Use of alcohol protective behavioral strategies among college students: a critical review

Protective behavioral strategies (PBS) are specific behaviors one can utilize to minimize the harmful consequences of alcohol consumption. Recently, there has been an increasing amount of interest in use of PBS among college students, especially as an intervention target. The purpose of the present comprehensive review of the PBS literature was to examine the measurement of PBS and summarize the quantitative relationships between PBS use and other variables. The review found inconsistency across studies in terms of how the use of PBS is operationalized and found only two PBS measures with good psychometric properties that have been replicated. Although several antecedents to PBS use were identified, most were only examined in single studies. Moderators of the predictive effects of PBS use on outcomes have similarly suffered from lack of replication in the literature. Of all 62 published reports reviewed, 80% reported only cross-sectional data, which is unfortunate given that PBS use may change over time and in different contexts. In addition, only two attempted to minimize potential recall biases associated with retrospective assessment of PBS use, and only two used an approach that allowed the examination of both within-subject and between-subject effects. In terms of the gaps in the literature, there is a dearth of longitudinal studies of PBS use, especially intensive longitudinal studies, which are integral to identifying more specifically how, when, and for whom use of PBS can be protective.

Distinguishing subpopulations of marijuana users with latent profile analysis

BACKGROUND

Although marijuana is the most commonly used illicit drug in the United States, little is known about the effects of typical marijuana use patterns and whether there are distinct subgroups of marijuana users.

METHODS

The present study used latent profile analysis to determine the number of distinct subgroups of marijuana users in a large sample of college students (n=2129 past month marijuana users across 11 universities). We also examined how these distinct groups differ on several putative risk/protective factors (e.g., personality traits, perceptions of marijuana, and motives for using marijuana).

RESULTS

Using the Lo-Mendell-Rubin Likelihood Ratio Test, we identified four latent classes with the largest class consisting of infrequent marijuana users, and three other classes demonstrating increasingly frequent use and more negative consequences with the most severe class being the smallest class. We found the largest between-class differences (i.e., distinctions across classes) to be on identification with being a marijuana user and use of protective behavioral strategies (PBS), such that the heavier user classes showed higher identification with marijuana users and lower use of PBS.

CONCLUSIONS

Our findings demonstrate that college student marijuana users are a heterogeneous group with different profiles of risk/protective factors and that those who use marijuana a few times per month are different from those who are near-daily or daily users. Our findings also serve as a call to action for the field to consider examining identification with being a marijuana user and the use of PBS in future marijuana studies.

Marijuana eCHECKUPTO GO: Effects of a personalized feedback plus protective behavioral strategies intervention for heavy marijuana-using college students

BACKGROUND

Marijuana use is common among U.S. college students. Liberalization of marijuana use policies is hypothesized to decrease social norms discouraging use, which protects against marijuana use. This may increase the importance of protective behavioral strategies (PBS) to reduce marijuana use harm.

METHODS

This study tested direct and moderated (by sex) program effects of an adapted version of the Marijuana eCHECKUPTO GO, a web-based marijuana use intervention providing university-specific personalized feedback (PF) with normative information and PBS to students attending a university in a state with legalized adult recreational marijuana. Participants were 298 heavy-using college students randomly assigned to receive Marijuana eCHECKUPTO GO or strategies for healthy stress management (HSM). General linear models (GLMs) tested direct program effects on proximal intervention targets, marijuana use, and use consequences. Multi-group GLMs then tested the moderating effect of sex on direct intervention effects.

RESULTS

Marijuana eCHECKUPTO GO participants reported decreases in estimated use prevalence (i.e., descriptive norms), self-reported hours high per week, days high per week, periods high per week, and weeks high per month. Sex moderated intervention effects on the use of PBS such that females in the PF condition increased their use of PBS more than males.

CONCLUSION

Results demonstrate preliminary support for the adapted Marijuana eCHECKUPTO GO in reducing marijuana use for "heavy college-aged users". Future research should test adapted Marijuana eCHECKUPTO GO sustained effects over time, and examine whether program effects on harm reduction manifest after sustained (e.g., booster) program implementation.

A cross-lagged panel model examining protective behavioral strategies: are types of strategies differentially related to alcohol use and consequences?

Protective behavioral strategies (PBS) are skills that can be used to reduce the risk of alcohol-related negative consequences. Studies have shown that, in general, PBS are related to less alcohol consumption and fewer negative consequences; however, other studies have suggested that not all types of PBS (e.g., stopping/limiting drinking [SLD], manner of drinking [MOD] and serious harm reduction [SHR]) are equally effective at reducing alcohol risk. In addition, few studies have explored the longitudinal relationships among PBS, alcohol use and consequences. Using a sample of heavy drinking college students (N=338), the current study examined PBS use, alcohol consumption and consequences across two time points three months apart. Cross-lagged panel models revealed that MOD predicted a reduction in alcohol use and negative consequences. SHR was longitudinally related to fewer negative consequences, but unrelated to alcohol use. SLD was not associated with drinking or consequences at follow-up. These results highlight the need for future research to examine the effects of different types of PBS and have implications for alcohol intervention programs that incorporate PBS skills training.

Marijuana protective behavioral strategies as a moderator of the effects of risk/protective factors on marijuana-related outcomes

Given that both marijuana use and cannabis use disorder peak among college students, it is imperative to determine the factors that may reduce risk of problematic marijuana use and/or the development of cannabis use disorder. From a harm reduction perspective, the present study examined whether the use of marijuana protective behavioral strategies (PBS) buffers or amplifies the effects of several distinct risk and protective factors that have been shown to relate to marijuana-related outcomes (i.e., use frequency and consequences). Specifically, we examined marijuana-PBS use as a moderator of the effects of impulsivity-like traits, marijuana use motives, gender, and marijuana use frequency on marijuana-related outcomes in a large sample of college students (n=2093 past month marijuana users across 11 universities). In all models PBS use was robustly related with use frequency and consequences (i.e., strongly negatively associated with marijuana outcomes). Among interactions, we found: 1) unique significant interactions between specific impulsivity-like traits (i.e., premeditation, perseverance, and sensation seeking) and marijuana-PBS use in predicting marijuana consequences, 2) unique significant interactions between each marijuana use motive and marijuana-PBS use in predicting marijuana use frequency and 3) marijuana-PBS use buffered the risk associated with male gender in predicting both marijuana outcomes. Our results suggest that marijuana-PBS use can buffer risk factors and enhance protective factors among marijuana using college students. Future research is needed to understand context-specific factors and individual-level factors that may make marijuana-PBS use more effective.

Impulsive sensation seeking, binge drinking, and alcohol-related consequences: Do protective behavioral strategies help high risk adolescents?

This study examined protective behavioral strategies (PBS) as a moderator of the relationship between impulsive sensation seeking and binge drinking and alcohol-related consequences in a sample of high school seniors (N=346). Hierarchical regression analyses indicated that impulsive sensation seeking was a significant predictor of binge drinking and alcohol-related consequences and that PBS moderated these relationships. Specifically, manner of drinking moderated the relationships such that among students with high impulsive sensation seeking, those using strategies related to how they drink (e.g. avoiding rapid and excessive drinking) reported lower levels of binge drinking and alcohol-related consequences than those using fewer of these strategies. Clinical implications are discussed including using personality-targeted interventions that equip high impulsive sensation seeking adolescents with specific strategies to reduce binge drinking and alcohol-related consequences.

Protective behavioral strategies mediate problem-focused coping and alcohol use in college students

OBJECTIVE

Protective behavioral strategies have emerged as a construct protective against alcohol use. The current study examines the theoretical associations among general coping styles, protective behavioral strategies, drinking to cope motives, and alcohol use in college students.

METHOD

Analyses of fully latent variables were conducted using structural equation modeling in a sample of 327 college students.

RESULTS

Protective behavioral strategies partially mediated the association between problem-focused coping and alcohol use. Behaviorally oriented problem-focused coping strategies accounted for the positive relationship between problem-focused coping and protective behavioral strategies whereas cognitively oriented problem-focused coping strategies were associated with less use of protective behavioral strategies and increased alcohol use.

CONCLUSIONS

This is the first study to find that protective behavioral strategies are more likely to be used by college students who endorse using a problem-focused coping style, especially if they tend to use behaviorally oriented problem-focused coping strategies. These findings extend the literature on protective behavioral strategies and indicate that students less likely to use problem-focused coping skills to deal with stress in general may need additional interventions to increase their use of protective behavioral strategies.

Regulate yourself: Emotion regulation and protective behavioral strategies in substance use behaviors

Although research suggests links between emotion regulation strategies and substance use outcomes, little work has examined the relationship between specific strategies (i.e., reappraisal and suppression) and outcomes (i.e., alcohol and cannabis consumption and related problems). To date, no research has examined the association between emotion regulation strategies and protective behavioral strategies used while engaging in substance use. Thus, the current study examined these relations for females and males. Undergraduates (N = 643) completed an online battery of self-report measures. Using structural equation modeling, results indicated improved Emotion Regulation Questionnaire model fit after one item was removed. Reappraisal was negatively associated with alcohol binge frequency and related problems for females, though suppression was negatively related to these outcomes for males. Reappraisal was also negatively associated with cannabis-related problems for males only. Reappraisal was positively associated with all types of protective behavioral strategies use for females, whereas only alcohol-specific serious harm reduction and cannabis protective behavioral strategies were significant for males. Latent variable interactions between reappraisal and protective behavioral strategies were significant for past-month cannabis use and related problems for males and indicated protective behavioral strategies use was more protective against past-month use and cannabis-related problems for those high in reappraisal. Although replication is necessary, these preliminary findings suggest the link between emotion regulation strategies and substance use outcomes among college students is complex and future work may benefit from examining these relations from an emotion regulation flexibility perspective.

Friend or foe: Personal use and friends' use of protective behavioral strategies and spring break drinking

The present study examined associations between use of protective behavioral strategies (PBS) by college students and their friends and drinking-related outcomes during Spring Break (SB). Moreover, this study examined the influence of friends' own PBS use on participants' PBS use during SB. Participants included college students (N = 694) and their nominated friends (N = 131) who were part of a larger study of SB drinking. Data were collected via web-based surveys that participants and friends took after SB, which assessed SB PBS, drinking, and related negative consequences. Results indicated that higher levels of Serious Harm Reduction (SHR) strategies and Limiting/Stopping (LS) strategies were associated with increased consumption, higher likelihood of experiencing any consequences, and an increased number of consequences. A different pattern emerged for Manner of Drinking (MD) strategy use; participants utilizing higher levels of MD strategies drank less and had fewer consequences. LS and MD strategies used by the participant's friends appeared to have less of an impact on the participant's drinking outcomes. However, greater friends' use of SHR strategies was associated with increased alcohol use by the participant, but not with consequences. Greater friends' use of SHR strategies was associated with greater SHR strategy use by the participant. Friends' LS and MD strategies were not associated with participant drinking, consequences, or PBS. These findings highlight the potential utility of interventions that focus on drinking behaviors on specific high-risk occasions for those at risk as well as for their friends.

Moderators of the Effects of Alcohol Protective Behavioral Strategies: Three Attempts of Replication and Extension

BACKGROUND

Protective behavioral strategies (PBS) can be used to reduce alcohol-related harm when drinking. Despite much research demonstrating that use of protective behavioral strategies (PBS) is associated with decreased alcohol use/problems, few studies have examined moderators of these associations. Moderation tests are important as they define the boundary conditions of the protective effects of PBS use (i.e., identify for whom and in what context PBS use reduces harm).

OBJECTIVES

We aimed to replicate and extend the findings from three published studies that have examined putative moderators of PBS-alcohol associations: self-regulation, negative urgency, and drinking refusal self-efficacy.

METHOD

Participants were recruited from a psychology department participant pool at a large, southwestern university in the United States (N = 628).

RESULTS

Although we replicated most main effects and bivariate correlations, we failed to replicate any of the moderation effects (i.e., interaction effects). Conclusions/Importance: We urge PBS researchers to attempt to replicate moderation effects in independent samples to determine these effects' reproducibility. Limitations and future directions are discussed.

A longitudinal examination of protective behavioral strategies and alcohol consumption among adult drinkers

Previous studies suggest that employing specific behavioral strategies when drinking can prevent excessive alcohol consumption and related harms. However, these studies have typically examined these 'protective behavioral strategies' (PBSs) in combination, limiting understanding of whether individual strategies differ in their effectiveness. Further, most existing research is cross-sectional in design, precluding the determination of causal relationships between PBS use and alcohol consumption. To address these research gaps, the present study sought to longitudinally (i) identify which individual PBSs are significantly related to reduced alcohol consumption over time and (ii) explore the effectiveness of individual PBSs among specific population groups. The sample comprised 1328 Australian adult drinkers (47% male) who completed an online survey assessing engagement in PBSs and alcohol consumption at two time points approximately four weeks apart. Reported enactment of the PBS 'Count your drinks' was associated with a significant reduction in alcohol consumption between T1 and T2. In contrast, enactment of the PBSs 'Ask a friend to let you know when you have had enough to drink', 'Put extra ice in your drink', 'Use a designated driver', and 'Leave drinking venues at a pre-determined time' was associated with an increase in alcohol consumption. The results thus suggest that many PBSs may not be effective in reducing alcohol consumption and that some may be associated with higher levels of intake. The results have implications for the development of harm-minimization campaigns designed to encourage drinkers to reduce their alcohol consumption.

The event-level impact of one's typical alcohol expectancies, drinking motivations, and use of protective behavioral strategies

INTRODUCTION

Much of the past research on the excessive consumption of alcohol by college students has focused on the interplay of individual factors and typical drinking patterns, but this is not adequate to understand behavior as it occurs. The need to understand drinking at the event-level is critical in order to develop event-level prevention. To this end, this study examined a conceptual model of college students' drinking events in order to determine the potential mediating effect of drinking motives and protective behavioral strategies (PBS) in the relationship between alcohol expectancies and event-level alcohol use and consequences.

METHODS

An existing data set containing information about 2279 college student drinking events were analyzed for this study. Students completed surveys during the administration of a commercial online alcohol course during 2010 and 2011. A theoretical model was analyzed with structural equation modeling.

RESULTS

Both typical use of PBS and drinking motives mediated the relationship between expectancies and event-level alcohol use and problems. Positive expectancies were associated with greater positive motives, greater motives were associated with less use of PBS, and less PBS use was then, in turn, associated with higher event-level intoxication. Lastly, higher intoxication was associated with more serious consequences during the event.

CONCLUSION

This is the first study to simultaneously explore the relationship between these factors and event-level drinking. There is a great need to continue to further explore the dynamic nature of drinking at the event-level to illuminate potential leverage points amendable to change.

Perceived vulnerability moderates the relations between the use of protective behavioral strategies and alcohol use and consequences among high-risk young adults

Drinking protective behavioral strategies (PBS) have been associated with reductions in alcohol use and alcohol-related consequences in young adults. PBS subscales, Limiting/Stopping (LS), Manner of Drinking (MOD), and Serious Harm Reduction (SHR), have been examined in the literature; LS, MOD, and SHR have mixed support as protective factors. Understanding moderators between PBS and alcohol use and related consequences is an important development in PBS research in order to delineate when and for whom PBS use is effective in reducing harm from alcohol use. Perceptions of vulnerability to negative consequences, included in health-risk models, may be one such moderator. The current study examined whether two types of perceived vulnerability (perceived vulnerability when drinking; perceived vulnerability in uncomfortable/unfamiliar situations) moderated the relations between LS, MOD, SHR strategies and alcohol use and related negative consequences. High-risk young adults (N = 400; 53.75% female) recruited nationally completed measures of PBS, alcohol use and related consequences, and measures of perceived vulnerability. Findings demonstrated that perceived vulnerability when drinking moderated the relations between MOD strategies and alcohol use. The interactions between perceived vulnerability when drinking and PBS did not predict alcohol-related consequences. Perceived vulnerability in unfamiliar/uncomfortable social situations moderated relations between MOD strategies and both alcohol use and related negative consequences; no other significant interactions emerged. Across both perceived vulnerability types and MOD strategies, those with the highest levels of perceived vulnerability and who used MOD strategies the most had the greatest decrements in alcohol use and related negative consequences. Prevention and intervention implications are discussed.

Protective behavioral strategy use and motivations for drinking: exploring Alternatives to Drinking strategies

Protective behavioral strategy (PBS) use is associated with less alcohol consumption and fewer alcohol-related problems. Further, greater endorsement of social or enhancement drinking motives (i.e., positive motives) is associated with less frequent PBS use. Limited research has, however, explored coping or conformity motives (i.e., negative motives) in relation to PBS. Consequently, the present study aimed to (1) identify the types of PBS most strongly associated with negative and positive motives and (2) examine different types of PBS as mediators of the relationship between each drinking motive and alcohol outcomes. Participants were college students (n=303; 70% women) who completed measures of drinking motives, PBS, alcohol use, and alcohol-related problems. Results indicated that greater endorsement of positive drinking motives were more strongly associated with less frequent use of PBS while drinking whereas negative motives were more strongly related to less frequent Alternatives to Drinking strategy use. Further, strategies used while drinking were more relevant in a model of positive drinking motives and Alternatives to Drinking strategies were more relevant in a model of negative motives. These findings may suggest that whereas individuals with stronger positive motives have difficulty using strategies while drinking, individuals who drink to cope or conform have greater difficulty utilizing Alternatives to Drinking strategies. Based on our results demonstrating that different types of PBS are more relevant for various types of drinkers, it may be important for future interventions to discuss not only the participant's PBS use but also their motivations for consuming alcohol.

Weighing the Pros and Cons of Using Alcohol Protective Behavioral Strategies: A Qualitative Examination among College Students

BACKGROUND

Alcohol protective behavioral strategies (PBS) are behaviors engaged in immediately prior to, during, after, or instead of drinking with the explicit goal of reducing alcohol use, intoxication, and/or alcohol-related harms. Despite the quantitative support for alcohol PBS as a protective factor among college student drinkers, we know of no qualitative research aimed at determining college student drinkers' perceptions regarding the advantages and disadvantages of using PBS.

OBJECTIVES

In the style of a decisional balance exercise, we asked college student drinkers (analytic n = 113) to identify 5 reasons they would not use PBS (cons) and 5 reasons they would use PBS (pros).

METHOD

Participants (majority female, 77.0%) were recruited from a psychology department participant pool at a large, southeastern university in the United States. Within our analytic sample, participants on average consumed 6.38 (SD = 8.16) drinks per typical week of drinking and reported consuming alcohol on average 7.5 days (SD = 5.83) in the last 30 days.

RESULTS

Using a descriptive phenomenological approach, we identified 2 themes for pros (prevention of specific negative alcohol-related consequences and general safety) and 4 themes for cons (goal conflict, ineffectiveness, difficulty of implementation, and negative peer/social repercussions). Overall, participants reported more pros than cons and this discrepancy (i.e., number of PBS pros minus number of PBS cons) was positively related to self-reported frequency of PBS use. Conclusions/Importance: Taken together, we hope that clinicians/researchers will probe individual's reasons for choosing to use (or not use) PBS in order to tailor or improve existing PBS-based interventions.

Endorsement of the "firewater myth" affects the use of protective behavioral strategies among American Indian and Alaska Native students

Belief in an American Indian/Alaska Native (AI/AN) specific biological vulnerability (BV) to alcohol problems (aka the "firewater myth") has been found to be associated with worse alcohol outcomes among AI/AN college students who drink, despite also being associated with greater attempts to reduce drinking. In the current study, we examined the associations of belief in a BV and belief that AI/AN people have more alcohol problems with the use of alcohol protective behavioral strategies (PBS) among AI/AN college students. PBS examined, as measured by the Protective Behavioral Strategies Scale-20, included manner of drinking, limiting/stopping drinking, and serious harm reduction strategies. Participants were college students who identified being AI/AN (n = 137) and had drank in the past month, and were selected from a larger multi-site study on PBS. Mediation models revealed that greater belief in a BV and belief that AI/AN people have more alcohol problems were both negatively associated with manner of drinking, which in turn was associated with greater past month alcohol use and alcohol consequences. These beliefs were not significantly associated with other PBS. Consistent with prior research with other student populations, both manner of drinking and limiting/stopping drinking were associated with less alcohol use and all three domains of PBS were directly associated with fewer alcohol consequences. The results suggest that these beliefs regarding AI/AN people and alcohol negatively affect the use of strategies aimed at avoiding drinking behavior that can lead to rapid drinking and a higher blood alcohol content, contributing to alcohol consequences.

Alcohol-related protective behavioral strategies as a mediator of the relationship between drinking motives and risky sexual behaviors

Risky sexual behaviors (RSB) frequently occur in the context of alcohol use and are associated with distinct drinking motives among college students. Use of alcohol protective behavioral strategies (PBS) is associated with reductions in alcohol use and related problems, which may extend to alcohol-related RSB. Moreover, as PBS use mediates the relationship between positive reinforcement drinking motives and alcohol-related problems, the same may be true for alcohol-related RSB, specifically. The current study examined whether PBS mediates the relationship between drinking motives and RSB among college students. Participants (N = 2039, 72.8% female, M_age = 19.79) from ten universities across ten U.S. states completed an online survey assessing past-month drinking motivation, alcohol PBS, alcohol consumption, and RSB. To test study aims, a saturated path model in which drinking motives were modeled as predictors of RSB via PBS use subscales and alcohol consumption was conducted. Several double mediation effects were found, such that stronger endorsement of motives (i.e., social, enhancement, conformity, coping for depression) were associated with lower PBS (particularly manner of drinking and serious harm reduction), which was associated with higher alcohol use, which was associated with higher RSB. Multi-group models found the mediation effects to be gender invariant, although several differences in direct associations were found across genders. For college students high in positive reinforcement motives (i.e., social or enhancement) for drinking, interventions that aim to increase PBS use, specifically related to modifying the manner in which one drinks and avoiding very dangerous consequences, may be effective in reducing alcohol-related RSB.

Understanding perceived usefulness and actual use of protective behavioral strategies: The role of perceived norms for the reasons that young adult drinkers use protective behavioral strategies

INTRODUCTION

The current study examines the norms-behavior link by investigating a novel cognition for protective behavioral strategies (PBS)-descriptive and injunctive norms for close friends' reasons to use PBS (e.g., limit drinking, reduce consequences)-in relation to one's own perception of usefulness and personal use of PBS. Further, we tested whether the association between perceived norms for reasons to use PBS and personal PBS use was mediated by perceived usefulness of PBS.

METHODS

College student drinkers ages 18-24 [N = 301; 53% female, 69% White, mean age = 20.16 years (SD = 1.54)] were recruited for a larger study. Eligible students reported alcohol use 2+ days a week and 1+ occasions of heavy episodic drinking in the last two weeks. Linear regression tested whether descriptive and injunctive norms for reasons to use PBS were associated with perceived usefulness and personal use of PBS; path analysis was used to test mediation. All analyses were conducted by PBS subscale (limiting/stopping, serious harm reduction, manner of drinking).

RESULTS

Descriptive norms for reasons to use PBS (i.e., perceptions that close friends use PBS to reduce drinking/consequences) were positively associated with perceived usefulness and personal PBS use for limiting/stopping and to some extent manner of drinking. For each subscale, the association between descriptive norms for reasons to use PBS and personal PBS use was mediated by perceived usefulness of PBS. Results were not significant for injunctive norms.

CONCLUSIONS

Findings suggest descriptive norms, rather than injunctive norms, for close friends' reasons to use PBS, may be relevant for inclusion in brief interventions.

A psychometric evaluation of the Protective Behavioral Strategies Scale-20 among internet samples of adult drinkers

Protective behavioral strategies (PBS) are most commonly defined as behaviors that are used while drinking to reduce alcohol use and/or limit alcohol-related problems. Few studies have examined and quantified PBS use among non-college student populations. The purpose of the present two studies was to evaluate the psychometric properties of the Protective Behavioral Strategies Scale-20 (PBSS-20; Treloar, Martens, & McCarthy, 2015) among internet samples of adult drinkers. In the first study, we conducted an exploratory factor analysis of the PBSS-20 with a sample (n = 360) of adult drinkers who were recruited from Mechanical Turk. We then conducted a second study that recruited adult drinkers from Mechanical Turk and randomly split the data in half. With the first split-half sample (n = 339), we conducted a confirmatory factor analysis of the PBSS-20 and assessed the internal consistency and concurrent validity of the subscales. With the second split-half sample (n = 338), we tested measurement invariance across gender. The results support a three-factor structure of the PBSS-20 that is similar to what has been found among college students. However, six items were dropped and two Serious Harm Reduction items loaded best onto the Manner of Drinking factor. Furthermore, two subscales demonstrated adequate internal consistency and all three subscale were negatively associated with alcohol-related outcomes. Similar to college students, there was lack of measurement invariance across gender. We discuss the implications of the present findings in extending research on PBS to the more general population of U.S. adult drinkers.

The role of underutilization of protective behavioral strategies in the relation of social anxiety with risky drinking

Social anxiety is prominent among undergraduates and increases the risk of experiencing alcohol problems. In fact, social anxiety more than quadruples the risk of developing an alcohol use disorder, yet it is inconsistently related to heavier drinking. Inconsistent findings may be due to lack of attention on protective behavioral strategies (PBS) among socially anxious drinkers. PBS are cognitive-behavioral strategies to reduce drinking and alcohol-related harm. Due to the nature of social anxiety, affected individuals may be especially vulnerable to PBS underutilization, leading to heavier and more problematic drinking. The current study examined the mediating role of PBS in the relationships of social anxiety with past-month drinking and alcohol problems using cross-sectional data among current (past-month) heavy undergraduate drinkers (N = 431). Social anxiety was significantly positively related to past-month alcohol problems and peak drinking. Social anxiety was significantly negatively related to typical drinking, drinking frequency, and PBSS Manner of Drinking. Social anxiety was indirectly (via PBSS Manner of Drinking) related to greater past-month peak drinks and more drinking problems. Findings suggest that socially anxious persons may be vulnerable to heavier and more problematic drinking due to PBS underutilization. Treatment implications are discussed.

Use of protective behavioral strategies and blackout experience among mandated college students

OBJECTIVE

Alcohol-induced blackouts are experienced by approximately half of college students who drink. People who use protective behavioral strategies (PBS) tend to experience fewer alcohol-related consequences of drinking, but the relationship between PBS and blackouts is unknown. This study examines the associations among the use of protective behavioral strategies and blacking out.

METHODS

Participants were 484 college students, aged 18-22 (56% male, 51% first-year), who were mandated to complete alcohol education following an alcohol violation. Before the intervention, participants completed questionnaires that included questions about past month peak consumption, alcohol-related consequences, marijuana use frequency, and frequency of PBS use. Logistic regression analyses were conducted to evaluate how use of PBS was related to the odds of experiencing a blackout, controlling for consumption and other risk factors.

RESULTS

Participants endorsing greater overall use of PBS had decreased odds of having experienced a blackout. However, this association depended on the type of PBS being used. Participants endorsing greater use of PBS regarding manner of drinking and stopping/limiting drinking had decreased odds of having experienced a blackout, but those who endorsed greater use of PBS relating to serious harm reduction did not.

CONCLUSIONS

This study adds nuance to the idea that PBS protect against adverse alcohol-related consequences. Only PBS that serve to limit or slow consumption appear to be protective against experiencing blackouts. Research on specific associations between types of PBS and consequences may lead to improved outcomes in interventions that incorporate PBS.

College Alcohol Beliefs and Alcohol Outcomes: The Mediating Effects of Alcohol Protective Behavioral Strategies

The present study examined the mediating role of alcohol protective behavioral strategies (i.e. serious harm reduction [PBS-SHR], manner of drinking [PBS-MOD], stopping/limiting drinking [PBS-SLD]) on the relationships between college alcohol beliefs and alcohol outcomes (i.e. hazardous drinking and alcohol-related negative consequences) in an attempt to replicate recent findings in the early stages of college alcohol belief and PBS research. Methods: Participants were 625 traditional age undergraduate college students (M = 19.00, SD = 1.72; 63.7% White; 80.7% female) recruited from a southeastern United States university who reported past 30-day alcohol consumption. All participants completed measures of college alcohol beliefs, alcohol PBS use, hazardous drinking, and alcohol-related negative consequences through an online survey. Results: Higher college alcohol beliefs were associated with greater hazardous drinking and alcohol-related negative consequences. Further, PBS-MOD mediated the positive relationship college alcohol beliefs had with hazardous drinking, such that higher college alcohol beliefs predicted less PBS-MOD use which was associated with greater hazardous drinking. Discussion: These findings provide further evidence to support previous findings highlighting the additional protective value of certain alcohol PBS especially for college students with high college alcohol beliefs.

Factor analysis of a short form of the Protective Behavioral Strategies for Marijuana scale

OBJECTIVE

The Protective Behavioral Strategies for Marijuana Scale (PBSM), a 17-item scale targeting strategies for mitigating the negative consequences of cannabis use, highlights a range of behaviors that can reduce harm beyond straightforward decreases in quantity or frequency. The 17-item scale's factor structure remains under-examined but could reveal meaningful distinctions among strategies. This study aimed to confirm the factor structure of the short form of the PBSM.

METHODS

This study recruited cannabis-using undergraduates (N = 454,M_age = 19.6, 68.8% female, 39% White), who reported using cannabis approximately 2.3 days per week with mild cannabis-related consequences (CAPQ; M = 9.74).

RESULTS

A confirmatory factor analysis demonstrated poor fit for the one-factor model of the PBSM, prompting an exploratory factor analysis. Analyses revealed two internally reliable factors: a "Quantity" factor, strategies specific to mitigating overuse and limiting amounts consumed and an "Context" factor loosely related to troubles with others. This two-factor model accounted for over half of the total variance; invariance testing indicated reduced fit as models became more restrictive. Though each of the factors covaried negatively with both days of use and problems, Context had a stronger relation to both variables compared to Quantity. Only Context predicted fewer cannabis problems and use.

CONCLUSIONS

The two-factor solution suggests further work on the psychometric properties of the scale could provide heuristic information to allow for more nuanced approaches in clinical and research settings. Theoretically, each factor might have novel links to some constructs but not others in ways that could assist harm-reduction strategies and treatment.

The potential individual- and population-level benefits of encouraging drinkers to count their drinks

Introduction

Cross-sectional studies have established a link between overall engagement in protective behavioral strategies (PBSs) and reduced alcohol consumption. However, there are mixed results on the effectiveness of individual PBSs, with some found to result in increased consumption. A recent study examining the effects of PBS use over time found the 'Count your drinks' strategy to be most reliably associated with reduced alcohol consumption among 16 strategies. Given the apparent superior efficacy of this PBS, this exploratory study aimed to extend these results by (i) determining the extent to which increasing the frequency of PBS enactment is associated with alcohol consumption over time and (ii) predicting potential changes in population-level consumption resulting from higher levels of PBS use.

Method

1250 drinkers aged 18-70 years provided data at two time points relating to their drinking practices. Multiple regression analyses were conducted to model the relationship between changes in frequency of enactment of the 'Count your drinks' PBS and alcohol consumption. Coefficients were used to predict average reductions in alcohol consumption over one year associated with increased frequency of use of this PBS.

Results

Larger increases in the frequency of using the 'Count your drinks' PBS were associated with greater reductions in alcohol consumption. Exploratory extrapolation analyses demonstrated the potential for substantial reductions in overall alcohol consumption.

Conclusion

The results suggest health promotion efforts designed to increase the frequency with which drinkers count their drinks could produce substantial annual decreases in alcohol consumption at both individual and population levels.

A confirmatory factor analysis of the Protective Behavioral Strategies Scale among OEF/OIF veterans

INTRODUCTION

Military veterans of the wars in Afghanistan and Iraq (OEF/OIF/OND) are at-risk for increased alcohol consumption and alcohol-related consequences. The Protective Behavioral Strategies Scale (PBSS) has been shown to be a reliable and valid measure of assessing strategies to facilitate more responsible drinking and to reduce alcohol-related harm among college student populations. The purpose of this study was to examine the psychometric properties of the PBSS among the OEF/OIF veteran population.

METHOD

Participants were 251 veterans (94% male; 83% White; M age=31.77years) who were participating in a larger alcohol intervention trial and reported consuming alcohol within the past 30days.

RESULTS

Confirmatory Factor Analyses indicated the model fit of the PBSS was similar to college student samples. Although a confirmatory three-factor model best fits the data, model fit indices were slightly below commonly accepted guidelines. All PBSS subscales were negatively correlated with alcohol outcomes. Greater use of Manner of Drinking (MOD) and Stopping/Limiting Drinking (SLD) strategies were associated with less alcohol consumption and lower peak BAC. Greater use of MOD strategies was associated with less alcohol-related problems.

CONCLUSIONS

Findings provide initial support for use of the PBSS among OEF/OIF veterans. Strategies aimed at Stopping/Limiting Drinking and the Manner of Drinking may be more effective with a veteran sample. Additional studies examining the external validity of this measure are encouraged.