Barriers and Facilitators to Behavioral Healthcare for Women Veterans: a Mixed-Methods Analysis of the Current Landscape

Women veterans have historically faced barriers to behavioral health treatment, particularly through the VA. In conjunction, there have been changes in behavioral healthcare delivery resulting from efforts to improve care for women veterans and the COVID-19 pandemic (e.g., widespread telehealth implementation). The current study draws on a quantitative and qualitative study centering current perspectives of women veterans in their choices to seek or not seek behavioral healthcare in VA and non-VA settings through interviewing 18 women recruited from a larger survey study on veteran behavioral health (n = 83 women, n = 882 men) on their experiences with behavioral health care access and satisfaction, including barriers and facilitators to seeking care. Quantitative findings are descriptively reported from the larger study, which outlined screening for behavioral health problems, behavioral health utilization, treatment modality preferences, and barriers/facilitators to care. While women in the survey sample screened for various behavioral health disorders, rates of treatment seeking remained relatively low. Women reported positive and negative experiences with telehealth and endorsed many barriers to treatment seeking in interviews not captured by survey findings, including lack of women-specific care (e.g., care for military sexual trauma, women-only groups), reports of stranger harassment at the VA, and lack of female providers. Women veterans continue to face barriers to behavioral healthcare; however, ongoing efforts to improve care access and quality, including the implementation of telehealth, show promise in reducing these obstacles. Continued efforts are needed to ensure diverse treatment modalities continue to reach women veterans as this population grows.

An Examination of Pregaming Behavior and Motives among Sexual and Gender Minority College Students

Introduction: Pregaming is a popular but high-risk drinking behavior common among college students. Although sexual and gender minority (SGM) college students are a vulnerable population with regards to hazardous alcohol use and alcohol consequences, there is currently limited research investigating the pregaming behavior of this group. The present study aimed to (1) examine mean level differences in pregaming behaviors and motives between SGM and non-SGM college students and (2) explore how SGM status was associated with pregaming behaviors and if SGM status moderated the association between motives and pregaming behaviors. Methods: The sample consisted of 485 college student drinkers in the US, with 19% (n = 93) identifying as SGM. All participants completed measures of past 30-day pregaming frequency and quantity (yielding a total pregaming drinks outcome) and drinking consequences experienced on pregaming days. Results: SGM participants consumed significantly fewer pregaming drinks than non-SGM participants, but did not significantly differ on alcohol-related consequences or drinking motives. The pregaming motive of intimate pursuit moderated the association between SGM status and total pregaming drinks, such that non-SGM participants with high intimate pursuit motives drank the heaviest. Conclusions: Our findings suggest that SGM students consume significantly fewer pregaming drinks than their non-SGM counterparts. However, they may be at a similar risk of experiencing pregaming consequences as non-SGM students. SGM students were less susceptible to the effect of intimate pursuit motives on pregaming drink consumption. This study offers support for past research regarding the effects of certain pregaming motives on pregaming drink consumption and consequences.

Bidirectional Associations Between Pain and Perceived Stress Among Veterans: Depressive Disorder as a Predisposing Factor

OBJECTIVE

Military veterans who were injured in combat very often report pain along with co-occurring perceived stress and preexisting depressive disorder. The systems model of pain is a theoretical model suggesting that pain and perceived stress are bidirectionally associated at the within-person level, and associations are heightened among those with depressive disorder. However, the systems model of pain has not been adequately tested. Testing the systems model of pain could illuminate salient treatment targets for combat-injured veterans with pain and co-occurring psychological problems.

METHODS

The present study empirically tests the systems model of pain among a sample of combat-injured veterans ( N = 902) surveyed five times during an 18-month period. We used a multigroup, autoregressive latent trajectory with structured residual statistical model to test the within-person associations between pain and perceived stress and determine whether associations differ between veterans with and without a positive screen for depressive disorder.

RESULTS

In line with the systems model of pain, pain and perceived stress were bidirectionally associated only among combat-injured veterans with depressive disorder. Among such veterans, perceived stress was positively associated with subsequent pain ( b = 0.12; 95% confidence interval = 0.06-0.17), and pain was positively associated with subsequent perceived stress ( b = 0.44; 95% CI = 0.11-0.77).

CONCLUSIONS

Our work highlights the interplay between pain and its psychological correlates among a particularly at-risk population. Clinicians addressing pain and perceived stress among combat-injured veterans should be prepared to identify and address depressive disorder.

A latent profile analysis of social anxiety, depression, and pregaming motives among heavy-drinking college students

BACKGROUND

Pregaming is a high-risk drinking behavior that is associated with heavy drinking and negative alcohol-related consequences. College students may engage in pregaming for several reasons, including to enhance social experiences or cope with negative affect. Research shows that associations between drinking, social anxiety, and depression are multifaceted. However, our understanding of the complex associations of mental health symptoms with pregaming motives and behaviors remains limited.

METHODS

This study examined heterogeneity in how pregaming motives, social anxiety, and depression associate with past 30-day pregaming variables (quantity, frequency, and negative consequences). We used latent profile analysis (LPA) in a sample of heavy-drinking university students (N = 479).

RESULTS

LPA results indicated four profiles: mild/moderate social anxiety and depression symptoms, moderate motives (n = 285), minimal social anxiety and depression symptoms, low motives (n = 61), subclinical/elevated social anxiety and depression symptoms, high motives (n = 75), and clinically elevated social anxiety and depression symptoms, moderate motives (n = 58). The subclinical/elevated symptoms, high motives profile reported the highest pregaming frequency and consequences, including blackouts. Individuals in the clinically elevated symptoms, moderate motives profile reported more consequences than those in the minimal symptoms, low motives and mild/moderate symptoms, moderate motives profiles. Individuals in the minimal symptoms, low motives profile reported the fewest consequences.

CONCLUSIONS

Among these students, social anxiety and pregaming motives were associated with more frequent pregaming and social anxiety and depression were associated with greater negative consequences. Interventions that target pregaming-specific motives among students with mental health symptoms may be warranted to reduce this risky behavior and associated drinking-related harm.

A mobile-based pregaming drinking prevention intervention for college students: A pilot randomized controlled trial

OBJECTIVE

Pregaming is among the riskiest drinking behaviors in which college students engage, often leading to elevated blood alcohol levels and negative alcohol-related consequences. Yet, tailored interventions to reduce risk associated with pregaming are lacking. The present study was designed to develop and evaluate the efficacy of a brief, mobile-based intervention targeting heavy drinking during pregaming among college students, called Pregaming Awareness in College Environments (PACE).

METHOD

PACE was developed using two innovations to facilitate behavior change: (a) a mobile-based application to increase intervention accessibility and (b) personalized pregaming-specific intervention content delivered using a harm reduction approach with cognitive behavioral skills training. After development and β-testing, we employed a randomized clinical trial with 485 college students who reported pregaming at least once per week in the past month (Mage = 19.98; 52.2% from minoritized racial and/or ethnic groups; 65.6% female). Participants were randomly assigned to PACE (n = 242) or a control condition website (n = 243), which consisted of general information about the effects of alcohol. Analysis assessed intervention effects on pregaming drinking, global drinking, and alcohol-related consequences at 6 and 14 weeks postintervention.

RESULTS

Although participants in both conditions reduced drinking, small and significant intervention effects favoring PACE were found at 6-week follow-up for overall drinking days, pregaming days, and alcohol-related consequences.

CONCLUSIONS

Findings suggest the brief mobile PACE intervention has potential to address risky drinking, but more intensive pregaming-focused efforts may be necessary to achieve stronger and lasting effects among college students. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Study protocol for a sequential multiple assignment randomized trial to reduce risky drinking among service members and their partners

BACKGROUND

Military spouses and partners in relationships with a heavy drinking service member report high levels of mental health concerns and consequences, which are compounded when both partners drink heavily. Military spouses and partners -termed "concerned partners" (CPs)-may be an important gateway for motivating service members (SMs) to seek care. However, CPs may first need to reduce their own drinking and improve their communication to effectively support and encourage changes for their service member partner. Partners Connect is a web-based intervention aimed at improving communication and relationship quality and increasing SM help-seeking.

METHODS

The current study design is a two-stage Sequential Multiple Assignment Randomized Trial (SMART) to develop an adaptive CP intervention to decrease CP drinking and increase SM help-seeking. CPs aged 18 and older (n = 408) will be recruited via social media and followed for six months. In stage one, we will randomize CPs to either a 4-session web-based intervention (Partners Connect) or to receive communication resources from the Gottman Institute website. The goal is to have CPs invite their SM to complete an online personalized normative feedback (PNF) session. If their SM completes the PNF at stage one, CPs will be considered "responders," if the SM does not complete, CPs who are "non-responders" will be re-randomized during stage two to receive either (1) a CRAFT workbook or (2) phone-based CRAFT if in Partners Connect; or (1) Partners Connect or (2) a CRAFT workbook if in Gottman.

DISCUSSION

By first intervening with the service member's CP, we aim to better equip them to engage their service member partner in treatment services. In doing so, we develop a model that increases treatment accessibility and appeal among a group that may not otherwise seek care.

CLINICALTRIALS

gov Identifier: NCT05619185.

High Spirits? Exploring "Halloweekend" Alcohol and Cannabis Use Among Heavy-Drinking College Students

OBJECTIVE

Specific events are associated with heavier and riskier substance use behaviors among college students, including holidays like Halloween, which may include several days of themed parties/events ("Halloweekend"). The current study compared drinking, pregaming (i.e., fast-paced drinking before going out for the night), cannabis use, same-day alcohol and cannabis co-use, and negative alcohol-related consequences over Halloweekend compared with two adjacent non-Halloween weekends among a sample of heavy-drinking university students.

METHOD

Participants (N = 228; 65% female) provided 28 days of daily diary data. We used a three-level generalized linear mixed model (GLMM) approach estimating zero-inflated Conway-Maxwell Poisson regressions to assess the effect of weekend and specific weekend day on number of overall drinks, number of pregaming drinks, and negative alcohol-related consequences. Proportions tests assessed for differences in any cannabis use and daily co-use between Halloweekend and non-Halloween weekends.

RESULTS

Zero-inflated portions of the GLMMs indicated that general drinking, pregaming, and negative consequences were most prevalent on Halloweekend and Fridays and Saturdays. Count portions of the models indicated that general drinking quantity was highest during these periods, and participants experienced a greater number of negative consequences on Halloweekend compared with the weekend before; no differences were observed in the quantity of pregaming drinks consumed across weekends or days. No significant differences in cannabis use or co-use were observed between weekends.

CONCLUSIONS

Given risk associated with Halloweekend compared with weekends immediately before and after, interventions targeting alcohol use and pregaming on Halloweekend may be beneficial to reduce related harm for heavy-drinking students.

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).

A Longitudinal Study of Alcohol and Cannabis Use in Young Adulthood: Exploring Racial and Ethnic Differences in the Effects of Peer and Parental Influences From Middle Adolescence

OBJECTIVE

This study assessed how changes from middle adolescence to young adulthood in peer and parental influences relate to frequency of alcohol and cannabis use in young adulthood and evaluated the differences between three racial/ethnic groups.

METHOD

The analytic sample (n = 2,808; 52.9% female; 54% Hispanic, 22.9% White, 23.1% Asian/Pacific Islander) was derived from a longitudinal cohort initially recruited from 16 middle schools in Southern California who completed annual surveys. Data were collected across six waves beginning in Spring 2013 (mean age = 16.2) through Spring 2019 (mean age = 21.6).

RESULTS

Multigroup latent growth models revealed consistent increases during adolescence and young adulthood in perceived peer and parental approval of alcohol and cannabis and in the amount of time spent around peers who used these substances. After we controlled for prior use, these increases related to alcohol and cannabis use at age 21, with few exceptions. The time spent around peers most strongly influenced later cannabis use for Hispanic young adults, whereas the influence of peer approval on later alcohol and cannabis use, and parental approval on later alcohol use, was strongest among White young adults.

CONCLUSIONS

The frequency of alcohol and cannabis use in young adulthood was shaped, in part, from increases in direct and indirect peer influence and perceived parental approval of substance use across two important developmental periods. The findings highlight the importance of early and sustained intervention efforts targeting these social influences, especially among White adolescents, which may potentially decrease alcohol and cannabis use as youth enter young adulthood.

A mobile-based pregaming drinking prevention intervention for college students: study protocol for a randomized controlled trial

BACKGROUND

Pregaming is a high-drink context popular among college students that often leads to elevated blood alcohol levels and negative consequences. Over 15 years of research studies have demonstrated that pregaming represents one of the riskiest known behaviors among college students, yet no pregaming-specific interventions have been developed to help prevent this behavior. General brief interventions for students do not reduce pregaming behavior and may not be appropriate, as they do not help students develop skills unique to the pregaming context that could help them drink less. We developed a brief, mobile-based intervention that is proposed to prevent heavy drinking during pregaming for college students, with the ultimate goal that behavioral reductions in this risky practice will ultimately affect global drinking and prevent consequences.

METHODS/DESIGN

The intervention, Pregaming Awareness in College Environments (PACE), was developed by combining two innovations to facilitate behavior change: (1) a mobile-based application that increases accessibility, is easy and engaging to use, and broadens the reach of the intervention content and (2) personalized pregaming-specific intervention content with harm reduction and cognitive behavioral skills proven to be mechanisms preventing and reducing heavy drinking among college students. After a develop and beta-test phase, we propose to test the efficacy of PACE in a preliminary randomized controlled trial with 500 college students who pregame at least once per week. Pregaming, general drinking, and alcohol-related consequences outcomes will be examined in the immediate (2 weeks post-intervention) and short-terms (six and 14-week post-intervention). We will also evaluate moderator effects for age, sex, and heaviness of drinking to allow for more refined information for a planned larger test of the intervention to follow this initial trial of PACE.

DISCUSSION

This pregaming intervention clinical trial, if found to be efficacious, will culminate with an easily-disseminated mobile-based intervention for college student drinkers. It has the potential to reach millions of college students, perhaps as a clinical tool used by college counseling centers as an adjunct to formal care or as a preventive tool for first-year students or other high-risk groups on campus.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier NCT04016766.

Increased Risk for Sexual Violence Victimization on Drinking Days Involving Pregaming

Alcohol consumption has been associated with increased risk for sexual violence victimization and perpetration. Pregaming, a popular activity among college students that involves heavy and quick drinking prior to going out for the night and often results in high blood alcohol levels (BALs), may convey increased risk for sexual violence-potentially due to greater likelihood of contact with intoxicated perpetrators and significantly impaired victim ability to consent or resist. Yet no published work has evaluated whether there is increased risk for victimization on drinking days that involve pregaming. Using a sample of 390 college student drinkers who completed a past 30-day Timeline Followback, we examined heavy drinking behavior, estimated BALs, and experience of sexual violence victimization during 1,899 drinking days, of which 30% involved pregaming. After controlling for demographics, we found that participants drank approximately two more drinks and reached significantly higher BALs on drinking days where they pregamed as compared to drinking days where they did not pregame. Nearly 6% of drinking days that included pregaming involved sexual violence victimization, compared to about 2% of drinking days where pregaming did not occur. Participants were at 2.71 times the odds of experiencing sexual violence, primarily unwelcomed comments and nonconsensual sexual touching, during drinking days with pregaming. This study represents a first step toward greater understanding of the sexual violence and pregaming link, but future research assessing perpetrator behavior and context-specific factors (e.g., amount consumed by victims and perpetrators, location of sexual violent events and peers present) are needed.

Why Young Adults Obtain a Medical Marijuana Card: Associations with Health Symptoms and Heaviness of Use

Objective.

Prior studies documenting more frequent and problematic use among young adults who have acquired medical marijuana (MM) cards have broadly compared those who use medically to those who use recreationally. Gaining a better picture of how health symptoms and problematic use vary both within those who have a MM card for specific condition domains and between those who do not have a MM card can provide key information for medical practitioners and states interested in adopting or updating MM policies.

Method.

The current study categorizes young adults authorized to use MM into three mutually exclusive groups based on endorsements of qualifying conditions: (1) Physical Health only (e.g., AIDS, arthritis, cancer; n = 34); (2) Behavioral Health only (e.g., anxiety, depression, sleep problems; n = 75); and (3) Multiple Conditions (a physical and behavioral health condition; n = 71). Multiple and logistic regression models examined differences across marijuana use, problems, mental health, physical health, and sleep quality for MM condition categories and for those that only use marijuana recreationally (n = 1,015).

Results.

After adjusting for socio-demographic factors (age, sex, sexual orientation, educational status, employment status, race/ethnicity, mother’s education, prior intervention involvement in youth), MM card holders, particularly those with physical health or multiple health conditions, reported heavier, more frequent, and more problematic and risky marijuana use compared to those using recreationally. Despite this pattern, those in different MM condition categories were generally not found to be more symptomatic in domains of mental or physical health relevant to their respective conditions, compared to different category groups or to those using recreationally.

Conclusions.

Findings emphasize the importance of providers conducting a careful assessment of reasons for needing a card, along with use, to reduce potential harms while adding credibility to a medical movement with genuine promise of relief for many medical conditions.

Protective Behavioral Strategies and Alcohol Use While Pregaming: The Moderating Role of Depression and Anxiety Symptoms

The study evaluated the moderating role of anxiety and depression symptoms on the association between subscales on the Protective Behavioral Strategies for Pregaming (PBSP) scale (safety and familiarity, setting drink limits, pacing drinking, and minimizing intoxication) and alcohol consumption during pregaming. Methods: Participants were 359 traditional age undergraduate college students (M = 20, SD = 1.37; 61.7% female; 61.2% White) who reported pregaming in the past year. All participants completed measures through an online survey which evaluated PBSP, depression and anxiety symptoms, and alcohol use during pregame events in the past month. Results: Among students with high depression symptoms, the more frequent use of PBSP to minimize intoxication was not associated with alcohol consumption levels, whereas among those with low depression symptoms, higher use of PBSP to minimize intoxication was associated with higher alcohol consumption. Among those with high anxiety symptoms, the more frequent use of PBSP to minimize intoxication was associated with lower alcohol consumption at pregaming events, whereas among those with low anxiety symptoms, the use of this PBSP was associated with higher alcohol consumption. The more frequent use of PBSP related to safety and familiarity among those with high anxiety symptoms was unrelated to alcohol consumption during pregaming, whereas among those low in anxiety symptoms, the more frequent use of this PBSP was associated with lower alcohol consumption. Conclusion: The findings begin to inform clinical care and intervention techniques aimed at reducing harm associated with risky drinking practices among a vulnerable subset of college students.

Development of a Measure to Assess Protective Behavioral Strategies for Pregaming among Young Adults

Background: Although most young adults drink alcohol, there are specific drinking contexts that are associated with increased risk for alcohol-related consequences. One such drinking context is pregaming, which typically involves heavy drinking in brief periods of time and has consistently been linked to consequences within the pregaming event itself, on a night after pregaming, and in the long-term. Intervention efforts that specifically target this risky behavior are needed, but these efforts need to be informed by empirical work to better understand what behaviors young people engage in that can protect them from pregaming-related harms. Purpose: We designed this study to create a measure of protective behavioral strategies that young people use before, during, and after pregaming to inform future intervention work. Methods: We tested an item pool with 363 young adult college students who engaged in pregaming in the past year and conducted exploratory factor analysis to develop a 19-item Protective Behavioral Strategies for Pregaming (PBSP) scale, which featured four subscales of safety and familiarity, setting drink limits, pacing strategies, and minimizing intoxication. Results: Each subscale negatively and significantly correlated with measures of alcohol use and consequences, though subscales differed in their associations with specific pregaming outcomes and by sex. Conclusion: This initial exploratory examination of the PBSP scale's psychometric properties suggests that use of protective behavioral strategies used specifically during pregaming events may protect young people from heavy drinking and harms. More research with the PBSP scale is encouraged to determine its practical utility as a clinical and assessment tool with young people.

Measuring Protective Behavioral Strategies for Marijuana Use Among Young Adults

OBJECTIVE

Marijuana use can result in a variety of negative consequences, yet it remains popular among young adults and the general public at large. Combined with the growing empirical support for the benefits of medicinal marijuana as well as the steady increase in popular opinion regarding its legalization, it is of growing importance to identify strategies that may mitigate the harms related to marijuana use, reduce consumption levels, and limit resulting negative consequences among young adults who use marijuana. The purpose of this study was to develop and conduct initial psychometric analyses on a new scale, which we named the Protective Behavioral Strategies for Marijuana (PBSM) scale.

METHOD

A sample of undergraduate college students who reported past-6-month marijuana use (n = 210) responded to the initial pool of PBSM items and completed measures of marijuana use, consequences from marijuana use, alcohol use, and protective behavioral strategies for alcohol.

RESULTS

Results from an iterative principal component analyses process yielded a single-factor structure with 39 items. The PBSM mean composite score negatively associated with marijuana use and consequences, with the strongest correlations evident for pastmonth users. The PBSM also significantly positively correlated with alcohol protective strategies.

CONCLUSIONS

Protective behavioral strategies for marijuana appear to be a measurable construct that are related to marijuana frequency and consequences, and thus may be a useful component of intervention and prevention programs with young adults. More work testing the PBSM items with larger and more diverse samples of young adults is encouraged.

The Protective Behavioral Strategies for Marijuana Scale: Further examination using item response theory

Given recent state legislation legalizing marijuana for recreational purposes and majority popular opinion favoring these laws, we developed the Protective Behavioral Strategies for Marijuana scale (PBSM) to identify strategies that may mitigate the harms related to marijuana use among those young people who choose to use the drug. In the current study, we expand on the initial exploratory study of the PBSM to further validate the measure with a large and geographically diverse sample (N = 2,117; 60% women, 30% non-White) of college students from 11 different universities across the United States. We sought to develop a psychometrically sound item bank for the PBSM and to create a short assessment form that minimizes respondent burden and time. Quantitative item analyses, including exploratory and confirmatory factor analyses with item response theory (IRT) and evaluation of differential item functioning (DIF), revealed an item bank of 36 items that was examined for unidimensionality and good content coverage, as well as a short form of 17 items that is free of bias in terms of gender (men vs. women), race (White vs. non-White), ethnicity (Hispanic vs. non-Hispanic), and recreational marijuana use legal status (state recreational marijuana was legal for 25.5% of participants). We also provide a scoring table for easy transformation from sum scores to IRT scale scores. The PBSM item bank and short form associated strongly and negatively with past month marijuana use and consequences. The measure may be useful to researchers and clinicians conducting intervention and prevention programs with young adults. (PsycINFO Database Record

Examining the Role of Source Credibility and Reference Group Proximity on Personalized Normative Feedback Interventions for College Student Alcohol Use: A Randomized Laboratory Experiment

BACKGROUND

Personalized normative feedback (PNF) interventions are designed to reduce misperceived drinking norms by delivering feedback regarding the actual drinking behavior of college students, thereby leading to subsequent reductions in one's own drinking.

OBJECTIVE

We examined the roles of data source credibility and reference group proximity in the effectiveness of a laboratory-based PNF intervention to reduce perceived drinking norms and thereby decrease intentions to drink.

METHOD

Following completion of an online preintervention survey and using a 2 (highly credible data source/low credible data source) × 2 (proximal reference group/distal reference group) between-subjects factorial design, 104 college student drinkers were randomly assigned to condition. Participants then completed a postintervention questionnaire to assess for changes in various aspects of drinking.

RESULTS

Highly credible feedback was associated with greater reductions in perceived weekly drinking by American college students compared to feedback with low credibility. Similarly, more proximal than distal reference group feedback led to greater reductions in perceived weekly drinking by a same-gender/same-class year students at one's university. No condition effects emerged for intended drinks per week.

CONCLUSIONS

PNF interventions may benefit from considering data source credibility and reference group proximity to reduce misperceptions of college student drinking, depending on the goals and resources of practitioners implementing such programs. Even the use of such a distal reference group as American college students can indeed lead to a reduction of normative perceptions provided there is an emphasis on the credibility of the data source.

A parent-based intervention reduces heavy episodic drinking among first-year college students

A randomized controlled trial tested an interactive normative feedback-based intervention-codenamed "FITSTART"-delivered to groups of 50-100 parents of matriculating college students. The 60-min session motivated parents to alter their alcohol-related communication by correcting normative misperceptions (e.g., about how approving other parents are of student drinking) with live-generated data. Then, tips were provided on discussing drinking effectively. Incoming students (N = 331; 62.2% female) completed baseline measures prior to new-student orientation. Next, at parent orientation in June, these students' parents were assigned to either FITSTART or a control session. Finally, 4 months later, students completed a follow-up survey. Results revealed that students whose parents received FITSTART during the summer consumed less alcohol and were less likely to engage in heavy episodic drinking (HED) during the first month of college. These effects were mediated by FITSTART students' lower perceptions of their parents' approval of alcohol consumption. Further, FITSTART students who were not drinkers in high school were less likely to initiate drinking and to start experiencing negative consequences during the first month of college, where FITSTART students who had been drinkers in high school experienced fewer consequences overall and were significantly more likely to report that they did not experience any consequences whatsoever during the first month of college. Importantly, FITSTART is the first parent-based intervention to impact HED, one of the most well-studied indicators of risky drinking. Thus, interactive group normative feedback with parents is a promising approach for reducing college alcohol risk. (PsycINFO Database Record

Is Prepartying a Cause of Heavy Drinking and Consequences Rather Than Just a Correlate? A Longitudinal Look at the Relationship Between Prepartying, Alcohol Approval, and Subsequent Drinking and Consequences

BACKGROUND

Prepartying, or drinking before an event where more alcohol may or may not be consumed, has been positioned in the literature as a behavior engaged in by heavy drinkers. However, recent findings suggest that prepartying may confer distinct risks, potentially causing students to become heavier drinkers over time.

OBJECTIVES

The goals of this study were to disentangle the longitudinal relationships between prepartying, general and episodic alcohol consumption, and alcohol-related consequences by investigating (1) whether prepartying is associated with future consequences above and beyond current alcohol consumption habits and (2) whether augmentations in approval for alcohol and related increases in drinking mediate this relationship.

METHODS

One-hundred and ninety-five undergraduates completed online questionnaires at baseline, 6 months, and 12 months later.

RESULTS

Prepartying frequency was more strongly related to alcohol-related consequences one year later than was overall or episodic drinking. In addition, a path mediation model confirmed our hypothesis that this relationship is due to gradual increases in drinking which occur as a result of more approving attitudes toward alcohol brought on by exposure to prepartying. Conclusion/Importance: Findings suggest a new model for conceptualizing the relationship between prepartying, drinking, and consequences whereby students who get involved in prepartying may witness slow increases in their approval for alcohol use and, as a result, consumption. Importantly, results suggest that the increases in drinking displayed by prepartiers over the course of a year may account for the strong relationship between prepartying and later consequences. Prevention and intervention initiatives may benefit from directly targeting prepartying as a means of tempering risky alcohol use trajectories during one's college tenure.

Longitudinal Relationships Among Perceived Injunctive and Descriptive Norms and Marijuana Use

OBJECTIVE

The current study uses longitudinal data to examine the relative influence of perceived descriptive and injunctive norms for proximal and distal referents on marijuana use.

METHOD

Participants were 740 undergraduate students (67% female) who completed web-based surveys at two time points 12 months apart. Time 1 measures included reports of marijuana use, approval, perceived descriptive norms, and perceived injunctive norms for the typical student, close friends, and parents. At Time 2, students reported on their marijuana use.

RESULTS

Results of a path analysis suggest that, after we controlled for Time 1 marijuana use, greater perceived friend approval indirectly predicted Time 2 marijuana use as mediated by personal approval. Greater perceived parental approval was both indirectly and directly associated with greater marijuana use at follow-up. Perceived typical-student descriptive norms were neither directly nor indirectly related to Time 2 marijuana use.

CONCLUSIONS

The findings support the role of proximal injunctive norms in predicting college student marijuana use up to 12 months later. The results indicate the potential importance of developing normative interventions that incorporate the social influences of proximal referents.

Perceived parent and peer marijuana norms: the moderating effect of parental monitoring during college

This study examined descriptive and injunctive normative influences exerted by parents and peers on college student marijuana approval and use. It further evaluated the extent to which parental monitoring moderated the relationship between marijuana norms and student marijuana outcomes. A sample of 414 parent-child dyads from a midsize American university completed online surveys. A series of paired and one-sample t tests revealed that students' actual marijuana use was significantly greater than parents' perception of their child's use, while students' perception of their parents' approval were fairly accurate. The results of a hierarchical multiple regression indicated that perceived injunctive parent and student norms, and parental monitoring all uniquely contributed to the prediction of student marijuana approval. Furthermore, parental monitoring moderated the effects of perceived norms. For example, at low but not high levels of parental monitoring, perceptions of other students' marijuana use were associated with students' own marijuana approval. Results from a zero-inflated negative binomial regression showed that students who reported higher descriptive peer norms, higher injunctive parental norms, and reported lower parental monitoring were likely to report more frequent marijuana use. A significant Parental Monitoring × Injunctive Parental norms interaction effect indicated that parental approval only influenced marijuana use for students who reported that their parents monitored their behavior closely. These findings have intervention implications for future work aimed at reducing marijuana approval and use among American college students.

Development and validation of the Hookup Motives Questionnaire (HMQ)

Despite the high prevalence rates and growing research on hooking up among college students, no multidimensional inventory exists in the literature to assess motivations for hooking up. In the current study, we report on the development and validation of the Hookup Motives Questionnaire (HMQ), designed to assess the various reasons for hooking up. Exploratory and confirmatory factor analyses were conducted using 2 samples of college students (Campus 1, N = 401; Campus 2, N = 367). Exploratory factor analysis was undertaken to explore the psychometric properties of an initial set of 25 items, and confirmatory factor analysis was conducted to evaluate additional properties of the factor structure. The final factor structure of the HMQ contained 19 items that tapped 5 subscales representing social-sexual, social-relationship, enhancement, coping, and conformity motives. Results demonstrated good internal consistency and discriminant validity for the subscales. Moreover, criterion-related validity was satisfied by showing that HMQ subscales significantly correlated with hookup approval and behavior. Gender differences on the measures were found. The inventory offers considerable potential as a psychometrically sound instrument that may be administered to understand reasons for engaging in potentially risky hookup behaviors and used to inform the design of sexual health programs and interventions targeting young adults.

Experimentally induced distraction impacts cognitive but not emotional processes in think-aloud cognitive assessment

Studies have examined the impact of distraction on basic task performance (e.g., working memory, motor responses), yet research is lacking regarding its impact in the domain of think-aloud cognitive assessment, where the threat to assessment validity is high. The Articulated Thoughts in Simulated Situations think-aloud cognitive assessment paradigm was employed to address this issue. Participants listened to scenarios under three conditions (i.e., while answering trivia questions, playing a visual puzzle game, or with no experimental distractor). Their articulated thoughts were then content-analyzed both by the Linguistic Inquiry and Word Count (LIWC) program and by content analysis of emotion and cognitive processes conducted by trained coders. Distraction did not impact indices of emotion but did affect cognitive processes. Specifically, with the LIWC system, the trivia questions distraction condition resulted in significantly higher proportions of insight and causal words, and higher frequencies of non-fluencies (e.g., “uh” or “umm”) and filler words (e.g., “like” or “you know”). Coder-rated content analysis found more disengagement and more misunderstanding particularly in the trivia questions distraction condition. A better understanding of how distraction disrupts the amount and type of cognitive engagement holds important implications for future studies employing cognitive assessment methods.

Normative feedback for parents of college students: piloting a parent based intervention to correct misperceptions of students' alcohol use and other parents' approval of drinking

OBJECTIVE

Multi-component parent-based interventions (PBIs) provide a promising avenue for targeting alcohol use and related consequences in college students. Parents of college-aged children can have a significant influence on their children's alcohol use decisions. However, parents tend to underestimate their own child's alcohol use and overestimate other similar parents' approval of student drinking. These misperceptions could have important implications for parents' own attitudes and alcohol-related communication with their student. Targeting these misperceptions through normative feedback could help promote greater and more in-depth alcohol-related communication. The present study examines the potential efficacy of web-based alcohol-related normative feedback for parents of college students.

METHOD

A sample of 144 parents of college students received web-based normative feedback about students' alcohol use and approval, as well as other same-college parents' alcohol approval. Parents completed measures of perceived student alcohol use, student alcohol approval, other-parent alcohol approval, and intentions to discuss alcohol use both pre- and post-normative feedback.

RESULTS

Post-feedback, parents reported stronger intentions to talk to their student about alcohol, were less confident in their knowledge of their students' alcohol use, and believed that their student drank in greater quantity and more frequently than pre-feedback. Parents also perceived other parents to be less approving of alcohol use after viewing normative feedback.

CONCLUSIONS

These findings provide preliminary support for the use of web-based normative feedback for parents of college students. Given these promising results, further research developing and testing this approach merits attention.

Hooking up in the college context: the event-level effects of alcohol use and partner familiarity on hookup behaviors and contentment

The current study examined hooking up experiences through event-level analyses, including the connections involving alcohol use, the extent of physical contact, and postevaluations of the hookup event. Participants were 828 college students (67.0% female). Of students who reported hooking up sometime within the past year (54.8%), chi-square analyses revealed that they were more likely to have been drinking when they met their partners the night of the hookup. Females who were drinking beforehand and females who met their partners that night were more likely to feel discontent with their hookup decisions. Among participants who consumed alcohol prior to their last hookup, a notable 30.7% of females and 27.9% of males indicated that they would likely not have hooked up with their partners had alcohol not been involved. Further, 34.4% of females and 27.9% of males indicated that they would not have gone as far physically if they had not been drinking. Among participants who reported both drinking beforehand and hooking up with unfamiliar partners, greater number of drinks consumed was associated with more advanced sexual behaviors. The current findings highlight the potential risks associated with alcohol use in the hooking up culture.

The Influence of Reflective Opposite-Sex Norms and Importance of Opposite-Sex Approval on Adjudicated Student Drinking: Theoretical Extensions and Implications

This study examines the salience and influence of reflective norms regarding opposite-sex friends, dating, and sexual partners on drinking behaviors of heterosexual college students sanctioned for violating the campus alcohol policy (i.e., adjudicated students). Results revealed that the level of importance placed on approval from the opposite sex is an important moderator for women but not for men. Selectively augmenting existing adjudicated student interventions with reflective normative feedback may be an effective intervention approach.

What are other parents saying? Perceived parental communication norms and the relationship between alcohol-specific parental communication and college student drinking

This study examined parents' normative perceptions of other college parents' alcohol-specific communication, and how parents' perceived communication norms and alcohol-specific communication relate to student drinking outcomes. A sample of 457 student-parent dyads were recruited from a midsize university. Students completed Web-based assessments of alcohol-related attitudes and behaviors. Parents completed alcohol-specific measures of communication norms and parent-child communication, including communication content (i.e., targeted communication) and frequency of communication. Results indicated that parents overestimated how much other parents talked to their college students about the frequency and quantity of alcohol use, but underestimated how often parents initiated conversations about alcohol. In a path model, perceived communication norms positively predicted both targeted communication and frequency of communication. Perceived communication norms and targeted communication negatively predicted students' attitude toward alcohol use. In contrast, more frequent communication predicted students holding more approving attitudes toward alcohol. The relationship between parents' perceived communication norms and students' drinking behaviors was mediated by the parental communication variables and student attitudes. Tests of indirect effects were undertaken to examine meditational processes. The findings underscore relations involving parental perceived communication norms and parents' own alcohol communication and their children's drinking outcomes. The complex relationships of different types of parental communication and student outcomes warrant further research.

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.

Are they all the same? An exploratory, categorical analysis of drinking game types

Drinking games have become a ubiquitous part of the college student drinking culture and are associated with drinking to intoxication and increased alcohol consequences. Contemporary research commonly considers drinking games holistically, with little to no consideration to the different drinking game types. The current study describes the creation of a novel DG categorization scheme and reports differences between DG categories. Participants were 3421 college students (58% female) who completed online surveys. Based on participant responses, 100 distinct drinking games were identified and defined. Two student focus groups were conducted in which drinking game definitions and rules were verified by students. Drinking games were then categorized into five mutually exclusive categories: Targeted and Skill games, Communal games, Chance games, Extreme Consumption games, and Even Competition games. Finally, the frequency of games played in each category and typical player profiles were reported. Differences in peak drinks and frequency of specific alcohol consequences were documented according to game categories. The findings provide a novel drinking game categorization scheme and an exploratory analysis of basic differences between game categories.

Do as I Say, Not as You Perceive: Examining the Roles of Perceived Parental Knowledge and Perceived Parental Approval in College Students' Alcohol-Related Approval and Behavior

Objective

This study examined college students' accuracy in their perceptions of parental approval of engaging in various alcohol-related behaviors, evaluated the mediational role of student approval in the relation between perceived parental knowledge and drinking, and determined the extent to which perceived parental approval moderated the relation between perceived parental knowledge and student approval.

Design

Participants were 264 college student-parent dyads who completed independent online surveys.

Results

Students overestimated parental approval of the child drinking, and parents were more approving of a "typical student" drinking than they were of their own child drinking. Student approval mediated the relation between perceived parental knowledge and student drinking, controlling for other relevant predictors. Perceived parental approval moderated the relation between perceived parental knowledge and student approval, controlling for other notable predictors.

Conclusion

Parents continue to influence their child's alcohol-related attitudes and behaviors, even while in college.

Event-specific risk and ecological factors associated with prepartying among heavier drinking college students

Using event-specific data, the present study sought to identify relevant risk factors and risky drinking patterns associated with prepartying. Analyses focused on drinking outcomes as a function of drinking game playing and the social context on occasions where prepartying did and did not occur. This research utilized a representative two-site sample of prepartiers who also reported a heavy episodic drinking event in the past month (n=988). Results revealed that during a preparty event, participants drank significantly more, reached higher blood alcohol levels (BALs), and experienced significantly more negative consequences compared to the last occasion that they drank but did not preparty. Students who played drinking games when they prepartied had higher BALs and experienced more negative consequences than those who did not play drinking games. Whether females prepartied in a single-sex or coed setting had little effect on their BALs. For males, however, their BALs were greater when they prepartied in a coed setting compared to a single sex setting. Moreover, participants reported more negative consequences when they prepartied in a coed setting than in a single-sex setting. Finally, regression analyses demonstrated that participants' BAL, frequency of prepartying, and the interaction between BAL and frequency of prepartying all uniquely contributed to the prediction of event-specific alcohol-related negative consequences. As BAL increased, the number of negative consequences increased more sharply for those who prepartied infrequently, compared to those who prepartied frequently. Analyses were examined as a function of gender which revealed important gender effects and interactions. Interventions can be designed to intervene with high-risk prepartiers by using BAL education emphasizing the impact of time-limited prepartying drinking.

I can play all night: examining the relationship between perceived tolerance and drinking game alcohol consumption

The present study examined the impact of perceived tolerance to alcohol on maximum alcohol consumption while playing drinking games. Participants were student drinkers (N=3,546) from two west coast universities. Among these students, 69.2% (n=2,290) reported playing a drinking game in the past month. Analyses demonstrated game players had higher perceived tolerances, and consumed more alcohol than non-game players. A regression model revealed that higher levels of perceived tolerance were related to increased maximal alcohol consumption while playing drinking games. Study limitations and implications for future research are discussed.

Measuring college students' motives behind prepartying drinking: development and validation of the prepartying motivations inventory

Drinking motives are vital in identifying risk factors and better understanding alcohol-related outcomes. However, context-specific motivations could provide greater motivational perspective on high-risk context-specific alcohol use behaviors such as prepartying (consuming alcohol prior to attending one's intended destination) than general alcohol motivations. In the current study, students' open-ended responses to reasons for prepartying were collected from a large diverse sample (n=2497), and the most commonly offered reasons were used to create a prepartying motivations inventory (PMI) that was then administered to a different sample (n=1085). A split-half validation procedure was used for the purpose of evaluating the PMI's factor structure. Exploratory and confirmatory factor analyses yielded a final 16-item measure consisting of four distinct, but inter-related, factors: Interpersonal Enhancement, Situational Control, Intimate Pursuit, and Barriers to Consumption. Internal consistency reliability, discriminant validity, and criterion-related validity were empirically demonstrated. Results support the notion that individuals preparty for a variety of reasons that are distinct from general motives. Researchers are encouraged to use the PMI in future research with young adults to provide further understanding of prepartying behavior and its psychosocial correlates.

Prevalence, social contexts, and risks for prepartying among ethnically diverse college students

Prepartying, also known as pre-gaming, has emerged as a high-risk drinking event among U.S. college students. Research on factors related to prepartying behavior is in its relative infancy. The present study provides prevalence rates for prepartying across ethnic groups and examines how social context (whether prepartying took place with primarily male, female, or coed groups) and demographic factors may influence prepartying behavior. Participants were students from two West Coast universities (N=2546) whom identified as White, Asian and Pacific Islander American (APIA), Hispanic/Latino(a), or African American. The percentage of students who reported prepartying at least once in the past month, as well as the frequency and number of drinks consumed for prepartying occasions, varied by ethnic group and sex. A greater proportion of White students (60%) reported prepartying than Hispanic/Latino(a) (52%), African American (44%), and APIA (37%) students, though Hispanic/Latino(a) students who prepartied did so as often and consumed similar amounts of alcohol as White prepartiers. Across all ethnic groups, females who reported prepartying in coed groups consumed significantly more drinks than those who prepartied in primarily female groups. Finally, prepartiers within all ethnic groups consumed more drinks per week and experienced a higher number of alcohol-related consequences than non-prepartiers. The results suggest that future research and prevention programs should target prepartying and other high-risk events in at-risk students of ethnically diverse backgrounds and also consider the effects of gender in prepartying contexts on alcohol use.

Estimates and influences of reflective opposite-sex norms on alcohol use among a high-risk sample of college students: exploring Greek-affiliation and gender effects

Reflective opposite sex norms are behavior that an individual believes the opposite sex prefers them to do. The current study extends research on this recently introduced construct by examining estimates and influences of reflective norms on drinking in a large high-risk heterosexual sample of male and female college students from two universities. Both gender and Greek-affiliation served as potential statistical moderators of the reflective norms and drinking relationship. All participants (N=1790; 57% female) answered questions regarding the amount of alcohol they believe members of the opposite sex would like their opposite sex friends, dates, and sexual partners to drink. Participants also answered questions regarding their actual preferences for drinking levels in each of these three relationship categories. Overall, women overestimated how much men prefer their female friends and potential sexual partners to drink, whereas men overestimated how much women prefer their sexual partners to drink. Greek-affiliated males demonstrated higher reflective norms than non-Greek males across all relationship categories, and for dating partners, only Greek-affiliated males misperceived women's actual preferences. Among women however, there were no differences between reflective norm estimates or the degree of misperception as a function of Greek status. Most importantly, over and above perceived same-sex social norms, higher perceived reflective norms tended to account for greater variance in alcohol consumption for Greeks (vs. non-Greeks) and males (vs. females), particularly within the friend and sexual partner contexts. The findings highlight that potential benefits might arise if existing normative feedback interventions were augmented with reflective normative feedback designed to target the discrepancy between perceived and actual drinking preferences of the opposite sex.

Global sleep quality as a moderator of alcohol consumption and consequences in college students

The authors examined the relationship between global sleep quality and alcohol risk, including the extent to which global sleep quality moderated the relationship between alcohol use and drinking-related consequences. Global sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI) and alcohol-related consequences were assessed using the Rutgers Alcohol Problem Index (RAPI). The sample consisted of 261 college students (61.3% female, 58.2% Caucasian) who completed online surveys. Using a four-step hierarchical multiple regression model, global sleep quality was found to predict alcohol consequences, over and above assessed covariates (demographics and weekly drinking). Further, global sleep quality emerged as a strong moderator in the drinking-consequences relationship such that among heavier drinkers, those with poorer global sleep quality experienced significantly greater alcohol-related harm. Campus health education and alcohol interventions may be adapted to address the importance of maintaining a healthy lifestyle, both in terms of healthful sleeping and drinking behaviors, which appear to play a strong synergistic role in alcohol-related risk.

Poor adjustment to college life mediates the relationship between drinking motives and alcohol consequences: a look at college adjustment, drinking motives, and drinking outcomes

The current study examined whether the relationship between drinking motives and alcohol-related outcomes was mediated by college adjustment. Participants (N=253) completed an online survey that assessed drinking motives, degree of both positive and negative college adjustment, typical weekly drinking, and past month negative alcohol-related consequences. Structural equation modeling examined negative alcohol consequences as a function of college adjustment, drinking motives, and weekly drinking behavior in college students. Negative college adjustment mediated the relationship between coping drinking motives and drinking consequences. Positive college adjustment was not related to alcohol consumption or consequences. Positive reinforcement drinking motives (i.e. social and enhancement) not only directly predicted consequences, but were partially mediated by weekly drinking and degree of negative college adjustment. Gender specific models revealed that males exhibited more variability in drinking and their positive reinforcement drinking motives were more strongly associated with weekly drinking. Uniquely for females, coping motives were directly and indirectly (via negative adjustment) related to consequences. These findings suggest that interventions which seek to decrease alcohol-related risk may wish to incorporate discussions about strategies for decreasing stress and increasing other factors associated with better college adjustment.

Examining the relationships between acculturation orientations, perceived and actual norms, and drinking behaviors of short-term american sojourners in foreign environments

As little research has examined factors influencing increased and heavy drinking behavior among American sojourners abroad, this study was designed to examine how acculturation orientations (i.e., separation versus assimilation), host country per capita drinking rates, and perceptions about the drinking behavior among other sojourners and natives in the host country predicted alcohol risk abroad. A sample of 216 American college students completing study abroad programs completed a pre-abroad questionnaire to document their pre-abroad drinking levels, followed by a post-return questionnaire to assess drinking while abroad, acculturation orientations and perceived norms of drinking behavior within the foreign environment. A dichotomous variable was created to compare United States (U.S.) per capita drinking rates with those of the host country. Hierarchical repeated-measures ANOVAs examined the changes in drinking from pre-abroad to abroad levels. Participants studying in countries with higher drinking rates than the U.S. and those with higher perceptions about the drinking behavior in the country increased their drinking to a greater extent. Those with higher separation acculturation orientations and greater perceptions drank at heavier levels while abroad. Participants with a greater assimilation orientation and higher perceptions about native drinking, as well as those with a greater separation orientation and higher perceptions about other students' alcohol use drank the heaviest while abroad. These findings have implications for future preventive work with American students and other sojourning groups to promote pre-abroad knowledge of more accurate drinking norms and greater engagement in the culture to potentially prevent increased and heavier drinking.

Descriptive drinking norms: For whom does reference group matter?

OBJECTIVE

Perceived descriptive drinking norms often differ from actual norms and are positively related to personal consumption. However, it is not clear how normative perceptions vary with specificity of the reference group. Are drinking norms more accurate and more closely related to drinking behavior as reference group specificity increases? Do these relationships vary as a function of participant demographics? The present study examined the relationship between perceived descriptive norms and drinking behavior by ethnicity (Asian or White), sex, and fraternity/sorority status.

METHOD

Participants were 2,699 (58% female) White (75%) or Asian (25%) undergraduates from two universities who reported their own alcohol use and perceived descriptive norms for eight reference groups: "typical student"; same sex, ethnicity, or fraternity/sorority status; and all combinations of these three factors.

RESULTS

Participants generally reported the highest perceived norms for the most distal reference group (typical student), with perceptions becoming more accurate as individuals' similarity to the reference group increased. Despite increased accuracy, participants perceived that all reference groups drank more than was actually the case. Across specific subgroups (fraternity/sorority members and men) different patterns emerged. Fraternity/sorority members reliably reported higher estimates of drinking for reference groups that included fraternity/ sorority status, and, to a lesser extent, men reported higher estimates for reference groups that included men.

CONCLUSIONS

The results suggest that interventions targeting normative misperceptions may need to provide feedback based on participant demography or group membership. Although reference group-specific feedback may be important for some subgroups, typical student feedback provides the largest normative discrepancy for the majority of students.

Parents know best, but are they accurate? Parental normative misperceptions and their relationship to students' alcohol-related outcomes

OBJECTIVE

Parents often look to other parents for guidance, but how accurate are their perceptions? Expanding on existing normative literature to include parents of college students, this study first sought to determine whether parents accurately estimated the attitudes of other parents concerning their college student's alcohol-related behaviors. The effect of these (mis)perceived injunctive norms on the alcohol-related attitudes and behaviors of the parents' own children was then examined.

METHOD

Participants were 270 college student-parent dyadic pairs who completed independent online surveys. The student sample was 59% female; the parent sample was 78% female.

RESULTS

A structural equation model demonstrated that parents significantly overestimated other parents' approval of alcohol use by their respective child and, further, that these misperceptions strongly influenced parental attitudes toward their own child's drinking. Parental attitudes were subsequently found to be significantly associated with their child's attitudes toward drinking but were only marginally associated with the child's actual drinking, thereby underscoring the mediational effect of the child's attitudes.

CONCLUSIONS

This is the first study to document the influence of parental normative misperceptions regarding alcohol use by their college-age children, reinforcing the importance of parental attitudes on children's alcohol-related attitudes and behaviors in college. These findings support the need to complement student-based interventions with parent-based interventions aimed at increasing parental awareness and involvement. Further, the current findings indicate that normative interventions targeting parents offer a promising avenue by which to indirectly and positively influence college students' alcohol use.

Comparing Greek-Affiliated Students and Student Athletes: An Examination of the Behavior-Intention Link, Reasons for Drinking, and Alcohol-Related Consequences

While affiliation with Greek fraternities/sororities and intercollegiate athletic teams is associated with heavier drinking (Meilman et al., 1999), few studies have compared reasons for drinking among these groups. A sample of 1,541 students, identifying as either Greeks or athletes, completed an online survey. Athletes were significantly higher than Greeks on conformity reason for drinking. Tests of independent correlations indicated the magnitude of the past behavior to intention link was considerably stronger for Greeks. Greeks experienced significantly more social problems from drinking. Several group by gender ANOVA models found significant main effects with highest drinking rates, usually among Greek males, and lowest among female athletes. Understanding these specific group differences informs recommendations for group-specific and tailored educational interventions, which are discussed.

Direct and indirect effects of injunctive norms on marijuana use: the role of reference groups

OBJECTIVE

Little work has evaluated the relationship between injunctive norms and marijuana use. This study sought to establish whether misperceptions exist between perceived injunctive norms of typical college students and the actual approval level of the students. We also examined respondents' perceptions of which groups (typical student, close friends, and parents) were the most and least approving of marijuana. These variables were then applied to an explanatory model to assess their relationships with marijuana use.

METHOD

Participants were 3,753 students (61% female) randomly recruited from two West Coast campuses. Participants were asked about their own marijuana use and their own approval toward marijuana. Injunctive norms were assessed by asking respondents about their perceptions of how much other reference groups approved of marijuana.

RESULTS

Students overestimated the extent to which the typical student approves of marijuana use. A path model showed that perceived approval of both close friends and parents predicted actual/self-approval, which in turn was most predictive of personal marijuana use. Perceptions of typical-student and close friends' approval also directly predicted one's own use, whereas the path from parental approval to marijuana use was fully mediated by one's own approval.

CONCLUSIONS

Findings suggest that perceived injunctive norms may function differently with respect to marijuana use than they do with respect to alcohol use and raise questions about how to incorporate social-normative information into marijuana interventions.

"This would be better drunk": alcohol expectancies become more positive while drinking in the college social environment

The current study examined whether drinking and/or presence in the college social environment led to augmented positive alcohol expectancies among college students (N=225). Participants were approached during popular drinking nights as they exited events at which alcohol was consumed or in front of their residence as they returned home. Participants completed a brief questionnaire that included an assessment of demographics, breath alcohol concentration (BrAC), and positive expectancies. Within 48 h of baseline assessment, participants received via email a follow-up survey that re-assessed positive expectancies while sober. Positive sexual expectancies were more strongly endorsed while drinking in the college social environment for both males and females, while males also reported heightened liquid courage expectancies. In addition, positive expectancies were more strongly endorsed at higher doses of alcohol for males but not females. These findings suggest that interventions which seek to prevent alcohol abuse by targeting alcohol expectancies may wish to challenge positive expectancies in naturalistic college social settings.

Comparing injunctive marijuana use norms of salient reference groups among college student marijuana users and nonusers

Marijuana is the most commonly used illicit drug among college students and has the potential for various negative outcomes. Perceptions of what constitutes typical approval/acceptability of a reference group (i.e. injunctive social norms) have been shown to have strong utility as predictors of health-risk behaviors in the college context, yet this construct remains significantly understudied for marijuana use despite its potential for use in social norms-based interventions. The current research evaluated individuals' marijuana approval level and their perceptions of others' marijuana approval level (i.e. injunctive norms) for various reference groups (typical student on campus, one's close friends, and one's parents) as a function of individual user status (abstainers, experimenters, occasional users, and regular users). A diverse sample of 3553 college students from two universities completed an online survey. Among all user status groups, individual approval yielded mean scores paralleling that of perceived close friends' approval and all groups were relatively uniform in their perception of typical students' approval. Higher levels of marijuana use tended to produce higher endorsements of individual approval, perceived close friends' approval, and perceived parental approval. Among occasional and regular users, there were no differences between one's own approval level for use and the perceptions of close friends' approval, nor did they think the typical student was more approving than themselves. Abstainers and experimenters, however, perceived typical students and close friends to have more permissive attitudes than themselves. Implications and future directions for research regarding the role of injunctive marijuana use norms in the development of social norms intervention are discussed.

How drunk am I? Misperceiving one's level of intoxication in the college drinking environment

One effective event-level index that can assist in identifying risky intoxication levels among college students is blood alcohol concentration (BAC). Despite widespread exposure to BAC information, doubt exists as to whether American college students can accurately estimate their own BAC level or drinking behaviors while intoxicated. This study assessed whether students can accurately guesstimate their BAC level and drinking behaviors used to estimate BAC (eBAC) while drinking in social college settings. Participants (N = 225; 56.4% male) consisted of emerging adults attending either a 2- or 4-year college who had at least one alcoholic drink within the 2 hr before assessment. Participants were approached at night when returning from parties and/or alcohol-serving establishments. They completed an initial questionnaire, gave a breath sample to assess breath alcohol content, and then completed an online follow-up questionnaire within 48 hr of baseline assessment. Participants at lower levels of intoxication tended to slightly overestimate their BAC level, while those at higher levels tended to markedly underestimate their BAC level. In addition, discrepancies among breath alcohol content, guesstimated BAC, and eBAC were found as a function of gender. Lastly, differences in eBAC scores did not differ when drinking behaviors were obtained via in vivo versus retrospective methodology. Findings suggest that college students generally have difficulty assessing their BAC level and drinking behaviors while drinking in the college social setting. This study offers particular insight for research relying on estimates of BAC as well as interventions utilizing BAC education.

How drunk am I? Misperceiving one's level of intoxication in the college drinking environment

One effective event-level index that can assist in identifying risky intoxication levels among college students is blood alcohol concentration (BAC). Despite widespread exposure to BAC information, doubt exists as to whether American college students can accurately estimate their own BAC level or drinking behaviors while intoxicated. This study assessed whether students can accurately guesstimate their BAC level and drinking behaviors used to estimate BAC (eBAC) while drinking in social college settings. Participants (N = 225; 56.4% male) consisted of emerging adults attending either a 2- or 4-year college who had at least one alcoholic drink within the 2 hr before assessment. Participants were approached at night when returning from parties and/or alcohol-serving establishments. They completed an initial questionnaire, gave a breath sample to assess breath alcohol content, and then completed an online follow-up questionnaire within 48 hr of baseline assessment. Participants at lower levels of intoxication tended to slightly overestimate their BAC level, while those at higher levels tended to markedly underestimate their BAC level. In addition, discrepancies among breath alcohol content, guesstimated BAC, and eBAC were found as a function of gender. Lastly, differences in eBAC scores did not differ when drinking behaviors were obtained via in vivo versus retrospective methodology. Findings suggest that college students generally have difficulty assessing their BAC level and drinking behaviors while drinking in the college social setting. This study offers particular insight for research relying on estimates of BAC as well as interventions utilizing BAC education.

Group identification as a moderator of the relationship between perceived social norms and alcohol consumption

Previous research has shown that social norms are among the strongest predictors of college student drinking. Among college students, perceiving that others drink more heavily than themselves has been strongly and consistently associated with heavier drinking. Research has also shown that the more specifically others are defined, the stronger the association is with one's own drinking. In the current research, we evaluated whether group identification as defined by feeling closer to specific groups moderates the associations between perceived drinking norms in the group and one's own drinking. Participants included 3,752 (61% female) students who completed online assessments of their perceived drinking norms for 4 groups of students on their campus and identification with each group and participants' own drinking behavior. Results indicated that greater identification with same-sex students, same-race students, and same-Greek-status students was associated with stronger relationships between perceived drinking norms in the specific groups and own drinking.

WARMING UP AND STAYING LOOSE: THE PREVALENCE, STYLE, AND INFLUENCE OF PREPARTYING BEHAVIOR AND DRINKING GAMES AMONG INTERCOLLEGIATE ATHLETES

This study investigates the prevalence and influence of prepartying behavior along with the co-occurrence of drinking game participation among a sample of Division 1 student-athletes (N = 568) from two institutions. Results indicate that 67% (n =382) of the sample had prepartied in the past month, with 36% (n = 205) of the overall sample also having typically played drinking games in that context. Individuals that typically played drinking games while prepartying reported higher risk on the main outcome variables of overall past month alcohol consumption, prepartying-specific drinking behavior, and negative alcohol-related consequences than the prepartying-only group, which in turn evidenced higher consumption and risk when compared to the non-prepartying group. Moreover, males, as compared to females, demonstrated elevated scores on all outcome variables. Implications include the potential to help inform both prevention and intervention efforts among student-athletes.

Underestimations of blood alcohol concentration predict event-specific negative consequences

The current study sought to establish in vivo misperception of blood alcohol concentration (BAC) as a predictor of event-specific alcohol-consumption-related negative consequences. During spring 2010, 225 (56.4% male) college students, who had consumed at least one alcoholic drink within the 2 hr prior to assessment, completed a questionnaire, gave a breath sample to assess breath alcohol content, and later completed a follow-up questionnaire. Underestimation of BAC was predictive of event-specific, alcohol-consumption-related negative consequences, over and above other factors including total drinks consumed. This study highlights the need for more focused BAC education strategies at American universities.