Other; 15% Hispanic) as they exited the bar. Participants completed an intercept survey including self-reported measures of drinking, demographics, and social-environmental factors. A breath alcohol concentration (BrAC) reading was also obtained using a handheld breathalyzer device. Correlations between two self-reported outcomes, number of drinks consumed prior to and at the bar, and BrAC were significant among those in the lowest quartile of BrAC readings, but largely non-significant at moderate and high BrAC levels. Intention to get drunk that night was a robust predictor of alcohol consumption across self-reported outcomes and BrAC. Social factors (presence of drinking peers, witnessing drunk others) were predictive of self-reported alcohol use but not BrAC. AUDIT-C score was the only additional alcohol behavior predictive of objectively measured alcohol use. Self-reported outcomes and BrAC, as well as their association with key correlates, diverge at high levels of intoxication, when preventive intervention is most needed. Implications for further research and alcohol prevention practice are discussed.

To drink or not to drink: When drinking intentions predict alcohol consumption and consequences

OBJECTIVES

We examined daily associations between drinking intentions and drinking behaviour and tested past drinking behaviour and current social environment as potential moderators of the daily intention-behaviour association. We expected both more frequent past drinking and being in a high drinking environment to weaken the intention-behaviour association. We also tested intentionality as a moderator of the association between alcohol consumption and next-day negative outcomes, expecting that less intentional alcohol consumption would be related to greater stress and regret.

DESIGN

We tested these hypotheses using two separate micro-longitudinal studies of college students (Ns = 1,641, 540).

METHODS

In two samples, participants completed bursts of data collection in which they indicated their previous alcohol consumption and then completed 30 days of diary surveys in which they reported their alcohol consumption and social environment the previous evening and their levels of stress, regret, and drinking intentions that day.

RESULT

Consistent with our predictions, drinking intentions more strongly predicted drinking behaviour among individuals with less frequent past drinking behaviour, and, in Sample 1, drinking intentions more strongly predicted drinking behaviour among individuals in a low drinking environment. Contrary to hypotheses, results indicated that individuals with low drinking intentions were more likely to experience stress the next day, particularly if they consumed less alcohol. Greater consumption, however, was related to greater odds of experiencing regret, but this was stronger among individuals with higher drinking intentions.

CONCLUSIONS

Findings are discussed in terms of the complex interplay between intentions and both social environment and contextual factors with respect to predicting drinking level and related problems.

Attitude toward heavy drinking as a key longitudinal predictor of alcohol consumption and problems

BACKGROUND

Little research has considered the importance of a person's attitude toward heavy drinking when evaluated against other well-known predictors of alcohol use and related harm including drinking motives and drinker identity. The current study aimed to evaluate whether one's favorable attitude toward heavy drinking is a unique predictor of prospectively assessed drinking-related outcomes when considered against descriptive and injunctive norms, drinking intentions, drinking motives, and drinker identity.

METHODS

Participants in the current study comprised mandated students (n = 374; 54% male) who violated a campus alcohol policy and received a brief intervention (eCHECKUP TO GO). Analyses included the use of negative binomial regression to examine baseline predictors- attitude toward heavy drinking, perceived descriptive and injunctive norms, drinking intentions, drinking motives, and drinker identity-of prospective alcohol use outcomes and alcohol-related problems 1 month later.

RESULTS

We found that one's attitude toward heavy drinking remains a significant predictor of binge frequency, peak drinking, and alcohol-related problems when accounting for norms, intentions, motives, and identity.

CONCLUSIONS

This study has important theoretical and intervention implications. Indeed, the finding that one's attitude toward heavy drinking remains a significant predictor of alcohol-related outcomes when intentions are included in the model has implications within the theory of planned behavior. Furthermore, attitude toward heavy drinking has predictive utility when considered against descriptive and injunctive norms, drinking motives, and drinker identity. These findings contribute to a growing literature suggesting that attitudes could be an important intervention target when the goal is to change drinking behavior.

Nonmedical Prescription Drug Use Among Female Adolescents: The Relative Influence of Maternal Factors, Social Norms, and Perceptions of Risk and Availability

Increasing understanding of the risk and protective factors for adolescent nonmedical use of prescription drugs (NMUPD) could inform prevention efforts. Several correlates have been identified, including parental factors, perceptions about use and accessibility, social norms, and age. However, these constructs have rarely been simultaneously examined using paired data from parents and adolescents. We aimed to examine the relative influence of these correlates among dyads (N=349) of mothers and adolescent daughters. Using multiple logistic regression, daughters' past NMUPD and inclination for future NMUPD were regressed onto descriptive norms for friend use, perceived drug accessibility and risk of harm from use, daughter age, mothers' disapproval about use, mothers' past NMUPD and inclination for future NMUPD, and the mother-daughter relationship quality. Akaike weights and lasso regressions were also estimated to evaluate the relative importance of each correlate. Higher descriptive norms for friend use, older age, and mothers' inclination for NMUPD were risk factors for daughters' NMUPD, while a closer mother-daughter relationship and mothers' disapproving attitudes towards NMUPD were protective factors. The three analysis approaches were corroborative. Results suggest friend descriptive norms, mother-daughter relationship quality, and mothers' attitudes about NMUPD are important prevention targets.

Unplanned versus planned simultaneous alcohol and marijuana use in relation to substance use and consequences: Results from a longitudinal daily study

Objective: The current study expands the literature on simultaneous alcohol and marijuana (SAM) use by focusing on the distinction between unplanned and planned SAM use to identify potential intervention targets. This study explored whether unplanned or planned SAM use was associated with differences in alcohol and/or marijuana use and consequences. Method: A community sample of young adults (aged 18-25) with recent alcohol and SAM use was recruited [N = 409; mean (SD) = 21.61 (2.17) years; 50.9% female; 48.2% non-Hispanic/Latinx White]. Participants completed five 2-week bursts of online daily surveys (2 ×/day; 81.99% of morning and 82.23% of afternoon surveys completed) and reported on substance use intentions and behavior. Results: Descriptive findings showed that among days on which participants reported SAM use, 41.85% of the days were unplanned SAM use days. Based on daily-level results from multilevel models, on days with unplanned SAM use, young adults reported consuming fewer drinks, fewer hours high from marijuana, and lower subjective intoxication/high, compared to planned SAM use days, thus indicating that planned SAM use was riskier. Unplanned SAM use was not significantly associated with positive or negative consequences related to alcohol or marijuana, after accounting for the number of drinks or hours high from marijuana. Conclusions: Current findings suggest that interventions should target days on which young adults are planning to engage in SAM use. Future work is needed to identify factors that predict planned SAM use on specific occasions and also to disentangle the potential role of unplanned heavy use. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Synthesizing Indirect Effects in Mediation Models With Meta-Analytic Methods

AIMS

A mediator is a variable that explains the underlying mechanism between an independent variable and a dependent variable. The indirect effect indicates the effect from the predictor to the outcome variable via the mediator. In contrast, the direct effect represents the predictor's effort on the outcome variable after controlling for the mediator.

METHODS

A single study rarely provides enough evidence to answer research questions in a particular domain. Replications are generally recommended as the gold standard to conduct scientific research. When a sufficient number of studies have been conducted addressing similar research questions, a meta-analysis can be used to synthesize those studies' findings.

RESULTS

The main objective of this paper is to introduce two frameworks to integrating studies using mediation analysis. The first framework involves calculating standardized indirect effects and direct effects and conducting a multivariate meta-analysis on those effect sizes. The second one uses meta-analytic structural equation modeling to synthesize correlation matrices and fit mediation models on the average correlation matrix. We illustrate these procedures on a real dataset using the R statistical platform.

CONCLUSION

This paper closes with some further directions for future studies.

Intentions and motives to experience alcohol-induced blackout among young adults in college

Blackouts are typically considered a negative consequence of alcohol use. Yet some college students report consuming alcohol with the intention of blacking out. This study examined intentions and motives for blackout drinking among young adults in college. College students with a past-year history of blackout (N = 350, 56% female, 73% White) completed an anonymous online survey. Descriptive statistics were used to examine the incidence of blackout intentions, and individuals who did and did not report future blackout intentions were then compared on drinking patterns, depressive symptoms, social norms, and outcome expectancies. Overall, 135 participants (39%) reported consuming alcohol in the past 30 days with the intention of losing memory of the night's events, and 107 (31%) reported blackout intentions in the next 30 days. When asked (via open text box) to indicate their motives for past blackout intentions, the majority of participants provided responses that fit with coping, social, or enhancement drinking motives. A larger proportion of men than women reported blackout intentions. As a group, those reporting future blackout intentions reported heavier, more frequent, and more problematic drinking, as well as more symptoms of depression and more positive (but not negative) outcome expectancies. A substantial subset of college students reporting a blackout in the past year also endorsed intentions to experience a blackout in the next 30 days. Given strong associations between intentions and subsequent behavior, interventions targeting blackout styles of drinking are warranted. The extent to which "blackout" drinking motives differ from traditional drinking motives is unclear. (PsycInfo Database Record (c) 2020 APA, all rights reserved).