Have I had one drink too many? Assessing gender differences in misperceptions of intoxication among college students

Alcohol Feedback, Reflection, and Morning Evaluation (A-FRAME): Refining and testing feasibility and acceptability of a smartphone-delivered alcohol intervention for heavy-drinking young adults

BACKGROUND

Young adults drink heavily and experience negative alcohol consequences. To capitalize on mornings after drinking as an optimal time to intervene, we developed a novel, theory-based personalized feedback intervention (PFI) called Alcohol Feedback, Reflection, and Morning Evaluation (A-FRAME), to reduce heavy drinking. An initial prototype was refined via feedback from college students who drink heavily. The goal of the present study was to conduct an open trial to establish feasibility and acceptability of the refined PFI.

METHODS

The refined PFI was delivered for 4 weeks to 18 heavy-drinking young adults (Mage = 22.61, 44% women, 66.7% White, 27.8% Black, 16.7% Asian, 5.6% Native American/Alaskan Indian, 22.2% Hispanic/Latino). Participants completed a goal-setting procedure, followed by 28 daily surveys. Surveys indicating prior-day drinking were followed by the option to view personalized feedback (e.g., goal attainment, blood alcohol concentration [BAC], peer norms, protective behaviors). Aggregated feedback was also delivered at the 14- and 28-day marks. Participants completed a post-test acceptability survey and individual interviews to inform further refinement.

RESULTS

The response rate to daily surveys was 93.8% and all participants completed study procedures, demonstrating feasibility. Daily feedback was reviewed about half (45.5%) of the time it was offered (i.e., following drinking days). Biweekly feedback was viewed 50% and 56% of the time at 14- and 28-day marks, respectively. Other benchmarks for acceptability were supported by survey and interview results.

CONCLUSIONS

Open trial results support the feasibility and acceptability of this theory-based intervention for heavy-drinking young adults. A planned randomized controlled trial will evaluate efficacy.

Subjective intoxication predicts alcohol-related consequences at equivalent alcohol concentrations in young adults using ecological momentary assessment and alcohol sensors

OBJECTIVE

Subjective intoxication (SI) when drinking may serve as an internal barometer of whether to continue drinking or engage in potentially unsafe behavior. Mobile assessments offer the potential to use SI as a prospective risk indicator during drinking episodes; little evidence exists for the validity of real-time SI measures. We test the correspondence of SI with estimated blood alcohol concentration and transdermal alcohol concentration (TAC) in young adults' natural settings. We provide a novel test of whether SI features (peak and mean SI) uniquely predict consequences adjusting for alcohol concentration.

METHOD

Two hundred twenty-two heavy-drinking young adults (Mage = 22.3, 64% female, 79% non-Hispanic White, 84% undergraduates) participated in a 6-day study that used ecological momentary assessment of drinking and TAC sensors. SI was assessed every 30 min during drinking episodes. Multilevel modeling was used to test hypotheses.

RESULTS

Momentary SI and estimated blood alcohol concentration had moderate associations at the moment and day levels (standardized βs = 0.5-0.6); SI was moderately associated with TAC at the day level (βs = 0.5). Associations between SI and alcohol concentration varied widely between persons and across days. Day-level SI features predicted consequences when adjusting for alcohol concentration (incidence rate ratios, IRRs = 1.29-1.70).

CONCLUSIONS

Our two-item SI measure shows evidence of validity in real-world settings with heavy-drinking young adults. SI was significantly correlated with alcohol concentration and was a unique predictor of consequences. The strength of these associations varied greatly across persons and days. Real-time SI measurement may be useful in preventive interventions, but continued research is needed into when and for whom momentary SI is most predictive of risk. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

An Event-Level Investigation of Factors Associated With Young Women's Experiences of Coerced Consensual Sex

Little is known about instances of coerced consensual sex in which women report both that they consented to have sex and that their partner used coercive tactics (e.g., made threats) to get them to have sex when they did not want to. Yet, these experiences are frequently reported by young sexually active women. We examined the relationship between sexual victimization history and the woman's level of alcohol intoxication in the likelihood of experiencing coerced consensual sex using event-level data collected over a 1-year period from 548 young adult nonproblem drinking women who engaged in sexual activity with men. Twenty percent (n = 112) reported at least one incident of coerced consensual sex. A generalized estimating equation model revealed main effects of daily estimated blood alcohol content (eBAC) and sexual victimization severity. The more women increased their alcohol consumption above their own average and the more severe their sexual victimization history, the more likely they were to experience coerced consensual sex. Our findings highlight the fact that coercion and consent are not mutually exclusive in some situations and shed light on this important yet understudied coercive sexual experience.

Does a Brief Motivational Intervention Reduce Frequency of Pregaming in Mandated Students?

BACKGROUND

Pregaming, also known as frontloading or predrinking, is a common but risky drinking behavior among college students. However, little is known about the way in which a brief motivational intervention (BMI) addressing general alcohol use and consequences may impact pregaming frequency.

OBJECTIVES

This study examined whether mandated students reduced frequency of pregaming following a BMI when pregaming was spontaneously discussed and whether gender moderated these effects.

METHODS

Participants (n = 269, 32% female) were mandated college students who had received a campus-based alcohol citation and continued to exhibit risky alcohol use six weeks after receiving a brief advice session. Participants were randomized to a brief motivational intervention (BMI, n = 145) or assessment only (AO, n = 124) and completed follow-up assessments at 3, 6, and 9 months postintervention. Hierarchical Linear Modeling (HLM) was used to examine both between-person (Level 2) effects (i.e., condition) and within-person (Level 1) effects (i.e., time) on pregaming frequency. Analyses examining discussions of pregaming within the BMI were conducted using a subsample of the BMI sessions which had been transcribed (n = 121).

RESULTS

Participants in the BMI group did not significantly reduce the frequency of pregaming compared to those in the AO group, even when pregaming was explicitly discussed during the BMI. Moreover, the BMI was equally ineffective at reducing pregaming frequency for both males and females. Conclusion/Importance: Pregaming frequency appears to be resistant to conventional intervention efforts, but recent research suggests several innovative strategies for addressing pregaming in the college student population.

The Effect of Descriptive Norms on Pregaming Frequency: Tests of Five Moderators

BACKGROUND

Pregaming is highly prevalent on college campuses and associated with heightened levels of intoxication and risk of alcohol consequences. However, research examining the correlates of pregaming behavior is limited. Descriptive norms (i.e., perceptions about the prevalence or frequency of a behavior) are reliable and comparatively strong predictors of general drinking behavior, with recent evidence indicating that they are also associated with pregaming.

OBJECTIVES

We tested the hypothesis that higher descriptive norms for pregaming frequency would be associated with personal pregaming frequency. We also tested whether this effect would be stronger in the context of several theory-based moderators: female gender, higher injunctive norms (i.e., perceptions of others' attitudes toward a particular behavior), a more positive attitude toward pregaming, a stronger sense of identification with the drinking habits of other students, and stronger social comparison tendencies.

METHODS

College student drinkers (N = 198, 63% female) participated in an online survey assessing frequency of pregaming, descriptive norms, and hypothesized moderators.

RESULTS

A multiple regression model revealed that higher descriptive norms, a more positive attitude toward pregaming, and stronger peer identification were significantly associated with greater pregaming frequency among drinkers. However, no moderators of the association between descriptive norms and pregaming frequency were observed.

CONCLUSIONS/IMPORTANCE

Descriptive norms are robust predictors of pregaming behavior, for both genders and across levels of several potential moderators. Future research seeking to understand pregaming behavior should consider descriptive norms, as well as personal attitudes and identification with student peers, as targets of interventions designed to reduce pregaming.

Brief Motivational Interventions Are Associated With Reductions in Alcohol-Impaired Driving Among College Drinkers

OBJECTIVE

Alcohol-impaired (AI) driving among college students remains a significant public health concern and may be the single most risky drinking outcome among young adults. Brief motivational interventions (BMIs) have been shown to reduce alcohol use and problems, but their specific efficacy for decreasing AI driving among college students is unknown. The present study analyzed data from three randomized controlled trials of BMI (Murphy et al., 2010: n = 74; Borsari et al., 2012: n = 530; and Martens et al., 2013: n = 365) to evaluate whether BMIs are associated with reductions in AI driving among college student drinkers.

METHOD

Participants in all three studies were randomized to BMI or control conditions. Participants reported whether they had driven under the influence (yes/no) following the BMI over the follow-up period.

RESULTS

Separate binary logistic regression analyses were conducted for each study. For Studies 1 and 2, these analyses revealed that a BMI was significantly associated with reductions in AI driving at the final (6-month and 9-month, respectively) follow-up compared with the control condition. For Study 3, analyses revealed that a single-component BMI focused on the correction of misperceptions of descriptive norms was significantly associated with reductions in AI driving compared with the control group at the final (6-month) followup, whereas a single-component BMI focused on the use of protective behavioral strategies was not. Change in drinking level did not mediate the relationship between the condition and the change in AI driving.

CONCLUSIONS

Counselor-administered BMIs that include descriptive normative feedback are associated with significant reductions in AI driving compared with control.

Elevated alcohol demand is associated with driving after drinking among college student binge drinkers

BACKGROUND

Alcohol-impaired driving among college students represents a significant public health concern, yet little is known about specific theoretical and individual difference risk factors for driving after drinking among heavy drinking college students. This study evaluated the hypothesis that heavy drinkers with elevated alcohol demand would be more likely to report drinking and driving.

METHOD

Participants were 207 college students who reported at least 1 heavy drinking episode (4/5 or more drinks in 1 occasion for a woman/man) in the past month. Participants completed an alcohol purchase task that assessed hypothetical alcohol consumption across 17 drink prices and an item from the Young Adult Alcohol Consequences Questionnaire that assessed driving after drinking.

RESULTS

In binary logistic regression models that controlled for drinking level, gender, ethnicity, age, and sensation seeking, participants who reported higher demand were more likely to report driving after drinking.

CONCLUSIONS

These results provide support for behavioral economics models of substance abuse that view elevated/inelastic demand as a key etiological feature of substance misuse.

How estimation of drinking influences alcohol-related consequences across the first year of college

BACKGROUND

This study examined how well students estimate their overall drinker type and the relation between the accuracy of this estimation with alcohol-related consequences. The study also explored the association between psychosocial alcohol variables and underestimation or overestimation of drinker type.

METHODS

College students (n = 1,895) completed questionnaires at baseline (precollege matriculation) assessing self-reported drinker types (SI), protective and risky drinking behaviors, drinking expectancies, attitudes, and norms. Postbaseline assessment occurred during the fall semester sophomore year and included the number and type of alcohol consequences experienced during the previous year. Students' SIs were coded as accurate, overestimated, or underestimated relative to their empirically derived latent class analytic drinker class. The association between drinker type accuracy and consequences and membership in the high-risk Multiple and Repeated Consequence group was assessed, as was the relationship between the psychosocial alcohol variables and accuracy.

RESULTS

Eighteen percent of students underestimated and 10% overestimated their drinker type. Students who under- or overestimated their drinker type reported experiencing more consequences, even after controlling for drinking. Increases in positive alcohol expectancies, protective and risky drinking behaviors, and descriptive peer norms were positively associated with underestimation of drinker type. Only protective and risky drinking behaviors were associated with overestimation.

CONCLUSIONS

This study underscores the importance of accurate estimation of drinker type and the risk of experiencing alcohol consequences. Future research and intervention strategies are discussed.

Identifying theoretical predictors of risky alcohol use among noncollege emerging adults

OBJECTIVE

Studies show that emerging adults who do not obtain postsecondary education are at greater risk for developing alcohol use disorders later in life relative to their college-attending peers. Research examining constructs amenable to change within this population is necessary to inform intervention efforts. Thus, the current study aimed to identify psychosocial correlates of risky alcohol use for noncollege emerging adults. A secondary goal was to examine whether gender moderated the relationships between the psychosocial constructs and alcohol use.

METHOD

Participants were a nationally representative sample of noncollege emerging adults (18-22 years old) who reported using alcohol in the past year, recruited through an established Internet panel (N = 209; 125 women). A path model was used to examine the relationship between theoretically derived constructs (expectancies, attitudes, normative beliefs) and risky (peak) drinking. A second model examined a multigroup solution to assess moderating effects of gender.

RESULTS

The full-sample model revealed significant associations between attitudes toward drinking and risky drinking. The model assessing gender differences revealed association between normative beliefs and drinking for women but not men, whereas attitudes were significantly associated with risky drinking for both men and women.

CONCLUSIONS

Findings highlight the importance of attitudes and, for women, descriptive norms in the etiology of risky drinking among noncollege emerging adults, which emphasizes their potential utility in the development and adaptation of interventions for this at-risk population.

Gender differences in natural language factors of subjective intoxication in college students: an experimental vignette study

BACKGROUND

Examining the natural language college students use to describe various levels of intoxication can provide important insight into subjective perceptions of college alcohol use. Previous research (Levitt et al., Alcohol Clin Exp Res 2009; 33: 448) has shown that intoxication terms reflect moderate and heavy levels of intoxication and that self-use of these terms differs by gender among college students. However, it is still unknown whether these terms similarly apply to other individuals and, if so, whether similar gender differences exist.

METHODS

To address these issues, the current study examined the application of intoxication terms to characters in experimentally manipulated vignettes of naturalistic drinking situations within a sample of university undergraduates (n = 145).

RESULTS

Findings supported and extended previous research by showing that other-directed applications of intoxication terms are similar to self-directed applications and depend on the gender of both the target and the user. Specifically, moderate intoxication terms were applied to and from women more than men, even when the character was heavily intoxicated, whereas heavy intoxication terms were applied to and from men more than women.

CONCLUSIONS

The findings suggest that gender differences in the application of intoxication terms are other-directed as well as self-directed and that intoxication language can inform gender-specific prevention and intervention efforts targeting problematic alcohol use among college students.

Artificial sweeteners versus regular mixers increase breath alcohol concentrations in male and female social drinkers

BACKGROUND

Limited research suggests that alcohol consumed with an artificially sweetened mixer (e.g., diet soft drink) results in higher breath alcohol concentrations (BrACs) compared with the same amount of alcohol consumed with a similar beverage containing sugar. The purpose of this study was to determine the reliability of this effect in both male and female social drinkers and to determine if there are measureable objective and subjective differences when alcohol is consumed with an artificially sweetened versus sugar-sweetened mixer.

METHODS

Participants (n = 16) of equal gender attended 3 sessions where they received 1 of 3 doses (1.97 ml/kg vodka mixed with 3.94 ml/kg Squirt, 1.97 ml/kg vodka mixed with 3.94 ml/kg diet Squirt, and a placebo beverage) in random order. BrACs were recorded, as were self-reported ratings of subjective intoxication, fatigue, impairment, and willingness to drive. Objective performance was assessed using a cued go/no-go reaction time task.

RESULTS

BrACs were significantly higher in the alcohol + diet beverage condition compared with the alcohol + regular beverage condition. The mean peak BrAC was 0.091 g/210 l in the alcohol + diet condition compared with 0.077 g/210 l in the alcohol + regular condition. Cued go/no-go task performance indicated the greatest impairment for the alcohol + diet beverage condition. Subjective measures indicated that participants appeared unaware of any differences in the 2 alcohol conditions, given that no significant differences in subjective ratings were observed for the 2 alcohol conditions. No gender differences were observed for BrACs, and objective and subjective measures.

CONCLUSIONS

Mixing alcohol with a diet soft drink resulted in elevated BrACs, as compared with the same amount of alcohol mixed with a sugar-sweetened beverage. Individuals were unaware of these differences, a factor that may increase the safety risks associated with drinking alcohol.