Protective Behavioral Strategies and Alcohol Consumption: The Moderating Role of Drinking-Group Gender Composition

Likelihood of Young Adult Engagement in Protective Behavioral Strategies for Alcohol Use across Drinking Contexts: Implications for Adaptive Interventions

OBJECTIVE

This study examined how young adults' likelihood to engage in protective behavioral strategies (PBS) to reduce alcohol harms varies across physical and social contexts for drinking.

METHOD

We conducted an online survey with 514 heavy drinking young adults (Mage = 22.4 years, 52% women, 30% Hispanic/Latin(x), 40% non-White). Participants were asked to rate their likelihood to engage in 26 PBS generally, and specifically in six physical contexts (e.g., bar/club), and six social contexts (e.g., in a large group). We conducted regression analyses to examine the overall effect of context on the likelihood to engage in each PBS and post-hoc Tukey tests to assess pairwise comparisons of the differences in likelihood to engage in each PBS across response options for physical and social context. Analyses were conducted using the full sample, and for men and women separately.

RESULTS

There were significant differences in six strategies across physical contexts; likelihood to engage in PBS varied across public and private spaces for different strategies. We also found significant differences in five strategies across social contexts; participants were more likely to engage in PBS among larger numbers of people and those who are intoxicated. There were numerous differences in pairwise comparisons of PBS engagement across physical and social contexts for women, while men demonstrated only two differences in PBS across physical context.

CONCLUSIONS

Results suggest that alcohol interventions for young adults that include PBS should consider tailoring strategies to the individual and the specific context of the drinking event.

Associations between Gender Expression, Protective Coping Strategies, Alcohol Saliency, and High-Risk Alcohol Use in Post-Secondary Students at Two Canadian Universities

BACKGROUND

This study, conducted in October 2017 at two Canadian universities, aimed to explore the relationships between gender expression, protective coping strategies, alcohol saliency, and high-risk alcohol use.

METHODS

Validated scales were employed to assess these variables using survey data. Multivariate analyses were conducted to investigate the associations between these factors and high-risk drinking.

RESULTS

This study revealed significant associations between high-risk drinking and androgynous gender roles (OR = 1.58, 95% CI: 1.19-2.10) as well as among self-reported males (OR = 2.21; 95% CI: 1.77-2.75). Additionally, protective behavioural strategies were inversely related to high-risk drinking (OR = 0.95; 95% CI: 0.94-0.96), while higher alcohol saliency exhibited a positive correlation with high-risk drinking (OR = 1.12; 95% CI: 1.11-1.14).

CONCLUSIONS

These findings underscore the importance of considering gender, alcohol saliency beliefs, and protective behavioural strategies in the development and refinement of interventions aimed at reducing high-risk alcohol use on Canadian campuses.

Cognitive Distortions Associated with Alcohol and Marijuana Use in Uruguayan Citizens

Background: Psychological distress (i.e., incipient symptoms of anxiety, stress, and depression) may promote substance use through increased emission of cognitive distortions. These are automatic irrational thoughts that can promote distress, which in turn increases substance use. Aim: This study analyzed, in a sample of Uruguayan citizens, the unique contribution of cognitive distortions on the frequency and quantity of alcohol or marijuana use, over and above the contribution of psychological distress or the use of emotion regulation strategies. We also assessed whether these variables were associated with having initiated or resumed the use of a substance. Methods: A survey asked about alcohol and marijuana use, psychological distress, emotion regulation strategies, and cognitive distortions. The study comprised a convenience sample of 1132 participants (Mean age = 29.07 ± 8.19 years, 72.26% women). Separate hierarchical linear regression analyses were conducted on the frequency and quantity of alcohol or marijuana use, whereas a logistic regression was applied on having initiated or resumed the use of a substance. Results: Several cognitive distortions were significant predictors of frequency and quantity of alcohol consumption or frequency of marijuana use, over and above psychological distress. Differential emission of automatic thoughts was also associated, along with higher scores of psychological distress, with a significantly higher probability of having initiated the use of a new substance or having resumed the use of a substance. Conclusions: Cognitive distortions may promote alcohol and marijuana use. Interventions aimed at modifying these distortions should be considered to reduce the emission of these behaviors.

Impact of Sex and Gender on Clinical Management of Patients with Advanced Chronic Liver Disease and Type 2 Diabetes

Gender differences in the epidemiology, pathophysiological mechanisms and clinical features in chronic liver diseases that may be associated with type 2 diabetes (T2D) have been increasingly reported in recent years. This sexual dimorphism is due to a complex interaction between sex- and gender-related factors, including biological, hormonal, psychological and socio-cultural variables. However, the impact of sex and gender on the management of T2D subjects with liver disease is still unclear. In this regard, sex-related differences deserve careful consideration in pharmacology, aimed at improving drug safety and optimising medical therapy, both in men and women with T2D; moreover, low adherence to and persistence of long-term drug treatment is more common among women. A better understanding of sex- and gender-related differences in this field would provide an opportunity for a tailored diagnostic and therapeutic approach to the management of T2D subjects with chronic liver disease. In this narrative review, we summarized available data on sex- and gender-related differences in chronic liver disease, including metabolic, autoimmune, alcoholic and virus-related forms and their potential evolution towards cirrhosis and/or hepatocarcinoma in T2D subjects, to support their appropriate and personalized clinical management.

The Health Belief Model in the Context of Alcohol Protective Behavioral Strategies

Objective: Alcohol use continues to be prevalent and problematic among young adult samples. Protective behavioral strategies (PBS), which are harm reduction strategies utilized while drinking, have been linked to decreased alcohol use and subsequent alcohol-related problems. An individual's likelihood of adopting PBS and other health behaviors, according to The Health Belief Model (HBM), is dependent on perceived susceptibility to and severity of adverse health outcomes, as well as perceived benefits and barriers related to implementing those behaviors. The present study examined whether the perceived effectiveness of PBS in the context of the HBM leads to an increase in PBS use. Method: The analytic sample (n =694 college students, M_age =20.21, SD =4.37, 63.26% female, 72.05% Caucasian) self-reported demographics, weekly alcohol consumption (i.e., frequency, intensity, and quantity), alcohol-related problems, use of PBS, and perceived effectiveness of PBS use. A latent variable model was used to test the effect of perceived PBS effectiveness on PBS use, alcohol consumption, and alcohol-related problems. Results: Perceived PBS effectiveness was associated with a higher likelihood of using PBS subtypes (Manner of Drinking, Stopping/Limiting Drinking, and Serious Harm Reduction), which in turn was associated with reductions in alcohol consumption and problems. Conclusions: These findings suggest that increasing perceptions of PBS effectiveness may lead to more PBS use, decreased alcohol consumption, and fewer alcohol-related problems. Future research could implement longitudinal methodology to assess attempts to increase perceived effectiveness of PBS use and potentially establish a causal link between these perceptions, PBS use, and alcohol-related outcomes.

Adolescent school injuries and classroom sex compositions in German secondary schools

BACKGROUND

School injuries are an important adolescent health problem. Previous research suggests that relevant risk behaviors for school injuries, risk-taking and aggression, are highly susceptible to peer effects. Specifically, evidence suggests that the ratio of men and women in peer groups (sex ratio) affects individuals' propensity for aggression and risk-taking. However, potential associations of classroom sex ratios with adolescent school injury risks have not been studied so far. The purpose of this paper is to investigate the association of classroom sex compositions with adolescent school injuries.

METHODS

We investigate the association of classroom sex ratios with school injuries in a longitudinal survey dataset containing 13,131 observations from 9,204 adolescent students (ages 13-16) from secondary schools in Germany. The data also allow us to identify injuries due to aggressive behavior and analyze these injuries in detail. We use multilevel logistic regression models to analyze risks of both overall and aggression-related school injuries.

RESULTS

Adolescent students' risk for school injuries is significantly and positively associated with male-skewed classroom sex ratios (OR = 1.012, p=0.012). Specifically, the risk of sustaining a school injury increases by 33.5 percent when moving from the 10th to the 90th classroom sex ratio percentile. Moreover, we find an even stronger positive association between male-dominated classrooms and aggression-related injury risks (OR = 1.022, p=0.010). Compared to classroom sex ratios at the 10th percentile, the risk of an aggression-related injury is 78 percent higher in classrooms with a sex ratio at the 90th percentile. Finally, we find that both boys' and girls' injury risks equally increase with a higher proportion of male students in their classroom.

CONCLUSIONS

Our findings indicate that sex composition of classrooms is an important contextual factor for adolescent school injuries, in particular school injuries resulting from aggression. These findings illustrate the need to integrate a contextual perspective on school injuries among adolescent students both into research and into intervention planning.

Examining Cross-Country and Sex Differences on a Comprehensive Assessment of Protective Behavioral Strategies for Alcohol

OBJECTIVE

Use of protective behavioral strategies (PBS) has been associated with reduced alcohol-related harms among college students. However, most of this research has been conducted among U.S. samples. The present study examines the use of PBS in an international context.

METHOD

Participants (n = 1512) were recruited from universities in Spain (n = 298), Argentina (n = 439), and the U.S. (n = 775) to determine if there are differences in PBS use across countries and/or across sex. Further, we examined whether the association between PBS use and negative consequences differ across country and sex.

RESULTS

We found that U.S. students reported the most frequent use of Stopping/Limiting Drinking PBS (M = 3.32, SD = 1.23) compared to Argentine (M = 2.89, SD = 0.97) and Spanish (M = 2.83, SD = 0.94) students. Argentine students reported the least frequent use of Serious Harm Reduction PBS (M = 4.57, SD = 0.99) compared to U.S. (M = 5.09, SD = 0.98) and Spanish (M = 5.03, SD = 0.78) students. Elastic net regression analyses stratified by country indicated most individual PBS predicted decreased negative alcohol-related consequences, although two items consistently predicted increased consequences and we observed some variability in the most predictive specific strategies in each country. Across each subscale and for 32 of 40 individual items, females reported more frequent use of PBS than males (ps<.05).

CONCLUSIONS

From the perspective of developing and adapting interventions, we recommend the cultural context in which PBS are used is taken into account. Although future work is needed to delineate cultural factors underlying the country-level differences we found, these findings have implications for the most promising PBS to target for college students in each country.

The intersection race/skin color and gender, smoking and excessive alcohol consumption: cross sectional analysis of the Brazilian National Health Survey, 2013

This study aims to investigate whether the intersectional identities defined by race/skin color and gender are associated with smoking and excessive consumption of alcohol in a representative sample of Brazilian adults. This is a cross-sectional study with 48,234 participants in the Brazilian National Health Survey (PNS) - 2013. Crude and adjusted odds ratios (OR) and respective 95% confidence intervals (95%CI) were used to estimate the associations of intersectional categories of race/skin color and gender (white woman, brown woman, black woman, white man, brown man, black man) with smoking and excessive consumption of alcohol, based on the combination of weekly "days" and "servings". The prevalence of smoking varied from 10.6% for white women to 23.1% for black men, while the prevalence of elevated consumption of alcohol ranged from 3.3% to 14%, respectively. In comparison to white women, only white, brown, and black men presented greater chances of smoking, reaching the OR of 2.04 (95%CI: 1.66-2.51) in black men. As to excessive consumption of alcohol, all intersectional categories showed greater chances of consumption than white women, with the greatest magnitude in black men (OR = 4.78; 95%CI: 3.66-6.23). These associations maintained statistical significance after adjustments made for sociodemographic, behavioral, and health characteristics. Results demonstrated differences in smoking habit and excessive consumption of alcohol when the intersectional categories were compared to traditional analyses. These findings reinforce the significance of including intersectionality of race/skin color and gender in epidemiological studies.

Risky Behaviours of Spanish University Students: Association with Mediterranean Diet, Sexual Attitude and Chronotype

The most common drugs that are consumed by young people are alcohol and tobacco, which are especially prevalent in universities. These risk behaviours can be determined by a series of intrinsic and extrinsic factors. The aim of this study was to evaluate the consumption of alcohol and tobacco by Spanish university students and the relationship between the Mediterranean diet, sexual attitudes and opinions, and chronotype. A multicentre observational study enrolled 457 students from two public universities in Spain. The study period was from December 2017 to January 2018. The majority of the participants consumed alcohol (90.2%), tobacco consumption was low (27.2%), with a high percentage of students (78.6%) having a low dependence on nicotine. The surveyed students demonstrated a high adherence to the Mediterranean diet, which was shown to be associated with less risky alcohol consumption. The Mediterranean diet is a part of healthy lifestyle, and avoiding heavy drinking results in the intention to maintain such a lifestyle. In addition, unhealthy eating habits (skipping breakfast, eating sweets and pastries daily, and fast-food consumption) had a tendency to induce risky alcohol consumption. Therefore, to promote healthy lifestyle habits, it is considered important to establish programs that promote healthy diets in university settings and to evaluate them periodically.

Factors associated with alcohol and tobacco consumption as a coping strategy to deal with the coronavirus disease (COVID-19) pandemic and lockdown in Spain

Aim

To provide a population-based characterization of sociodemographic and clinical risk and protective factors associated with consumption of alcohol, tobacco, or both as a coping strategy in a sample of the Spanish general population during the early phase of the COVID-19 pandemic.

Methods

Cross-sectional study based on an online snowball recruiting questionnaire. The survey consisted of an ad hoc questionnaire comprising clinical and sociodemographic information and the Spanish versions of the Depression, Anxiety, and Stress Scale (DASS-21) and the Impact of Event Scale (IES).

Results

The final sample included 21,207 individuals [mean age (SD) = 39.7 (14.0); females: 14,768 (69.6%)]. Up to 2867 (13.5%) of participants reported using alcohol, 2545 (12%) tobacco and 1384 (6.5%) both substances as a strategy to cope with the pandemic. Sex-related factors were associated with alcohol consumption as a coping strategy [female, OR = 0.600, p < 0.001]. However, education level, work status, and income played different roles depending on the substance used to cope. Having a current mental disorder was associated only with tobacco consumption as a coping strategy [OR = 1.391, p < 0.001]. Finally, sex differences were also identified.

Conclusions

Sociodemographic, clinical, and psychological factors were associated with consumption of alcohol, tobacco, or both as a coping method for the COVID-19 pandemic and lockdown. Our findings may help develop specific intervention programs reflecting sex differences, which could minimize negative long-term outcomes of substance use after this pandemic.

Relations among protective behavioral strategies, biological sex, and ADHD symptoms on alcohol use and related problems: Who benefits most, and from what type of strategy?

Attention-deficit/hyperactivity disorder (ADHD) symptoms among college students are associated with high rates of alcohol use and alcohol-related consequences. Use of protective behavioral strategies (PBS) is generally related to lower levels of alcohol use and problems; however, it is unclear how effectively students with ADHD symptoms can implement PBS, and whether certain types of PBS use may yield better outcomes. This study examined relations between PBS type and ADHD symptoms on both alcohol use and consequences, and whether these relations varied by biological sex. Participants were 875 college student drinkers from three universities who completed measures of ADHD symptoms, PBS, past-month alcohol use, and alcohol-related consequences. There were significant moderation effects of ADHD symptoms, such that the relation between PBS use and alcohol use was more pronounced for students high in inattention, and the relation between PBS use and alcohol-related consequences was more pronounced for students high in either inattention or hyperactivity/impulsivity symptoms. These relations were found for both manner of drinking and stopping/limiting drinking PBS, and they tended to be strongest for male students. There were no significant interaction effects that included serious harm reduction PBS; for all students, increased use of this type of PBS was associated with fewer problems. These results suggest that PBS are likely effective for students with ADHD symptoms. Interventions that provide explicit instruction in employing PBS, particularly related to manner of drinking and stopping/limiting drinking strategies, are recommended for students with ADHD symptoms.

ELSA 2018 Cohort: Protective Behavioral Strategies as Mediators of the Relationship between Risk Factors and Alcohol Outcomes in Argentinean College Freshmen

AIMS

The present study examined which types of alcohol protective behavioral strategies ([PBSs], Manner of Drinking [MOD] strategies, Serious Harm Reduction [SHR] or Limiting/Stopping Drinking strategies [LSD]) mediate the effects of a comprehensive number of distal antecedents on alcohol drinking quantity and alcohol-related negative consequences.

METHODS

A sample of 762 last-month college freshman drinkers from Argentina (Mean age = 19.60 ± 3.80) completed a survey that assessed alcohol outcomes (drinking quantity during a typical week and alcohol-related negative consequences), frequency of use of PBS and a set of distal antecedents (i.e. age at drinking onset, drinking motives, college alcohol beliefs and impulsivity-like traits).

RESULTS

MOD significantly mediated the effects of college alcohol beliefs (higher beliefs were associated with lower MOD use) and coping motives (higher coping motives were associated with lower MOD use) on alcohol outcomes. SHR significantly mediated the effects of sex (women reported more frequent SHR use) and enhancement motives (higher motivation was associated with lower SHR use) on alcohol-related negative consequences.

CONCLUSION

Our findings partially support a mediational role of PBS in the association between risk factors and alcohol outcomes, and offer valuable information for the design of interventions to reduce alcohol use in South-American college students. More studies examining PBS as mediators of distal antecedents are needed to fully understand the peculiarities of these associations in different cultures.