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Trangenstein PJ, Tiongson PJ, Lu Y, Lipson SK, Xuan Z, Naimi TS, Jernigan DH. Gender and sexual identity and harms from others' drinking among U.S. college students: Results from a multi-campus survey. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:1978-1982. [PMID: 36036804 PMCID: PMC9971347 DOI: 10.1080/07448481.2022.2112045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 05/16/2022] [Accepted: 08/07/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND College is a critical life stage for alcohol-related harms to others (AHTOs), gender, and sexual identity. We tested associations between inclusively-defined gender and sexual identities (separately) and AHTOs among college students. METHODS The Healthy Minds Study (n = 8,308) provided data about three AHTOs: (1) babysitting a drunk student, (2) alcohol-related unwanted sexual advance, and (3) alcohol-related sexual assault. Independent variables included gender and sexual identity. RESULTS One in four students (25.5%) reported babysitting, 6.2% reported unwanted advances, and 1.2% reported sexual assaults. Compared to cisgender males, cisgender females had higher odds of reporting babysitting (aOR = 1.36, p < 0.001) and unwanted advances (aOR = 2.59, p < 0.001); trans masculine students had higher odds of reporting sexual assaults (aOR = 4.49, p = 0.04). CONCLUSIONS AHTOs are prevalent on college campuses, and cisgender female and trans masculine students have higher odds of experiencing them. Alcohol interventions may protect cisgender female and gender minority students from the drinkers around them.
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Affiliation(s)
| | - Patrick J.D. Tiongson
- Boston University School of Public Health, Department of Health Law, Policy & Management, Boston, MA, USA
| | - Yi Lu
- Health Effects Institute, Boston, MA, USA
| | - Sarah K. Lipson
- Boston University School of Public Health, Department of Health Law, Policy & Management, Boston, MA, USA
| | - Ziming Xuan
- Boston University School of Public Health, Department of Community Health Sciences, Boston, MA, USA
| | - Timothy S. Naimi
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada
| | - David H. Jernigan
- Boston University School of Public Health, Department of Health Law, Policy & Management, Boston, MA, USA
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2
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Douglass MA, Prince MA. The secondhand effects of alcohol use and the risks of drinking to cope. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:2211-2219. [PMID: 35997681 DOI: 10.1080/07448481.2022.2108323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 06/06/2022] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
Objective:The secondhand effects of alcohol use (SEA) are adverse consequences caused by another's drinking. This study explored the relationship among the experience of SEAs, alcohol use, and alcohol related consequences (ARC). In addition, we examined whether coping (i.e., adaptive, maladaptive, substance use coping, maladaptive coping without substance use items) served as a moderator of SEA effects on alcohol outcomes. Method: 1,168 students completed a survey assessing SEA, alcohol outcomes, ARC, and coping strategies. Results: SEA was significantly positively associated with alcohol use (RRheavydrinking = 1.05, SE = 0.005, p < .01; RRAUDIT = 1.04, SE = .005, p < .01) as well as ARC (RR = 1.06, SE = .005, p < .01). Various forms of maladaptive coping moderated the relationship between SEA and alcohol outcomes. Conclusion: This study provided evidence for a relationship between SEA and more alcohol use and ARC. This relationship was exacerbated by maladaptive coping.
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Affiliation(s)
- Morgan A Douglass
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | - Mark A Prince
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
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3
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Hatch MR, Wilson SE, Mastroleo NR, DiBello AM, Carey KB. Values of College Students Mandated to an Alcohol Intervention: A Qualitative Examination. Subst Use Misuse 2022; 57:2094-2100. [PMID: 36315498 PMCID: PMC11418017 DOI: 10.1080/10826084.2022.2136492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background: Personal values motivate action and have been shown to influence behavioral choices. Objectives: The purpose of this qualitative study was to identify which values are important to college student drinkers and what underlying principles and motivations support those values. A sample of 198 students who received a university mandate to complete an alcohol education intervention following a campus alcohol policy violation wrote essays regarding their values. These essays were categorized and thematically analyzed by the research team. Results: The majority of values fell under the category of Relationships, followed by Morality, Future Orientation, Wellness, and Benevolence. Conclusions: Most students placed a high value on their commitment to others, which may provide insight into effective and novel ways in which health messages could be communicated to college students. Additionally, findings show a relative lack of future-oriented values, particularly among the heavy-drinking students. Because future orientation is associated with engaging in less risky health behaviors, results suggest it may be beneficial to cultivate goal setting tasks early in college student education to enhance the efficacy of health promotion messages.
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Affiliation(s)
- Melissa R Hatch
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Sayre E Wilson
- College of Community and Public Affairs, Binghamton University, Binghamton, NY, USA
| | | | - Angelo M DiBello
- Center for Alcohol and Substance, Rutgers University, New Brunswick-Piscataway, NJ, USA
| | - Kate B Carey
- Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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4
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Boyle MA, Alliegro MC, Bolts OL, Hazen MN, Prince MA. You're Stressing Me Out: The Secondhand Effects of Alcohol. Subst Use Misuse 2022; 57:490-493. [PMID: 34913827 DOI: 10.1080/10826084.2021.2012697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Introduction: Secondhand effects of alcohol use (SEA) are adverse consequences experienced by an individual due to another's drinking (i.e., study/sleep interrupted, being insulted or humiliation, sexual assault or rape). SEA is a serious public health concern among college students due to its serious consequences and high prevalence (60-84%). The present study examined the associations among SEA, personal alcohol use, depression, anxiety, and stress. Methods: 836 students completed an online survey that assessed for study variables. Results: SEA significantly predicted all outcomes with those endorsing SEA reporting higher levels of depression, anxiety, and stress. Moreover, participants who endorsed SEA also reported 30% more frequent binge drinking and 18% more drinks on their heaviest reported drinking day. Conclusions: Findings indicate that the experience of SEA is a risk factor for poor mental and behavioral health outcomes among college students.
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Affiliation(s)
- Morgan A Boyle
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | - Marissa C Alliegro
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | - Olivia L Bolts
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | - Marguerite N Hazen
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | - Mark A Prince
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
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5
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Associations between Harmful Experiences from Alcohol Use of Others and Mental Health in Korean Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214240. [PMID: 31683758 PMCID: PMC6861898 DOI: 10.3390/ijerph16214240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 10/26/2019] [Accepted: 10/29/2019] [Indexed: 11/24/2022]
Abstract
This study assessed alcohol-induced harm to those not drinking and investigated its association with mental health in Korean adolescents. The 14th Korea Youth Risk Behavior Survey (2018) was used and 60,040 adolescents were analyzed. Harm from others’ alcohol consumption was assessed by four criteria: teasing in public places, being scared in public places, sleep problems, and unsafety of public places due to people drinking alcohol. Mental health included stress, depressive symptoms, suicidal ideation, and attempted suicide. Harm reported due to the alcohol use of others was 5.8% for teasing in public places, 33.6% for being scared in public places, 5.6% for sleep problems, and 40.2% for unsafety of public places among total study participants. Experiences of teasing in public places due to people who drank alcohol were associated with an increased risk of stress, depressive symptoms, suicidal ideation, and suicide attempts. Similarly, experiences of being scared in public places, sleep problems, and unsafety of public places due to people who drank alcohol were associated with poor mental health. In the stratified analysis, alcohol-induced harm was associated with poor mental health in both non-drinkers and drinkers. Harmful experiences from others’ alcohol consumption were associated with poor mental health among Korean adolescents.
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Smith RL, Salvatore JE, Aliev F, Neale Z, Barr P, Dick DM. Genes, Roommates, and Residence Halls: A Multidimensional Study of the Role of Peer Drinking on College Students' Alcohol Use. Alcohol Clin Exp Res 2019; 43:1254-1262. [PMID: 31034622 DOI: 10.1111/acer.14037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 03/21/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Peer drinking is one of the most robust predictors of college students' alcohol use and can moderate students' genetic risk for alcohol use. Peer effect research generally suffers from 2 problems: selection into peer groups and relying more on perceptions of peer alcohol use than peers' self-report. The goal of the present study was to overcome those limitations by capitalizing on a genetically informed sample of randomly assigned college roommates to examine multiple dimensions of peer influence and the interplay between peer effects and genetic predisposition on alcohol use, in the form of polygenic scores. METHODS We used a subsample (n = 755) of participants from a university-wide, longitudinal study at a large, diverse, urban university. Participants reported their own alcohol use during fall and spring and their perceptions of college peers' alcohol use in spring. We matched individuals into their rooms and residence halls to create a composite score of peer-reported alcohol use for each of those levels. We examined multiple dimensions of peer influence and whether peer influence moderated genetic predisposition to predict college students' alcohol use using multilevel models to account for clustering at the room and residence hall level. RESULTS We found that polygenic scores (β = 0.12), perceptions of peer drinking (β = 0.37), and roommates' self-reported drinking (β = 0.10) predicted alcohol use (all ps < 0.001), while average alcohol use across residence hall did not (β = -0.01, p = 0.86). We found no evidence for interactions between peer influence and genome-wide polygenic scores for alcohol use. CONCLUSIONS Our findings underscore the importance of genetic predisposition on individual alcohol use and support the potentially causal nature of the association between peer influence and alcohol use.
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Affiliation(s)
- Rebecca L Smith
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Jessica E Salvatore
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia.,Virginia Institute for Psychiatric and Behavioral Genetics, Richmond, Virginia
| | - Fazil Aliev
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia.,Faculty of Business, Karabuk University, Karabuk, Turkey
| | - Zoe Neale
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia.,Virginia Institute for Psychiatric and Behavioral Genetics, Richmond, Virginia
| | - Peter Barr
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | | | - Danielle M Dick
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia.,College Behavioral and Emotional Health Institute, Virginia Commonwealth University, Richmond, Virginia
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7
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Riordan BC, Carey KB. Wonderland and the rabbit hole: A commentary on university students' alcohol use during first year and the early transition to university. Drug Alcohol Rev 2018; 38:34-41. [PMID: 30428500 DOI: 10.1111/dar.12877] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 10/16/2018] [Accepted: 10/18/2018] [Indexed: 01/02/2023]
Abstract
For new students, university can be a wonderland of opportunity. But the first few weeks of the university experience are also typified by change, stress and uncertainty. From a health promotion perspective, the first few weeks of the university experience present an important yet understudied opportunity for alcohol misuse prevention. In this narrative review, we distinguish students' alcohol use during their first year at university from what is known about their use in the first few weeks on campus. First, we outline the developmental context of the first year experience and the descriptive epidemiology of alcohol use and consequences. Second, we highlight how distinctly different the first few weeks of the university experience are relative to the rest of the academic year and overview the limited research on alcohol use and consequences during the first few weeks. Third, we overview the limited number of strategies that have focused on reducing alcohol use during the transition to university. Finally, we offer a number of suggestions for future research. A better understanding of the nature and determinants of alcohol use and consequences during the transition to university is critical to designing effective prevention and intervention strategies.
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Affiliation(s)
| | - Kate B Carey
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, USA
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8
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Riordan BC, Moradi S, Carey KB, Conner TS, Jang K, Reid KE, Scarf D. Effectiveness of a Combined Web-Based and Ecological Momentary Intervention for Incoming First-Year University Students: Protocol for a 3-Arm Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e10164. [PMID: 29764803 PMCID: PMC5974455 DOI: 10.2196/10164] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 03/27/2018] [Accepted: 03/28/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Alcohol use among university students is common, and those who drink often choose to drink heavily (ie, 4 or more drinks per session for women or 5 or more for men). Web-based interventions (WBIs), in which students complete assessments and receive personalized feedback about their alcohol use, and ecological momentary interventions (EMIs), which use mobile devices as a method of delivering intervention information, are 2 methods that have had some success in reducing alcohol use among university students. OBJECTIVE The aim of this study was to investigate the effectiveness of a combined WBI and EMI intervention to reduce alcohol use among university students. METHODS The study is a 3-arm randomized controlled trial. Participants will be randomized into either a WBI+EMI condition, a WBI-only condition, or an assessment-only control. Our sample will consist of first-year university students, recruited through 5 residential colleges at the University of Otago, New Zealand. All participants will complete an online survey at baseline (ie, before Orientation Week); those in the WBI-only and WBI+EMI conditions will immediately receive personalized feedback (ie, the WBI), whereas participants in the assessment-only condition will receive no feedback. In addition, participants randomized into the WBI+EMI, but not those in the WBI-only or assessment-only groups, will receive 8 Orientation Week (2 per day on nights with large social events) and 6 academic year EMIs (delivered fortnightly). Participants in all conditions will complete brief surveys at the end of the first and second semester and report their weekend alcohol use fortnightly throughout each semester via ecological momentary assessments. RESULTS The primary hypothesis is that participants in the WBI+EMI group will consume significantly fewer drinks during weekends in their first semester at university compared with WBI-only and assessment-only groups. Secondary hypotheses are that, when compared with the WBI-only and assessment-only groups, the WBI+EMI group will report consuming fewer drinks during Orientation Week, report experiencing fewer negative alcohol-related consequences after first semester, and report lower Alcohol Use Disorder Identification Test-Consumption scores following their first semester. CONCLUSIONS This study adds to a growing body of work investigating the utility of WBIs and EMIs in curbing alcohol consumption. In addition, the study will help to inform policy approaches aimed at curbing alcohol consumption and alcohol-related harm in university students. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12618000015246; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374104&isReview=true (Archived by WebCite at http://www.webcitation.org/6z9jRLTz6). REGISTERED REPORT IDENTIFIER RR1-10.2196/10164.
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Affiliation(s)
| | - Saleh Moradi
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Kate B Carey
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Tamlin S Conner
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Kyungho Jang
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Kelly E Reid
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Damian Scarf
- Department of Psychology, University of Otago, Dunedin, New Zealand
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9
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Novik MG, Boekeloo BO. Comparison of Student Self-Reported and Administrative Data Regarding Intercession into Alcohol Misuse among College Freshmen Dormitory Residents. JOURNAL OF COLLEGE STUDENT DEVELOPMENT 2013; 54:202-208. [PMID: 24659855 PMCID: PMC3959104 DOI: 10.1353/csd.2013.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Intercession into collegiate alcohol misuse by the Department of Resident Live (DRL) in freshmen dormitories at one large, Mid-Atlantic, diverse, public university was examined. Freshmen dormitory resident drinkers (n=357), 71% of whom reported alcohol misuse, were surveyed. Student self-report and DRL documentation, respectively, revealed that 6.4% and 7.8% (Kappa=.77) of drinkers were documented with an alcohol violation, 4.2% and 3.4% (Kappa=.81) lost housing priority points, 1.4% and .6% (Kappa=.28) were referred for alcohol counseling, and 1.4% and .3% (Kappa = .33) were taken to the emergency room. DRL infrequently interceded into alcohol misuse, perhaps because most misuse occurred off-campus.
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Affiliation(s)
- Melinda Griffin Novik
- Department of Health, Physical Education and Recreation, Missouri State University, 901 South National Avenue, Springfield, Missouri 65897
| | - Bradley O Boekeloo
- Department of Public and Community Health, University of Maryland, School of Public Health, 2387 Valley Drive, College Park, MD 20742
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10
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Boekeloo BO, Novik MG, Bush E. DRINKING TO GET DRUNK AMONG INCOMING FRESHMEN COLLEGE STUDENTS. AMERICAN JOURNAL OF HEALTH EDUCATION 2013; 42:88-95. [PMID: 23440674 DOI: 10.1080/19325037.2011.10599176] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study examined college freshmen who intentionally drink alcohol to get drunk (DTGD). Survey data from 307 incoming freshmen college students living in freshmen residence halls who reported drinking alcohol in the last 30 days were analyzed. The majority (76.9%) of these self-reported drinkers reported DTGD. Relative to other freshmen drinkers, those who reported DTGD were significantly more likely to have consumed alcohol before going out to a party or bar, participated in a drinking game, drank heavily on a non-school night but not on a school night, used liquor, used beer, combined alcohol and drugs, experienced a hangover, vomited, passed out, and/or blacked out. The associations support DTGD as a measure of pre-meditated, controlled, and intentional consumption of alcohol to reach a state of inebriation. Common intentional drunkenness as observed in this study population may have implications for college alcohol risk reduction programs.
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Affiliation(s)
- Bradley O Boekeloo
- Department of Public and Community Health, University of Maryland, School of Public Health, 2387 Valley Drive, College Park, MD 20742, , 301-405-8546
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Boekeloo BO, Novik MG. Clinical approaches to improving alcohol education and counseling in adolescents and young adults. ADOLESCENT MEDICINE: STATE OF THE ART REVIEWS 2011; 22:631-48, xiv. [PMID: 22423468 PMCID: PMC3367837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Clinical prevention trials (approaches to educating and counseling) of adolescents (teens and young adults aged 12 to 25) about risks related to alcohol use indicate that reduction in adolescent alcohol use is possible with nonphysicians as interventionists and physicians as interventionists supported by patient counseling guides and resources. Opportunities for personalized, interactive adolescent education with goal setting appears key to intervention success. Physicians might also be more effective if they are aware of emerging alcohol problems among youth, systems-level resources for counseling adolescents about prevention, and appropriate guidance for parents. Recommendations and resources for clinicians working with adolescents regarding alcohol misuse are provided.
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Affiliation(s)
- Bradley O Boekeloo
- University of Maryland School of Public Health, Prevention Research Center, Suite 2387, Building 255, Valley Drive, College Park, MD 20742, USA.
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12
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Novik MG, Boekeloo BO. Dimensionality and psychometric analysis of an alcohol protective behavioral strategies scale. JOURNAL OF DRUG EDUCATION 2011; 41:65-78. [PMID: 21675325 PMCID: PMC3367860 DOI: 10.2190/de.41.1.d] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The current study examined the dimensionality of a protective behavioral strategies (PBS) measure among undergraduate, predominantly freshmen (92.5%) college students reporting recent alcohol use (n = 320). METHOD Participants completed a web-based survey assessing 22 PBS items. Factor analyses determined the underlying factor structure of the items. Congruence of the factor structure among gender and racial sub-groups was examined by rotating the sub-groups' matrices via the Procrustes rotation method. Reliability analyses determined internal consistency. RESULTS A 2-factor solution was retained utilizing 17 of the original items. Both PBS sub-scales (Limits and Avoidance) had acceptable internal consistency across all samples. CONCLUSIONS This PBS Scale was determined to be bi-dimensional and reliable. The dimensions suggest two underlying foci: ways to limit alcohol intake and ways to avoid alcohol intake while socializing. Practical implications of these findings are discussed.
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Affiliation(s)
- Melinda G Novik
- Missouri State University, Springfield. Dept. of Health Physical Edcuation and Recreation, MO 65897, USA.
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13
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Misch DA. Changing the culture of alcohol abuse on campus: lessons learned from secondhand smoke. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2010; 59:232-234. [PMID: 21186456 DOI: 10.1080/07448481.2010.497524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Alcohol abuse is the single greatest public health hazard on American college and university campuses, but the culture of abusive alcohol consumption continues to be highly resistant to change. The author argues that secondhand smoke campaigns can be used as models to change the culture of alcohol abuse on campus. He proposes the implementation of "secondhand alcohol" campaigns and describes their essential components and advantages.
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Affiliation(s)
- Donald A Misch
- Wardenburg Health Center, University of Colorado at Boulder, Boulder, Colorado 80309-0119, USA.
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