Cross-Substance Associations With Transitions in Cannabis and Nicotine Use in a Statewide Sample of Young Adults in Washington State

OBJECTIVE

Understanding transitions in nicotine and cannabis use has implications for prevention and efforts to reduce harmful use. Focusing on cross-substance associations, we examined how use of one substance was associated with year-to-year transitions in frequency of use of the other among young adults in the context of legalized nonmedical cannabis.

METHOD

A statewide sample from Washington (N = 4,039; ages 18-25 at baseline) provided up to 3 years of annual data on past-month cannabis use and nicotine use (tobacco cigarettes and e-cigarettes/vaping). Manifest Markov models examined how use of each substance was associated with transitions in the other across categories of past-month no use, occasional use (1-19 days), and frequent use (≥20 days).

RESULTS

Occasional and frequent nicotine use (vs. no use) predicted higher probability of transitioning from no cannabis use to occasional or frequent cannabis use and from occasional use to frequent use, whereas associations with cessation and de-escalation were inconsistent in direction, small in magnitude, and not statistically significant. Cannabis use positively predicted onset of nicotine use, and associations of cannabis use with escalation from occasional to frequent nicotine use, de-escalation in use, and cessation in use were small and inconsistent in direction.

CONCLUSIONS

The findings corroborate prior research on cannabis and nicotine use as risk factors to address in prevention efforts. The findings do not provide strong support for prioritization of dual abstinence in efforts to encourage reductions in or cessation of cannabis or nicotine use among young adults.

Changes in Cannabis Use From 2014 to 2019 Among Young Adults in Washington State

INTRODUCTION

Understanding changes in cannabis use in the legalized nonmedical cannabis context is critical. Washington State, one the earliest states to implement legalization, presents a unique opportunity to examine how cannabis use and its consequences changed after the implementation of legalization for adults. With a focus on Washington State young adults, this study conducted in 2022-2023 examined changes in (1) cannabis use by sex and age, (2) preferred mode of use, and (3) cannabis use disorder symptoms.

METHODS

Using repeated cross-sectional data on young adults aged 18-25 years in Washington State from 2014 (premarket opening) to 2019 (N=12,945), logistic regression models assessed trends over time in the prevalence of any and frequent (20+ days) past-month cannabis use. Among individuals reporting use, multinomial logistic regressions estimated trends over time in the preferred mode of use and negative binomial regressions examined trends in the count of cannabis use disorder symptoms.

RESULTS

From 2014 to 2019, the prevalence of cannabis use converged by sex, with females being equally likely as males to report both any and frequent use by 2019. Among young adults reporting past-month use, smoking as the preferred mode of use decreased relative to other modes. Number of cannabis use disorder symptoms reported increased, which was not accounted for by changes in preferred mode of use.

CONCLUSIONS

During the 5-year period following the implementation of legalization, patterns of young adult cannabis use shifted, including particularly sharp increases among females and increases in cannabis use disorder symptoms. Future studies should investigate underlying causes for these important changes.

Injunctive Norms and Driving Under the Influence and Riding With an Impaired Driver Among Young Adults in Washington State

PURPOSE

Alcohol- and cannabis-impaired driving behaviors remain a public health concern especially among young adults (i.e., ages 18-25). Limited updates to prevention efforts for these behaviors may be due, in part, to limited understanding of malleable psychosocial predictors. The current study assessed associations between perceived injunctive norms (i.e., acceptability) of driving under the influence of alcohol (DUI-A) and cannabis (DUI-C), and riding with a driver under the influence of alcohol (RWI-A) and cannabis (RWI-C) in Washington State young adults.

METHODS

Participants included 1,941 young adults from the 2019 cohort of the Washington Young Adult Health Survey. Weighted logistic regressions assessed the associations between peer injunctive norms and impaired driving-related behaviors.

RESULTS

A weighted total of 11.5% reported DUI-A, 12.4% DUI-C, 10.9% RWI-A, and 20.9% RWI-C at least once in the past 30 days. Overlap between the outcomes was observed, indicating some young adults had engaged in multiple impaired driving-related behaviors. After controlling for substance use frequency, weighted logistic regressions indicated more positive perceived injunctive norms were associated with nearly 2 ½ times higher odds of DUI-A, 8 times higher odds of DUI-C, 4 times higher odds of RWI-A and six and a half times higher odds of RWI-C.

DISCUSSION

Results increase the understanding of how injunctive norms-a potentially malleable psychosocial factor-are associated with four impaired driving-related outcomes. Prevention programs that focus on assessing and addressing the norms of these outcomes individually and collectively, such as normative feedback interventions and media campaigns, may be helpful in reducing these behaviors.

The association between cannabis use and risk of non-medical pain reliever misuse onset among young adults in a legal cannabis context

BACKGROUND

Little is known about the prospective relationship between cannabis use and pain reliever misuse. This study examined associations of non-medical and medical cannabis use with onset of non-medical pain reliever misuse among young adults in Washington State (WA), where non-medical cannabis is legal.

METHODS

Data were from a cohort-sequential study of adults 18-25 residing in WA. Four annual surveys were used from cohorts recruited in 2014, 2015, and 2016. Participants who had not reported non-medical pain reliever misuse at baseline were included in discrete time survival analyses (N = 4,236). Odds ratios (ORs) were estimated for new onset of non-medical pain reliever misuse in any given follow-up year over the course of three years according to baseline non-medical and medical cannabis use.

RESULTS

When included separately in models, non-medical and medical cannabis use at baseline were associated with increased risk of non-medical pain reliever misuse adjusting for demographic characteristics as well as past year cigarette use and alcohol use (non-medical OR = 5.27; 95 % CI: 3.28, 8.48; medical OR = 2.21; 95 % CI: 1.39, 3.52). Including both forms of use in the model, associations of non-medical and medical cannabis use with non-medical pain reliever misuse onset remained (non-medical OR = 4.64; 95 % CI: 2.88, 7.49; medical OR = 1.65; 95 % CI: 1.04, 2.62).

CONCLUSIONS

Despite claims that cannabis use may reduce opioid use and related harms, findings suggest that cannabis use, including medical use, may not be protective, but instead may increase risk for non-medical pain reliever misuse.

Substance-Specific Risk Factors for Cannabis and Alcohol Use Among Young Adults Following Implementation of Nonmedical Cannabis Legalization

Laws regarding cannabis are rapidly changing in the USA as more states legalize nonmedical cannabis for adults aged 21 and older. Previous research has examined whether legalization has led to an increase in cannabis use as well as the use of other substances. The current study examined changes in cannabis- and alcohol-specific risk factors following legalization of nonmedical cannabis. We used 6 years of annual cross-sectional data (2014-2019) from 12,951 young adults age 18 to 25 who resided in Washington state. Risk factors examined include perceiving that use was common among same-age peers, believing use was acceptable, having easy access, and low perceived physical and psychological harm from use. Logistic regression models estimated annual rate of increase in these risk factors. All cannabis-specific risk factors increased among those aged 21+ (range of ORs for annual rate of change: 1.07-1.31) while significant increase in cannabis-related risk factors among those under age 21 was limited to perceptions of cannabis use being common (medical use: OR=1.08, 95% CI: 1.03, 1.12; nonmedical use: OR=1.13, 95% CI: 1.08, 1.18) and low perceived physical harm of occasional use (OR=1.08, 95% CI: 1.03, 1.13). Although descriptive norms for past-year use of alcohol among those aged 21+ increased (OR = 1.09, 95% CI: 1.02, 1.17), other risk factors for alcohol did not change significantly or, in the case of low perceived physical and psychological harm, decreased among both those under age 21 and those aged 21+ (range of ORs = 0.90-0.94). Given these findings show an increase in cannabis-specific risk factors since legalization was implemented, particularly among those young adults aged 21+, preventive interventions correcting risk misperceptions and related risk factors among young adults aged 21+ may prove efficacious in reducing use and resultant negative consequences.

Injunctive and descriptive normative feedback for college drinking prevention: Is the whole greater than the sum of its parts?

OBJECTIVE

Single-component personalized normative feedback (PNF) interventions and multicomponent personalized feedback interventions (PFI) have been shown to reduce alcohol consumption among college students. The present study compared the efficacy of PNF interventions targeting descriptive norms alone (descriptive PNF), injunctive norms alone (injunctive PNF), or their combination (combined PNF), against a multicomponent PFI and an attention control condition.

METHOD

Undergraduates (N = 1,137) across two universities who reported a minimum of one past-month episode of heavy episodic drinking (i.e., 4 +/5 + drinks on a single occasion for females/males) completed assessments at baseline and 3, 6, and 12 months postintervention.

RESULTS

Relative to the attention control, participants in each of the four intervention conditions showed greater reductions in perceived descriptive/injunctive norms, total drinks per week, and alcohol-related consequences. Peak estimated blood alcohol concentration was also reduced in the injunctive PNF, combined PNF, and multicomponent PFI conditions, with the latter two conditions showing an advantage for duration of effects. The multicomponent PFI condition also evidenced greater reductions than the injunctive PNF in descriptive norms at 3-month and injunctive norms at 6- and 12-month follow-ups. No other group comparisons on any outcome were significant.

CONCLUSIONS

Each intervention has merit for use in college student harm reduction efforts. Single-component or combined PNF could be considered a potential starting point, as PNF is less burdensome than a multicomponent PFI when considering ease and length of delivery. Results can inform optimization of norms-based interventions and guide recommendations on efficacious components for reducing alcohol use and harms on college campuses. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Prom, graduation and parties: Alcohol use and normative perceptions among high school seniors during specific events

BACKGROUND

Previous research has shown that a majority of adolescents in the United States initiate and drink alcohol prior to graduating high school and nearly twenty percent of high school seniors engage in heavy episodic drinking. Despite anecdotal evidence and media portrayals of alcohol use during high school events (e.g., prom), little is understood about alcohol use surrounding specific events that may be identified as "high-risk" events and addressed in specific interventions. Similarly, normative perceptions exert powerful influence on behaviors but little is understood about normative perceptions of alcohol use at high school events.

OBJECTIVES

The purpose of the present study was to understand whether high school alcohol use is associated with specific events by describing behaviors and normative perceptions.

METHODS

Participants were 386 U.S. college students age 18 to 19 (60.4 % female, mean age = 18.4) who provided retrospective accounts of their alcohol use surrounding senior year high school events (either before, which is relevant to pregaming addressed in this special issue, during, or after).

RESULTS

Most students did not drink surrounding high school events but nearly all reported that they perceived that the typical high school senior did. Those who did drink alcohol tended to drink heavily, particularly during prom. Alcohol use was associated with other high school events ranging from the beginning of senior year (e.g., Homecoming) though the end (e.g., graduation parties) CONCLUSIONS: Results indicate the importance of future research efforts tailoring intervention efforts around specific events and the applicability of personalized normative feedback approaches.

Assessing Adolescent Vaping Norms and Perceptions in a Statewide Multi-Community Project

Background: Adolescent e-cigarette use has increased dramatically in recent years and is quickly becoming a serious public health issue. While studies have identified the influence of social norms on the use of traditional cigarettes, few have examined these factors in the context of e-cigarettes and other vaping devices. Objective: The goal of this study was to examine social norms predictors of past 30-day e-cigarette use among high school students in 10 communities located in Minnesota. Results: In our sample (N = 3,285), students who believe most students in their school vape daily are more likely to have vaped in the past 30 days than those who believe most students vape weekly or less frequently. Further, students were likely to have used e-cigarettes in the past 30 days if they perceived that most students approved of vaping (i.e., they disagreed with the statement that, "vaping is not a good thing for anyone their age to do"). Findings from this study highlight social norms related to perceptions that increase the likelihood of past 30-day e-cigarette use. Conclusions: Results from this study lend themselves to norms-based prevention science strategies that are critical to reducing e-cigarette use among high school students.

Associations Between Positive Childhood Experiences and Adult Smoking and Alcohol Use Behaviors in a Large Statewide Sample

Childhood experiences are linked to myriad indices of health and wellbeing in adulthood, including substance use behaviors. Increasingly, there has been a paradigm shift in prevention science focused on healthy outcomes of positive experiences. The current study examined associations between retrospective reports of positive childhood experiences and patterns of smoking and alcohol use in adulthood. Data were from the 2019 Montana Behavioral Risk Factor Surveillance System survey (N = 6,495; M_age = 55.9 years; 49% male as assigned at birth). Outcomes examined with regard to positive childhood experiences included lifetime smoking (> 100 cigarettes), current smoking status, and past-month alcohol use indices (i.e., total drinks, typical quantity, heavy episodic drinking, and peak drinking occasion). Positive childhood experience scores were inversely associated with both smoking outcomes (AORs = 0.66 and 0.61). Curiously, positive childhood experiences were positively associated with any past-month alcohol use (AOR = 1.12), but among respondents who did use alcohol in the past month, positive childhood experiences were inversely associated with all indices of alcohol use patterns: total drinks (CR = 0.94), drinks per occasion (CR = 0.95), heavy episodic occasions (AOR = 0.91), and peak drinking (AOR = 0.95). Findings generally indicated that positive childhood experiences may be protective against cigarette and high-risk alcohol use behaviors in adulthood. Item-by-item analyses identified specific childhood experiences that may be particularly protective, which may inform prevention efforts and policy (prevention recommendations are discussed below).

Daily level predictors of impaired driving behaviors in young adults: Protocol design for utilizing daily assessments

Background

Motor vehicle crashes remain a leading cause of death among young adults (ages 18–25) in the United States. Many drivers implicated in these crashes are under the influence of alcohol, cannabis, or the simultaneous use of alcohol and cannabis. Extremely limited research has assessed impaired driving behaviors and their predictors at the daily level. Perceived norms and motives to use substances have empirical support suggesting they may impact impaired driving-related behavior. Novel approaches to assess these associations at the daily level are needed and may inform future intervention and prevention programs.

Objective

The goal of the current study is to utilize electronic daily assessments to assess driving under the influence of alcohol, cannabis, or simultaneous use and riding with a driver impaired by these substances to assess variability and predictors of these impaired driving-related behaviors at the daily level. This present manuscript details a protocol, measures, and a plan of analyses to assess how within-person differences in perceived norms and motives to use are associated with the likelihood of engaging in impaired driving-related behaviors.

Methods

Participants include young adults in Washington State who report simultaneous use in the past month and either driving under the influence of alcohol, cannabis, or simultaneous use, or riding with a driver under the influence of both substances in the past 6 months. Individuals who verify their identity and meet eligibility requirements will complete a baseline assessment after which they will be scheduled for training on the daily assessment procedure via Zoom. Next, they will be invited to complete daily surveys on Thursday, Friday, Saturday, and Sunday every other week for 6 months and a 6-month follow up assessment. Analyses will utilize multilevel models with days nested within individuals.

Results

The study is currently recruiting participants. A total of 192 participants have been recruited and 100 have completed the study protocol. Data collection is expected to be completed in Fall 2022.

Conclusions

This study utilizes a novel design to assess impaired driving and predictors at the daily level among young adults at high risk of impaired driving-related behaviors. Findings will provide unique data that will shape the knowledge base in the field of social science and public health substance use research and that may be helpful for future prevention and intervention efforts on impaired driving.

Thirty years of BASICS: Dissemination and implementation progress and challenges

The first clinical trial of the Brief Alcohol Screening and Intervention for College Students (BASICS) was launched at the University of Washington in 1990. Since that time, multiple trials have demonstrated the efficacy of BASICS and related approaches in a variety of young adult populations and this information has been widely disseminated. However, in practice BASICS implementation varies considerably, including formats and mediums (e.g., group, telehealth, written/electronic feedback alone) not studied in the original research. Even if delivered in an individual in-person format, implementation can stray substantially from the original design. Adaptations may be necessary to address campus resource constraints or other barriers to implementation but can have unknown impacts on intervention effectiveness. Thus, despite wide-scale efforts to disseminate and implement BASICS, challenges remain, and there are several critical research gaps that need to be addressed to support campuses in implementing BASICS successfully. The current manuscript reviews several ways in which BASICS has been adapted to address these challenges, and provides recommendations for best implementation practices as well as future research needed to improve implementation and effectiveness of BASICS going forward. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Cannabis Use Among Young Adults in Washington State After Legalization of Nonmedical Cannabis

Objectives. To examine changes in prevalence of cannabis use and of cannabis use disorder symptomatology among young adults from 2014 to 2019 in Washington State, where nonmedical (or "recreational") cannabis was legalized in 2012 and retail stores opened in July 2014. Methods. We used 6 years of cross-sectional data collected annually from 2014 (premarket opening) to 2019 from 12 963 (∼2000 per year) young adults aged 18 to 25 years residing in Washington. Logistic regression models estimated yearly change in prevalence of cannabis use at different margins and related outcomes. Results. Prevalence of past-year, at least monthly, at least weekly, and daily use of cannabis increased for young adults, although increases were driven by changes among those aged 21 to 25 years. There was also a statistically significant increase in prevalence of endorsing at least 2 of 5 possible symptoms associated with cannabis use disorder. Conclusions. Among young adults in Washington, particularly those of legal age, prevalences of cannabis use and cannabis use disorder symptomatology have increased since legalization. This trend may require continued monitoring as the nonmedical cannabis market continues to evolve. (Am J Public Health. 2022;112(4):638-645. https://doi.org/10.2105/AJPH.2021.306641).

Behavioral Willingness, Descriptive Normative Perceptions, and Prescription Stimulant Misuse among Young Adults 18-20

Objective: It is critical to gain further understanding of etiologic factors, such as descriptive normative perceptions and behavioral willingness, that are associated with prescription stimulant misuse (PSM) among young adults. Our primary hypotheses were that descriptive normative perceptions for PSM (i.e., perceptions of how much and how often others engage in PSM) and perceived peer willingness (i.e., perceptions of how open others are to PSM under certain circumstances) would be positively associated with higher willingness to engage in PSM, which in turn would account for significant shared variance with self-reported PSM. Method: Data were collected from a U.S. sample of 18-20-year-olds (N = 1,065; 54.5% females; 70.5% White) recruited for a larger study on alcohol-related risky sexual behavior. Results: Findings indicated higher descriptive normative perceptions and higher perceived peer willingness were associated with higher participants' willingness to engage in PSM. Participants' own willingness was positively associated with PSM. Finally, participants' own willingness to use, descriptive normative perceptions, and perceived peer willingness were associated with higher willingness to engage in PSM, which accounted for significant shared variance with self-reported PSM. Conclusions: Findings suggest the potential utility of personalized feedback interventions for PSM that focus on constructs such as descriptive normative perceptions and behavioral willingness.

Brief Alcohol Screening and Intervention for Community College Students (BASICCS): Feasibility and preliminary efficacy of web-conferencing BASICCS and supporting automated text messages

Objective: The Brief Alcohol Screening and Intervention for College Students (BASICS; Dimeff et al., 1999) is an evidence-based approach to reduce high-risk drinking and associated harms; however, implementation may present challenges for community colleges (CCs) that have limited budgets and mostly non-residential students. We examined feasibility, acceptability, and efficacy of BASICS for CC students (BASICCS) delivered remotely via web-conferencing with supporting automated text messages. Method: Participants included 142 CC students who reported exceeding National Institute on Alcohol Abuse and Alcoholism (NIAAA's) weekly low-risk drinking recommendations and/or heavy episodic drinking (HED). Participants were randomized to BASICCS or assessment-only control (AOC) and completed 1- and 3-month follow-up assessments. Results: Most students liked the personalized information in the program and found the web-conferencing platform useful, however intervention completion rate was 56%. Significant differences were found between BASICCS and AOC. At 1-month, individuals in BASICCS had 33% fewer alcohol consequences than those in AOC. At 3-month follow-up, individuals in BASICCS had lower estimated peak blood alcohol concentration, 29% fewer drinks per week, 62% fewer episodes of HED, and 24% fewer consequences than those in AOC. Conclusions: BASICCS showed evidence of being acceptable and the technology proved feasible, although the intervention completion rate in the non-treatment-seeking volunteer sample was modest. Preliminary evidence does suggest BASICCS shows promise in reducing alcohol use and consequences. Technology-based platforms could be a viable prevention solution for CC students. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Changes in college student alcohol use during the COVID-19 pandemic: Are perceived drinking norms still relevant?

With widespread concern for increased alcohol use during the COVID-19 pandemic, there is a pressing need to examine changes in young adults' alcohol use and to identify antecedents of increased use. We tested the hypothesis that self-reported changes in alcohol use during the pandemic (frequency, quantity, heavy episodic drinking) would relate to perceptions of peers' changes in alcohol use. In April of 2020, 507 college students self-reported changes in their alcohol use and perceived changes in use for typical students at their university (i.e., norms). Most students in our sample reported decreased alcohol use and perceived decreases in peers' alcohol use. Perceptions of peers' changes in alcohol use behavior strongly related to changes in students' own alcohol use. Findings provide strong support for norms-based strategies that can correct normative misperceptions by highlighting the fact that most college students are not in fact engaging in heavier alcohol use during the COVID-19 pandemic.

Daily-level effects of alcohol, marijuana, and simultaneous use on young adults' perceived sleep health

STUDY OBJECTIVES

Simultaneous alcohol and marijuana (SAM) use is increasingly prevalent among young adults but has adverse health consequences. The current study examined daily-level associations between perceived sleep health and SAM use, relative to non-substance-use days and alcohol- or marijuana-only days. We also estimated linear associations between alcohol/marijuana use and perceived sleep health and explored whether effects were moderated by combined use of alcohol and marijuana.

METHODS

A community sample of SAM-using young adults (N=409; Mage=21.61, SD=2.17; 50.9% female; 48.2% White; 48.9% college students) completed twice-daily surveys for five 14-day sampling bursts. Daily measurements assessed substance use and perceived sleep health in terms of subjective sleep quality, negative impact of sleep on functioning, and symptoms of insomnia.

RESULTS

Multilevel models indicated that, relative to non-substance-use days, participants reported poorer perceived sleep health on alcohol-only days, better perceived sleep health on marijuana-only days, and mixed evidence regarding SAM use (i.e., fewer perceived symptoms of insomnia, but poorer perceived next day functioning attributed to sleep). Daily-level estimates showed increased alcohol use was associated with poorer perceived sleep health, while stronger effects from marijuana were associated with better perceived sleep health. Across all indices of sleep health, only one linear association was moderated by combined use: The adverse association between alcohol and next day functioning was weaker on days alcohol was combined with marijuana.

CONCLUSIONS

Findings provide additional evidence for daily-level effects of alcohol and marijuana use on perceived sleep health and address an important literature gap regarding potential adverse effects of SAM use.

An International Comparison of a Web-Based Personalized Feedback Intervention for Alcohol use During the Transition out of High School in the United States and Sweden

Young adult drinkers engage in a range of drinking patterns from abstaining to heavy drinking in both the United States and Sweden. Heavy drinking during young adulthood in both countries is associated with a variety of negative consequences. Personalized feedback interventions have been identified as effective prevention strategies to prevent or reduce heavy drinking in the United States. This study examined transitions in drinking profiles and compared the efficacy of a personalized feedback intervention for 3965 young adults in the United States (1,735) and Sweden (2230) during their transition out of high school. Using goodness-of-fit criteria, results indicated that three drinking profiles exist among young adults transitioning out of high school: very low drinkers/abstainers, moderate to heavy drinkers, and very heavy drinkers. Latent Markov models revealed a moderating effect of country on personalized feedback intervention such that intervention condition participants in the United States were more likely to belong to the light drinker/abstainer or moderate to heavy profile relative to the very heavy drinking profile at 6-month follow-up. There was no significant effect of personalized feedback intervention in Sweden. Future research could investigate the impact of when personalized feedback interventions are administered and could examine if personalized feedback interventions should be more intentionally culturally adapted in order to be more effective.

Patterns, Consequences, and Motives in Simultaneous Use of Prescription Stimulant Medication with Alcohol and Marijuana

Nonmedical use of prescription stimulants (NPS) continues to be a concern on college campuses. Previous research demonstrates a strong link between NPS and use of other substances, particularly alcohol and marijuana among college students. Simultaneous use of NPS with other substances has become an increasing concern. Given the high rates of NPS and simultaneous NPS with other substances, research examining substance use patterns and motives among students is warranted. Method: This study evaluated group differences in alcohol and marijuana use patterns, consequences, and motives among college students: a) with no NPS history (No NPS); b) engaged in NPS with no simultaneous use (Non-Sim NPS); and c) engaged in simultaneous NPS with alcohol and/or marijuana (Sim NPS). Participants included 1,108 students from three universities who reported past-year marijuana and alcohol use. Results: Overall, 32.8% reported lifetime NPS with 12.5% indicating NPS in the previous 3 months, of which 51.1% reported simultaneous NPS with alcohol and 40.2% with marijuana. Significant group differences for all drinking and marijuana outcomes were found, with heaviest rates among the Sim NPS group, followed by the Non-Sim NPS group, and the No NPS group. The Sim NPS group reported greater motives for using marijuana to alter the effects of other substances. Conclusions: College students engaged in simultaneous NPS with alcohol and marijuana are a high-risk group that should be the focus of prevention and intervention programs in the campus setting.

Nonmedical Use of Prescription Stimulants as a "Red Flag" for Other Substance Use

BACKGROUND

Nonmedical use of prescription stimulants (NMPS) has increased on college campuses during the past two decades. NMPS is primarily driven by academic enhancement motives, and normative misperceptions exist as well. However, large, nationwide studies have not yet been conducted to generalize findings more broadly and gain a deeper understanding of the relationship between NMPS and other substance use (e.g. alcohol use, marijuana, etc.). The present study was conducted to lay the foundation for prevention efforts related to NMPS by establishing NMPS prevalence, practices surrounding NMPS, and other substance use.

METHODS

N = 2,989 students from seven universities around the U.S. completed a web-based survey assessing NMPS practices and related behaviors. Prevalence and factors associated with NMPS were explored.

RESULTS

Analyses revealed a 17% past-year prevalence of NMPS with associated widespread misperceptions of peer use. NMPS was significantly related to alcohol use, binge drinking, and marijuana use, as well as skipped classes and affiliation with Greek life.

CONCLUSIONS

Although most college students do not report NMPS, those who do also are more likely to report alcohol use, binge drinking, and marijuana use, and NMPS could be a "red flag" for other risk behaviors worth exploring. Implications for prevention and intervention are discussed.

Social (Un)distancing: Teammate Interactions, Athletic Identity, and Mental Health of Student-Athletes During the COVID-19 Pandemic

PURPOSE

Physical distancing measures to combat the spread of the novel coronavirus have presented challenges for the mental health and well-being of college students. As campus activities ceased, student-athletes abruptly became isolated from teammates and were no longer able to participate in sport activities that are often central to their identity as an athlete. However, student-athletes who have supportive social connections with teammates during this pandemic may maintain their athletic identity to a greater extent and report better mental health. The present study examined how student-athletes' mental health was associated with teammate social support, connectedness, and changes to athletic identity from before to during COVID-19.

METHOD

A sample of 234 student-athletes completed surveys before COVID-19 physical distancing (February 2020), with 135 (63% female) participating in a follow-up in the month following school closures (April 2020). Path models estimated the effects of teammate social support and connectedness (during COVID-19), as well as changes in athletic identity on indices of mental health.

RESULTS

Considering all path models tested, student-athletes who received more social support and reported more connectedness with teammates reported less dissolution of their athletic identity and-in most models-reported better mental health and well-being. Indirect effects indicated that student-athletes' change in athletic identity mediated the effects of teammate social support on psychological well-being and depression symptoms.

CONCLUSIONS

In addition to advancing theory on how small groups relate to mental health, these findings demonstrate the value in remaining socially connected with peers and maintaining role identities during the COVID-19 pandemic.

Simultaneous Alcohol and Marijuana Use Among College Students: Patterns, Correlates, Norms, and Consequences

BACKGROUND

Alcohol and marijuana users often engage in simultaneous alcohol and marijuana (SAM) use (i.e., using the 2 substances together so that their effects overlap), which can result in more negative consequences than using either substance alone. Nevertheless, little is known about SAM use among contemporary college students to aid in the development of preventive interventions. This study examined SAM use patterns, demographic correlates of SAM use, and normative influences on SAM use and related negative consequences among college students.

METHODS

Students who had used alcohol and marijuana in the past year were recruited from 3 state universities in states with different laws regarding recreational marijuana use (N = 1,389). They completed an online survey, which assessed their own alcohol, marijuana, and SAM use and related consequences, their perceptions of the proportion of same-gender peers and close friends who engaged in SAM use, marijuana access, and demographic characteristics.

RESULTS

About three-fourths of participants reported at least 1 occasion of SAM use in the past year with an average frequency of twice per month among SAM users. There were significant differences in SAM use prevalence and frequency by sociodemographic characteristics controlling for past-year alcohol and marijuana frequency. Students in a state with decriminalized recreational marijuana use reported higher frequency of past-year SAM use than students in states with legalized or criminalized use. There were significant demographic differences in perceived norms regarding SAM use among close friends and same-gender peers. SAM users endorsed significantly higher perceived peer and friend norms than nonusers. Also, higher perceived norms predicted more frequent SAM use and more negative consequences of use.

CONCLUSIONS

Results indicate a need for prevention programs on college campuses that address SAM use. Interventions that use personalized normative feedback may be effective.

Developing Text Messages to Reduce Community College Student Alcohol Use

Objectives The aim of this study is to evaluate how community college students with hazardous drinking perceived the usefulness of alcohol protective behavioral strategy text messages (TM-PBS). Methods Community college students with past hazardous single occasion or weekly drinking (N = 48; 60% female) were randomized to receive 2 TM-PBS on 3 typical drinking days per week for 2 weeks selected by: (1) research investigators (ie, based on clinical and theoretical application); (2) participants (ie, messages highly rated at baseline by the participants); or (3) a random process. Prior to 2 typical drinking days per week, immediately after receiving TMs, we asked: "How useful do you think this strategy will be for you when you drink? Text a number from 1 (not useful) to 5 (very useful)." Results Response rates for the 12 messages ranged from 72.9% to 87.5%, with no differences in response rates across selection categories (ie, investigator, participant, random). Investigator-selected messages were rated as less useful than messages that were self-selected by participants or messages that were selected at random. Conclusions TM-PBS chosen a priori by students were perceived as more useful than TM-PBS chosen by investigators, supporting this form of tailoring in alcohol interventions to optimize usefulness.

Crossover Effects of Protective Behavioural Strategies for Drinking on Gambling Consequences Among College Gamblers with Alcohol or Drug Abuse

Protective behavioural strategies (PBS) for drinking are behaviours that individuals engage in to reduce the amount they drink and drinking-related consequences. To date, little is known about associations that PBS might have with other risky behaviours that frequently coincide with drinking, such as gambling. The goal of this study was to examine the associations between three subscales of the Protective Behavioral Strategies Scale (PBSS) and gambling consequences in a college sample of gamblers who also met criteria for alcohol or drug abuse. We hypothesized that engaging in more drinking PBS would be associated with lower levels of gambling consequences. A sample of 316 students (55% female) completed an online survey and met criteria for problematic gambling behaviour (3 or more on the South Oaks Gambling Screen and 1 or more consequences on the Gambling Problem Index). Those endorsing a higher score on the Serious Harm Reduction subscale (but not the Stopping or Limiting Drinking or Manner of Drinking subscales) showed a lower level of lifetime gambling consequences, suggesting a crossover effect. Strategies to reduce serious harm represent a treatment target that could potentially reduce negative consequences associated with both drinking and gambling.

Crossover Effects of Protective Behavioural Strategies for Drinking on Gambling Consequences Among College Gamblers With Alcohol or Drug Abuse

Protective behavioural strategies (PBS) for drinking are behaviours that individuals engage in to reduce the amount they drink and drinking-related consequences. To date, little is known about associations that PBS might have with other risky behaviours that frequently coincide with drinking, such as gambling. The goal of this study was to examine the associations between three subscales of the Protective Behavioral Strategies Scale (PBSS) and gambling consequences in a college sample of gamblers who also met criteria for alcohol or drug abuse. We hypothesized that engaging in more drinking PBS would be associated with lower levels of gambling consequences. A sample of 316 students (55% female) completed an online survey and met criteria for problematic gambling behaviour (3 or more on the South Oaks Gambling Screen and 1 or more consequences on the Gambling Problem Index). Those endorsing a higher score on the Serious Harm Reduction subscale (but not the Stopping or Limiting Drinking or Manner of Drinking subscales) showed a lower level of lifetime gambling consequences, suggesting a crossover effect. Strategies to reduce serious harm represent a treatment target that could potentially reduce negative consequences associated with both drinking and gambling.Résumé Les personnes aux prises avec des problèmes d’abus d’alcool adoptent des stratégies comportementales de protection pour réduire leur consommation et ses conséquences. À ce jour, on sait peu de choses sur les possibles associations entre ces comportements et d’autres comportements à risque qui coïncident souvent avec l’abus d’alcool, comme le jeu. L’objectif de cette étude était d’examiner les associations entre trois sous-échelles de stratégies comportementales et les conséquences du jeu à l’aide d’un échantillon de joueurs universitaires qui répondaient également aux critères de consommation abusive d’alcool/de drogue. On a émis l’hypothèse que le fait d’adopter des stratégies comportementales à l’égard de la consommation d’alcool diminuerait l’importance des conséquences relatives au jeu. Un échantillon de 316 étudiants sondés en ligne (55 % de femmes) a répondu aux critères de comportement de jeu problématique (3 critères ou plus sur le South Oaks Gambling Screen [SOGC] et une ou plusieurs conséquences sur l’Indice de jeu excessif [PGSI]). Les personnes qui entrent dans des sous-échelles de réduction importante des méfaits (mais pas les sous-échelles d’arrêt ou de limitation de consommation ou de mode de consommation) ont montré, au fil du temps, une diminution des effets du jeu, ce qui laisse croire à un certain effet de croisement. On aborde dans cet article la portée de cette analyse sur la prévention et l’intervention.

NIAAA's College Alcohol Intervention Matrix

The College Alcohol Intervention Matrix (CollegeAIM) is a user-friendly, interactive decision tool based on a synthesis of the substantial and growing literature on campus alcohol use prevention. It includes strategies targeted at both the individual and environmental levels. Commissioned by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), CollegeAIM reflects the collective knowledge of 16 separate experts in the field, which makes it unique relative to other summaries of the science. CollegeAIM is designed to help college stakeholders compare and contrast different evidence-based prevention strategies to select a mix of individual and environmental strategies that will work best on and around their campuses. CollegeAIM is a living document, which will be updated to keep pace with the science. Colleges are therefore encouraged to ensure that evaluations of individual- or environmental-focused strategies on their campuses or in their communities make it into the published literature.

Perceived academic benefit is associated with nonmedical prescription stimulant use among college students

INTRODUCTION

College students are at higher than average risk for nonmedical use of prescription stimulants (NPS). A commonly identified motive among students who engage in NPS is to improve grades. Several research studies have observed that NPS most likely does not confer an academic advantage, and is associated with excessive drinking and other drug use. This study documents the proportion of the general college student population who believe that NPS will lead to improvements in academic performance.

METHODS

This study gathered online survey data from a large, demographically diverse sample of college students to document the prevalence of perceived academic benefit of NPS for improving grades and to examine the association between such belief and NPS.

RESULTS

Overall, 28.6% agreed or strongly agreed that NPS could help students earn higher grades, and an additional 38.0% were unsure. Students with a higher level of perceived academic benefit of NPS and more frequent patterns of drinking and marijuana use were more likely to engage in NPS, even after adjustment for a wide range of covariates.

CONCLUSIONS

The results underscore the need for interventions that simultaneously correct misperceptions related to academic benefit and target alcohol and marijuana use to reduce NPS.

Do college students improve their grades by using prescription stimulants nonmedically?

INTRODUCTION

Many college students engage in nonmedical use of prescription stimulants (NPS) because they believe it provides academic benefits, but studies are lacking to support or refute this belief.

METHODS

Using a longitudinal design, 898 undergraduates who did not have an ADHD diagnosis were studied. Year 3 GPA (from college records) of four groups was compared: Abstainers (did not engage in NPS either year; 68.8%); Initiators (NPS in Year 3 but not Year 2; 8.7%); Desisters (NPS in Year 2 but not Year 3; 5.8%); and Persisters (NPS in both years; 16.7%). Generalized estimating equations regression was used to estimate the association between NPS and change in GPA, controlling for sex and Year 2 GPA.

RESULTS

GPA increased significantly within Abstainers (p<0.05), but did not change significantly within the other groups. Overall, the relationship between NPS pattern group and change in GPA was not statistically significant (p=0.081). NPS was generally infrequent, but Persisters used more frequently than Desisters (11.7 versus 3.4days in Year 2) and Initiators (13.6 versus 4.0days in Year 3, both ps<0.001), controlling for sex and Year 2 GPA.

CONCLUSIONS

We cannot rule out the possibility that NPS prevented declines in GPA, but we can conclude that students who engaged in NPS showed no increases in their GPAs and gained no detectable advantages over their peers. The results suggest that prevention and intervention strategies should emphasize that the promise of academic benefits from NPS is likely illusory.

College Student Drug Prevention: A Review of Individually-Oriented Prevention Strategies

The current paper highlights the college years as a risk period for development, continuation, and escalation of illicit substance use and substance use disorders and reviews the literature related to the prevention and treatment of these disorders in college populations. Despite widespread implementation of college drug prevention programs, a review of the literature reveals few controlled trials targeting this population. However, alcohol prevention has been extensively studied, and many efficacious interventions for college drinking share theoretical and methodological underpinnings with interventions shown to be efficacious in drug prevention and treatment with other populations (i.e., school-based prevention, adolescent and adult drug treatment). These interventions could be adapted to target drug prevention on college campuses. Barriers to implementation and evaluation of these interventions on campus are discussed, and suggestions are made for future research and programmatic directions.

Drinking norms, readiness to change, and gender as moderators of a combined alcohol intervention for first-year college students

INTRODUCTION

Alcohol interventions targeting college students and their parents have been shown to be efficacious. Little research has examined moderators of intervention efficacy to help tailor interventions for subgroups of students.

METHOD

This study is a secondary data analysis of readiness to change, drinking norms, and gender as moderators of an efficacious peer- and parent-based intervention (Turrisi et al., 2009). Students (n=680) were randomized to the combined peer and parent intervention (n=342) or assessment-only control (n=338).

RESULTS

The combined intervention reduced peak blood alcohol content (BAC) compared to control. Gender and norms did not moderate the relationship between the intervention and drinking. Significant interactions were found between gender, precontemplation, and intervention. Students in the combined condition with higher precontemplation had lower weekly drinking compared to those with lower precontemplation. This pattern was also found among men for peak BAC and alcohol-related consequences but not among women, indicating a three-way interaction.

CONCLUSION

Interventions may need to consider readiness to change and gender to optimize effectiveness.

Impacts of Changing Marijuana Policies on Alcohol Use in the United States

BACKGROUND

Marijuana policies are rapidly evolving. In the United States, recreational use of marijuana is now legal in 4 states and medical marijuana is legal in 23 states. Research evaluating such policies has focused primarily on how policies affect issues of price, access to, use, and consequences of marijuana. Due to potential spillover effects, researchers also need to examine how marijuana policies may impact use and consequences of alcohol.

METHODS

The current paper is a critical review of articles evaluating alcohol outcomes associated with marijuana decriminalization, medical marijuana legalization, and nonmedical or recreational marijuana legalization. We identified articles and reports through (1) online searches of EBSCO host database including Academic Search Premier, Econlit, Legal Collection, Medline, PsycARTICLES, and PsycINFO, as well as PubMed and Google Scholar databases; (2) review of additional articles cited in papers identified through electronic searches; and (3) targeted searches of state and local government records regarding marijuana law implementation. We reviewed studies with respect to their data sources and sample characteristics, methodology, and the margin of alcohol and marijuana use, timing of policy change, and the aspects of laws examined.

RESULTS

The extant literature provides some evidence for both substitution (i.e., more liberal marijuana policies related to less alcohol use as marijuana becomes a substitute) and complementary (i.e., more liberal marijuana policies related to increases in both marijuana and alcohol use) relationships in the context of liberalization of marijuana policies in the United States.

CONCLUSIONS

Impact of more liberal marijuana policies on alcohol use is complex, and likely depends on specific aspects of policy implementation, including how long the policy has been in place. Furthermore, evaluation of marijuana policy effects on alcohol use may be sensitive to the age group studied and the margin of alcohol use examined. Design of policy evaluation research requires careful consideration of these issues.

The impact of defensiveness and incident reactions on post-sanction drinking behaviors among mandated students

INTRODUCTION

Prior studies with mandated students (students referred for an intervention following violation of a campus alcohol policy) have suggested that decreases in drinking behaviors may occur before clinical intervention. Others studies have suggested that greater reductions were associated with lower defensiveness and stronger incident reactions, such as responsibility and aversiveness. The current study sought to integrate these findings and examine the influence of pre-sanction drinking and perceptions on mandated students' post-sanction drinking levels prior to attending a brief intervention.

METHODS

Data were collected as part of a longitudinal study of brief interventions in a mandated student sample (N=61, 43% female, 97% White). Participants completed demographic measures, scales measuring incident reactions and defensiveness, and a Time Line Follow Back assessing drinking quantity and frequency both pre- and post-sanction.

RESULTS

Analyses revealed significant post-sanction decreases in quantity (average total drinks per month) and frequency (number of monthly drinking days). Pre-sanction drinking quantity and frequency significantly predicted post-sanction quantity and frequency, respectively. Interaction effects suggest higher post-sanction quantities among moderate and heavier drinkers with higher defensiveness and lower aversiveness perceptions, while perceptions did not influence outcomes among light drinkers. None of the interactions involving blame or responsibility, or predicting post-sanction frequency, were significant.

CONCLUSIONS

These findings suggest a complex relationship between pre-sanction drinking and student reactions. Implications for mandated student interactions and future research directions are discussed.

College Students' Perceptions of Depressed Mood: Exploring Accuracy and Associations

College is a time of high risk for depressed mood. Theories about depression (i.e. Cognitive Theory and Depressive Realism theory) are well researched, but suggest different venues of understanding the cognitive underpinnings of mood. In addition, much research is available about normative perceptions around substance use and how those perceptions relate to behaviors. However, there are no studies examining normative perceptions around depressed mood nor how these perceptions may relate to students' own well-being. Undergraduates (N=1577) ages 18-24 responded to an online survey as part of a larger study on drinking and depressed mood. The survey assessed symptoms of depression and feelings of sadness, depression and suicidal ideation experienced in the past 2 weeks, as well as students' perceptions of the prevalence of these feelings among other students. Rates of sadness and depression reported in the sample were relatively high; whereas rates of reported suicidal ideation were low. Most students under-estimated the prevalence of sadness and depression experienced by other students; a finding that was especially true for male students. Conversely, most students over-estimated the prevalence of suicidal ideation. Students who reported experiencing a given feeling in the past two weeks perceived greater rates of the feeling among other students. Depression symptoms were associated with both greater perceived prevalence of sadness, depression and suicidal ideation, as well as correct and over-estimates of the prevalence of sadness and depression. Implications for future directions in prevention and interventions efforts are discussed.

"Seems I'm not alone at being alone:" contributing factors and interventions for drinking games in the college setting

Alcohol use among college students is prevalent and sometimes takes the form of drinking games, in which players are required to drink in accordance with a set of pre-defined rules. Drinking games are typically associated with elevated alcohol consumption and risk to the individual. This perspective piece considers the potential role of social anxiety in motivating participation in drinking games, perceived norms surrounding drinking games (including ways they are portrayed and discussed in popular media), and the role of competitiveness. Implications for skills training-based prevention and intervention efforts are discussed.

Normative perceptions of non-medical stimulant use: associations with actual use and hazardous drinking

Approximately 10% of US college students are engaged in non-medical use of prescription stimulants (NMUPS) and that use is linked to concerning health, educational, and societal consequences. Few studies have assessed normative perceptions surrounding NMUPS. Accordingly, we examined self-reported use and normative perceptions for NMUPS and demographic factors that may be associated with them. We also investigated whether higher normative perceptions for NMUPS were related to the most commonly used and abused substance among college students (alcohol).

METHOD

1106 undergraduates participated in an online survey of normative perceptions of NMUPS and students' own drinking and stimulant use habits.

RESULTS

Students overestimated NMUPS by other students and those normative estimates were associated with higher NMUPS. Living in a fraternity or sorority was related to higher NMUPS and perceived norms. Finally, higher normative perceptions of NMUPS were associated with higher hazardous drinking.

CONCLUSION

The large discrepancy between actual use (generally low) and students' perceptions (generally high), and the relationship of these perceptions to both one's own use of NMUPS and alcohol suggests that interventions aimed at correcting norms may be useful.

Alcohol interventions for mandated students: behavioral outcomes from a randomized controlled pilot study

OBJECTIVE

This study investigated the effectiveness of three single-session interventions with high-risk mandated students while considering the influence of motivational interviewing (MI) microskills.

METHOD

This randomized, controlled pilot trial evaluated single-session interventions: Alcohol Skills Training Program (ASTP), Brief Alcohol Screening and Intervention for College Students (BASICS) feedback sessions, and treatment-as-usual Alcohol Diversion Program (ADP) educational groups. Participants were 61 full-time undergraduates at a southern U.S. campus sanctioned to a clinical program following violation of an on-campus alcohol policy (Mage = 19.16 years; 42.6% female).

RESULTS

RESULTS revealed a significant effect of time for reductions in estimated blood alcohol concentration (eBAC) and number of weekly drinks but not in alcohol-related consequences. Although ASTP and BASICS participants reported significant decreases in eBAC over time, ADP participant levels did not change (with no intervention effects on quantity or consequences). MI microskills were not related to outcomes.

CONCLUSIONS

RESULTS from this study suggest equivalent behavioral impacts for the MI-based interventions, although individual differences in outcome trajectories suggest that research is needed to further customize mandated interventions. Given the overall decrease in eBAC following the sanction, the lack of reduction in the ADP condition warrants caution when using education-only interventions.

Change IS Possible: Reducing High-Risk Drinking Using a Collaborative Improvement Model

OBJECTIVE

To describe the adoption of public health and improvement methodologies to address college students' high-risk drinking behaviors and to aid in prevention efforts.

PARTICIPANTS

Members of 32 colleges and universities, content experts, and staff members of the National College Health Improvement Program (NCHIP).

METHODS

A 2-year learning collaborative developed by NCHIP trained individuals from 32 different college and universities in using the Plan-Do-Study-Act cycle as a method to create and implement initiatives aimed at reducing students' high-risk drinking behaviors and related harms.

RESULTS

Participants experienced success ranging from noteworthy increases in type and amount of interventions directed at reducing high-risk drinking, to creating collaboratives across campus, the local community, and stakeholders. Challenges related to data collection and creating lasting cultural change remain.

CONCLUSIONS

The use of quality improvement methodologies and creation of a national collaborative successfully effected meaningful change in high-risk drinking behaviors on college campuses.

Use of drinking protective behavioral strategies and sexual perceptions and behaviors in U.S. college students

Alcohol use among college students is linked to an increased likelihood of engaging in risky sexual behaviors, including casual sex and unprotected sex. These behaviors increase college students' risks for negative social and health-related consequences. This study examined the relationship between drinking behaviors and protective behavioral strategies (PBS), expectancies and perceptions of sexual risk, and actual alcohol-related sexual behaviors and consequences. Sexually active college students completed Web-based self-report measures of drinking behaviors and use of PBS, alcohol expectancies and perceptions of risk, and sexual behaviors and related consequences (n = 524; 57.1% women). Findings indicated that PBS were related to lower expectancies of sexual risk and sexual disinhibition, and among lighter drinkers, lower expectancies of sexual enhancement from alcohol. PBS were also related to decreased perceptions of sexual-related risks, some alcohol-related sexual behaviors, including number of drinks before/during sex, and number of sexual consequences, but were not related to abstaining during sex, frequency of alcohol-related sexual behaviors, or general condom use. These findings demonstrate a disconnect between perceived and actual risks among college students, such that decreased perceptions of risk may not be associated with protective behaviors. Prevention and intervention implications are discussed.

Randomized controlled trial of a Spring Break intervention to reduce high-risk drinking

OBJECTIVE

Although recent studies have documented high-risk drinking occurring during Spring Break (SB), particularly on SB trips with friends, published intervention studies are few. In the present study, we evaluated the efficacy of event specific prevention strategies for reducing SB drinking among college students, compared to general prevention strategies and an assessment-only control group, as well as evaluated inclusion of peers in interventions and mode of intervention delivery (in-person vs. web).

METHOD

Participants included 783 undergraduates (56.1% women; average age = 20.5 years) intending to go on a SB trip with friends as well as to drink heavily on at least 1 day of SB. Participants completed assessments prior to SB and were randomized to 1 of 5 intervention conditions: SB in-person Brief Alcohol Screening and Intervention for College Students (BASICS; Dimeff, Baer, Kivlahan, & Marlatt, 1999), SB web BASICS, SB in-person BASICS with friend, SB web BASICS with friend, general BASICS, or an attention control condition. Follow-up assessment was completed 1 week after SB.

RESULTS

Although the SB web BASICS (with and without friends) and general BASICS interventions were not effective at reducing SB drinking, results indicated significant intervention effects for SB in-person BASICS in reducing SB drinking, particularly on trip days. Follow-up analyses indicated that change in descriptive norms mediated treatment effect and reductions in drinking, whereas SB drinking intentions and positive expectancies did not.

CONCLUSIONS

Overall, results suggest that an in-person SB-specific intervention is effective at reducing SB drinking, especially during trips. In contrast, interventions that contain non-SB-related content, are web-based, or seek to involve friends may be less effective at reducing SB drinking.

Electronic Feedback in College Student Drinking Prevention and Intervention

Alcohol consumption is prevalent among college students and can be associated with serious negative consequences. Several efficacious programs using one-on-one brief intervention techniques have been developed to target high-risk drinking by individual students, such as the Brief Alcohol Screening and Intervention for College Students (BASICS) (Dimeff et al. 1999). To reach a larger population (e.g., the incoming freshman class), researchers have adapted these interventions so that students can access them via the Internet or in some other electronic format.The purpose of this review is to discuss specific alcohol intervention programs that were (1) designed to be delivered remotely (e.g., via the Web or on an electronic device) without interaction with a provider and (2) were tested among college students using a randomized controlled trial design. Specific studies were drawn from earlier reviews as well as a comprehensive literature search. Although many programs have limited research support, and some findings are mixed, components that were directly translated from in-person BASICS to remote-delivery mediums (i.e., personalized feedback interventions [PFIs], personalized normative feedback [PNF] interventions), and broader programs that incorporate PFI/ PNF, show promise in reducing alcohol use and/or negative consequences. However, more research is needed and suggestions for how the field can move these interventions forward are discussed.

Social identity as a moderator of the association between perceived norms and marijuana use

OBJECTIVE

This study extends previous examinations of social influences and marijuana use in considering how heavy marijuana users view themselves relative to their peers. We were specifically interested in evaluating whether (a) heavy-using marijuana users would identify more strongly with other users than with typical students, (b) identification with other marijuana users would be more strongly associated with own use, and (c) the association between perceived norms and marijuana use would be moderated by identification with peers.

METHOD

Participants were 107 heavy (five or more times per month) marijuana users who completed an online survey assessing perceived norms for marijuana use, identification with typical students and other marijuana-using students, and marijuana use (frequency of use, joints per week, and hours high).

RESULTS

Participants unexpectedly identified more strongly with typical students rather than with other marijuana-using students. Identification with other marijuana users was, however, associated with more use. In addition, perceived norms were associated with more use but primarily among those who identified more with other users but not with typical students.

CONCLUSIONS

Heavy marijuana users may be reluctant to identify themselves as users and may prefer to think of themselves as typical students. This may provide clinical opportunities to highlight discrepancies. In addition, identification with other users and lack of identification with typical students may be risk factors for heavier use and good indicators of candidacy for norms-based interventions. In sum, the present findings extend our understanding of the influence of social identity among young adult marijuana users and suggest novel directions for intervention strategies.

RCT of web-based personalized normative feedback for college drinking prevention: are typical student norms good enough?

OBJECTIVES

Personalized normative feedback (PNF) interventions are generally effective at correcting normative misperceptions and reducing risky alcohol consumption among college students. However, research has yet to establish what level of reference group specificity is most efficacious in delivering PNF. This study compared the efficacy of a web-based PNF intervention using 8 increasingly specific reference groups against a Web-BASICS intervention and a repeated-assessment control in reducing risky drinking and associated consequences.

METHOD

Participants were 1,663 heavy-drinking Caucasian and Asian undergraduates at 2 universities. The referent for web-based PNF was either the typical same-campus student or a same-campus student at 1 (either gender, race, or Greek affiliation), or a combination of 2 (e.g., gender and race), or all 3 levels of specificity (i.e., gender, race, and Greek affiliation). Hypotheses were tested using quasi-Poisson generalized linear models fit by generalized estimating equations.

RESULTS

The PNF intervention participants showed modest reductions in all 4 outcomes (average total drinks, peak drinking, drinking days, and drinking consequences) compared with control participants. No significant differences in drinking outcomes were found between the PNF group as a whole and the Web-BASICS group. Among the 8 PNF conditions, participants receiving typical student PNF demonstrated greater reductions in all 4 outcomes compared with those receiving PNF for more specific reference groups. Perceived drinking norms and discrepancies between individual behavior and actual norms mediated the efficacy of the intervention.

CONCLUSIONS

Findings suggest a web-based PNF intervention using the typical student referent offers a parsimonious approach to reducing problematic alcohol use outcomes among college students.

Indicated prevention for college student marijuana use: a randomized controlled trial

OBJECTIVE

Marijuana is the most frequently reported illicit substance used on college campuses. Despite the prevalence, few published intervention studies have focused specifically on addressing high-risk marijuana use on college campuses. The present study evaluated the efficacy of an in-person brief motivational enhancement intervention for reducing marijuana use and related consequences among frequently using college students.

METHOD

Participants included 212 college students from 2 campuses who reported frequent marijuana use (i.e., using marijuana at least 5 times in the past month). Participants completed Web-based screening and baseline assessments and upon completion of the baseline survey were randomized to either an in-person brief intervention or an assessment control group. Follow-up assessments were completed approximately 3 and 6 months post-baseline. Marijuana use was measured by number of days used in the past 30 days, typical number of joints used in a typical week in the last 60 days, and marijuana-related consequences.

RESULTS

Results indicated significant intervention effects on number of joints smoked in a typical week and a trend toward fewer marijuana-related consequences compared with the control group at 3-month follow-up.

CONCLUSION

This study provides preliminary data on short-term effects of a focused marijuana intervention for college students at reducing marijuana use during the academic quarter.

Predictors of hooking up sexual behaviors and emotional reactions among U.S. college students

The present study examined factors associated with engaging in oral and vaginal sex and condom use during the most recent hookup, a term that refers to a range of physically intimate behaviors outside of a committed relationship, among college students. In addition, this research aimed to evaluate factors associated with experiencing positive and negative affect resulting from the most recent hookup. A random sample (N = 1,468) of undergraduates (56.4% female) completed a Web-based survey that was comprised of measures of drinking and sexual behavior. Participants (n = 824; 56.1%) who indicated they had ever hooked up were included in data analysis. Findings indicated that sex, partner type, alcohol use, attitudes towards hooking up, and attitudes towards sexual activity during hookups explained significant variance for oral sex, vaginal sex, condom use, and positive and negative affect related to the most recent hookup experience. Clinical implications regarding the role of situational stressors, such as the impact on affect following a hookup, and ways to reduce risks associated with stressors are discussed.

Pick your poison: stimuli selection in alcohol-related implicit measures

It is common for people to report strong preferences for certain types of alcohol, often as a function of past positive or negative experiences with particular types of drinks. Despite this individual difference, implicit measures related to alcohol frequently use nomothetic approaches--i.e., use a standard set of alcohol beverage stimuli--which may not match individuals' actual drinking behavior. Moreover, this mismatch may account for some of the inconsistencies across studies using implicit measures. The present study used an idiographic variant of the Implicit Association Test (IAT) in which participants (N=300) selected alcohol images that matched their drinking behavior (non-drinkers selected what they were offered most often). Results were consistent with previous research on alcohol preference: women selected more liquor and wine images, men selected more beer images; heavy episodic drinkers selected more beer and liquor images and selected fewer wine images than lighter drinkers and non-drinkers. In addition, IAT scores were sensitive to drinking levels in the expected direction and, importantly, were robust to stimuli selected. Thus, results provide initial validation of idiographic approaches to stimuli selection.