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1.  Use of Drinking Protective Behavioral Strategies in Association to Sex-Related Alcohol Negative Consequences: The Mediating Role of Alcohol Consumption 
Alcohol use has been implicated as a risk factor for sexual negative consequences, such as unprotected sexual intercourse. The present research was conducted to examine the relationship between drinking protective behavioral strategies and consensual sex-related alcohol negative consequences, and whether this relationship varied by gender. Additionally, typical number of drinks during sexual behavior was evaluated as a potential mediator of this association. Heavy drinking, sexually active college students (N = 297, 50.2% female) completed self-report measures of drinking protective behavioral strategies, alcohol consumption, and sex-related alcohol negative consequences. Findings indicated that women who used drinking protective behavioral strategies more frequently were less likely to experience sex-related alcohol negative consequences whereas this relationship was not significant for men. For women, this relationship was mediated by the typical number of drinks consumed during sexual behavior. The current research demonstrates that use of drinking protective behavioral strategies is related to a reduction in women's sex-related risks when drinking. Findings are discussed in terms of alcohol myopia theory. Implications for interventions aimed to reduce higher risk sexual behavior among college students are discussed.
doi:10.1037/a0018361
PMCID: PMC2891544  PMID: 20565149
alcohol; alcohol-related problems; protective behavioral strategies; sexual behavior; sexual risk taking
2.  A Group Motivational Interviewing Intervention Reduces Drinking and Alcohol-Related Negative Consequences in Adjudicated College Women 
Addictive Behaviors  2007;32(11):2549-2562.
College students who violate campus alcohol policies (adjudicated students) are at high risk for experiencing negative alcohol-related consequences and for undermining campus life. Further, college women may be especially at risk due to differential intoxication effects and sexual consequences experienced mainly by female students. Research on interventions for adjudicated students, especially adjudicated females, has been limited. One hundred and fifteen college women who received a sanction for violating campus alcohol policies participated in the study. The two hour group intervention focused on female-specific reasons for drinking and included decisional balance, goal setting and other exercises. Participants completed follow-up surveys for 12 weeks following the intervention and answered questions regarding alcohol consumption and alcohol-related negative consequences. Findings support the use of an MI-based intervention to reduce both alcohol consumption and consequences among adjudicated females. Specifically, alcohol use was reduced by 29.9% and negative consequences were reduced by 35.87% from pre-intervention to 3-month follow up. Further, the intervention appeared to successfully initiate change in the heaviest drinkers, as women who drank at risky levels reduced alcohol consumption to a greater extent than women who drank at moderate levels.
doi:10.1016/j.addbeh.2007.05.014
PMCID: PMC3391164  PMID: 17628347
adjudicated college students; motivational interviewing; female; college drinking
3.  Can you say no? Examining the relationship between drinking refusal self-efficacy and protective behavioral strategy use on alcohol outcomes 
Addictive behaviors  2013;38(4):1898-1904.
Preliminary research has demonstrated reductions in alcohol-related harm associated with increased use of protective behavioral strategies (PBS) and higher levels of drinking refusal self-efficacy (DRSE). To extend research that has evaluated these protective factors independently of one another, the present study examined the interactive effects of PBS use and DRSE in predicting alcohol outcomes. Participants were 1084 college students (63% female) who completed online surveys. Two hierarchical linear regression models revealed that both DRSE and PBS use predicted alcohol use and consequences. Additionally, DRSE moderated the relationship between PBS use and both typical weekly drinking and negative alcohol-related consequences, such that participants who reported lower levels of PBS use and DRSE in the social pressure or emotional regulation dimensions were at greatest risk for heavy drinking and consequences respectively. Interestingly, for those who reported higher levels of social and emotional DRSE, levels of PBS use had no impact on alcohol use or alcohol consequences respectively. These findings demonstrate that DRSE and PBS use differentially reduce risk, suggesting the utility of collegiate, alcohol harm reduction interventions that aim to both increase PBS use and bolster self-efficacy for greater harm reduction.
doi:10.1016/j.addbeh.2012.12.022
PMCID: PMC3582319  PMID: 23380495
College Student Drinking; Protective Behavioral Strategies; Drinking Refusal Self-Efficacy; Alcohol Consequences
4.  Alcohol Use and Perceived Social and Emotional Consequences among Perpetrators of General and Sexual Aggression 
Journal of interpersonal violence  2009;25(4):699-715.
This study examined the relation between alcohol use, alcohol-related aggression expectancies, and the perceived negative consequences of perpetrating general and sexual aggression. Participants (N = 2,941; 59% female) were incoming college freshmen who reported on the last three months of their senior year of high school. Hierarchical multiple regression analyses for general aggression revealed that heavy alcohol consumption at the time of the aggression and strong alcohol-related aggression expectancies were associated with more frequent social and emotional consequences. For sexual aggression, similar regression analyses found that any alcohol use at the time of the aggression, but not outcome expectancies, was associated with social and emotional consequences. Among individuals who perpetrated general and sexual aggression, consuming alcohol at the time of the aggression was positively associated with perceived negative social and emotional consequences. Results do not support the idea that alcohol is used as an excuse for aggressive behavior.
doi:10.1177/0886260509334399
PMCID: PMC3751407  PMID: 19528632
5.  The Impact of Parental Modeling and Permissibility on Alcohol Use and Experienced Negative Drinking Consequences in College 
Addictive behaviors  2009;34(6-7):542-547.
This study examined the impact of parental modeled behavior and permissibility of alcohol use in late high school on the alcohol use and experienced negative drinking consequences of college students. Two-hundred ninety college freshmen at a large university were assessed for perceptions of their parents’ permissibility of alcohol use, parents’ alcohol-related behavior, and own experienced negative consequences associated with alcohol use. Results indicate that parental permissibility of alcohol use is a consistent predictor of teen drinking behaviors, which was strongly associated with experienced negative consequences. Parental modeled use of alcohol was also found to be a risk factor, with significant differences being seen across the gender of the parents and teens. Discussion focuses on risk factors and avenues for prevention research.
doi:10.1016/j.addbeh.2009.03.019
PMCID: PMC2716564  PMID: 19398278
Parenting; alcohol use; college
6.  Preliminary Examination of Spring Break Alcohol Use and Related Consequences 
The authors examined the extent to which college student drinkers are at risk for experiencing negative alcohol-related consequences during Spring Break. A sample of first-year college student drinkers (N = 726) participated by completing an online survey assessing typical drinking, as well as Spring Break drinking and related consequences. Findings suggest Spring Break drinking was positively associated with alcohol-related consequences during Spring Break, even after controlling for sex and typical drinking. Furthermore, results indicated that typical drinking moderated the relationship between Spring Break drinking and expected zero-values (i.e., not reporting any Spring Break consequences), such that the association between SB drinking and the likelihood of being a zero-score was less evident for those who are typically lighter drinkers. Identifying and examining temporal and contextually relevant events and associated drinking is critical for understanding and ultimately preventing extreme drinking and associated consequences associated with specific events like spring break, which place many students at high risk for experiencing acute harm.
doi:10.1037/a0016482
PMCID: PMC2895976  PMID: 20025375
college; alcohol; alcohol-related problems; Spring Break; event-specific drinking
7.  Association Between Alcohol Intoxication and Alcohol-Related Problems: An Event-level Analysis 
Heavy drinking students experience a myriad of alcohol-related negative consequences. Use of event-level data permits predictions to be made regarding (a) the likelihood of alcohol-related consequences occurring after specific drinking events, and (b) moderators of the association between intoxication and consequences. College students (N = 183, 64% female) completed four consecutive 7-day drinking diaries and turned them in weekly. The diaries yielded prospective event-level data on daily drinks, time spent drinking, and negative consequences related to each drinking event. Alcohol intoxication on a given day was significantly associated with increased levels of risk, although this association was moderated by average level of intoxication. Furthermore, self-control was associated with increased likelihood of negative consequences at all levels of intoxication, and self-regulation and impulsivity moderated the event-level association between daily intoxication and likelihood of negative consequences. Results suggest that self-regulation subsumes impulsivity and self-control.
doi:10.1037/0893-164X.21.2.194
PMCID: PMC2430388  PMID: 17563139
Alcohol-related consequences; Event-level analyses; daily drinking diaries; moderation effects
8.  Smaller Feedback ERN Amplitudes During the BART are Associated with a Greater Family History Density of Alcohol Problems in Treatment-Naïve Alcoholics 
Drug and alcohol dependence  2007;92(1-3):141-148.
BACKGROUND
Alcoholism is characterized by impaired decision-making (i.e., choosing intoxication in the face of mounting negative consequences). This impairment may involve a reduced brain response to the negative consequences of behavior, which supports an inclination to engage in risky behaviors. The feedback error-related negativity (F-ERN) is hypothesized to reflect the valence attached to the negative consequences of behavior. Performance on the Balloon Analogue Risk Task (BART) measures risk-taking propensity. We recorded F-ERNs during the BART and during a BART simulation, where individuals observed the rewards and consequences of (someone else’s) BART performance.
METHODS
EEGs were recorded on 22 actively drinking, treatment-naïve alcoholics during the BART and BART simulation. F-ERNs were measured and their association with psychological and alcohol use measures was examined.
RESULTS
F-ERNs over fronto-central electrode sites were observed to balloon pops in the BART and BART simulation. F-ERNs during the BART were more than twice the amplitude of F-ERNs during the BART simulation. Smaller F-ERN amplitudes from the BART (but not the BART simulation) were associated with a greater family history density of alcohol problems.
CONCLUSION
The results suggest a possible link between the genetic vulnerability toward developing alcoholism and the brain’s response to the negative consequences of behavior.
doi:10.1016/j.drugalcdep.2007.07.017
PMCID: PMC2430520  PMID: 17869027
feedback; error-related negativity; alcoholism; decision-making; BART
9.  Does Clinician Continuity Over Two Brief Motivational Sessions Improve Outcomes in College Students? 
Previous research has shown that Brief Motivational Interventions (BMIs) are an effective treatment approach for reducing college student alcohol use and associated negative consequences. The purpose of this study was to determine whether clinician continuity (having the same vs. a different clinician) across an initial BMI and follow-up booster session was related to differences in session satisfaction, self-reported alcohol use, and alcohol-related negative consequences. Participants included 358 undergraduate students who were part of a larger randomized clinical trial. Results revealed no significant differences in alcohol use and associated consequences at follow-up between participants who met with the same vs. a different clinician. Clinician continuity was not significantly related to intervention fidelity in terms of BMI consistent qualities, relevance of information presented, or session satisfaction. These findings suggest that clinician continuity across BMIs for college students is not related to participant satisfaction or intervention effectiveness, especially if the clinicians adhere to empirically supported techniques.
doi:10.1016/j.jsat.2011.04.007
PMCID: PMC3166970  PMID: 21696911
College students; alcohol; brief motivational interviewing; booster session
10.  Pathophysiology Review Series: Alcohol Abuse, the Alveolar Macrophage, and Pneumonia 
Alcohol use, and misuse, has been a part of human culture for thousands of years. In the modern medical era a great deal of attention has been justifiably focused on elucidating the mechanisms underlying the psychological and biological addiction to alcohol. However, a significant percentage, if not the majority, of alcohol-related morbidity and mortality occurs in individuals who do not meet the formal diagnostic criteria for alcohol use disorders. For example, many serious medical consequences of chronic alcohol ingestion can occur in individuals who do not have signs or symptoms of alcohol dependence. There is now clear evidence that even in otherwise healthy-appearing individuals who chronically consume excessive amounts of alcohol that alveolar macrophage immune capacity is impaired and, as a consequence, these individuals are at significantly increased risk of pneumonia. This brief review summarizes some of the key mechanisms underlying this phenomenon and proposes a hypothetical scheme by which alcohol interferes with zinc bioavailability within the alveolar space and thereby dampens macrophage function.
doi:10.1097/MAJ.0b013e31823ede77
PMCID: PMC3288531  PMID: 22173040
pneumonia; ARDS; acute lung injury; glutathione; zinc
11.  Predicting Drinking Behavior and Alcohol-Related Problems Among Fraternity and Sorority Members: Examining the Role of Descriptive and Injunctive Norms 
The authors examined the relation between Greek students’ perceptions of alcohol consumption in their pledge classes (descriptive norms) and acceptability of drinking (injunctive norms) and the ability of these normative influences to predict drinking behavior, alcohol-related negative consequences, and symptoms of alcohol dependence concurrently and prospectively over 1 year. Participants were 279 men and 303 women recruited from incoming pledge classes of 12 fraternities and 6 sororities, who completed measures of descriptive and injunctive norms, alcohol use, and consequences. Results revealed that descriptive norms significantly predicted concurrent drinking. After controlling for baseline drinking, injunctive norms significantly predicted drinking 1 year later and predicted alcohol-related consequences and dependency symptoms at baseline and follow-up. The potential to incorporate injunctive norms into preventive interventions is discussed.
doi:10.1037/0893-164X.18.3.203
PMCID: PMC2912161  PMID: 15482075
12.  Protective strategies: A mediator of risk associated with age of drinking onset 
Addictive behaviors  2010;35(5):486-491.
The goal of the current study was to determine if failure to develop/utilize alcohol-specific strategies to manage drinking behavior might serve as a mechanism through which early alcohol exposure leads to higher levels of later alcohol use and alcohol-related negative consequences, while taking into account impulsivity as an underlying risk factor for both of these outcomes. Data were collected between September and December of 2005 from a random sample of college students via an online survey. A total of 309 students provided complete data on all measure of interest. Separate regression analyses predicting typical weekly alcohol consumption and alcohol-related problems indicated that use of alcohol-specific protective strategies partially mediated the effect of age of first use on these outcomes. An earlier age of onset was associated with less frequent use of alcohol-specific protective strategies, which in turn was associated with drinking- and alcohol-related problems. Implications for tailoring alcohol prevention and intervention programs targeting adolescents are discussed.
doi:10.1016/j.addbeh.2009.12.028
PMCID: PMC3039522  PMID: 20092955
Alcohol; Age of first use; Protective behavioral strategies; College students
13.  The Moderating Role of Gender in the Prospective Associations Between Expectancies and Alcohol–Related Negative Consequences Among College Students 
Substance use & misuse  2009;44(7):934-942.
This study examined if alcohol expectancies (assessed with the Comprehensive Effects of Alcohol–Brief Form) were prospectively related to negative consequences (assessed with the Rutgers Alcohol Problem Index) and if these associations varied by gender. Data were collected from 558 first-year college students at a university in the south-eastern United States as part of an intervention study conducted during their initial residence hall meetings of the fall semester of 2007. Only those students who used alcohol and completed both baseline and 3-month follow-up surveys were included in the analyses (n = 347). Mixed-model multivariate analyses indicated that higher sexuality and tension reduction expectancies were prospectively related to more alcohol consumption–related negative consequences for males but not for females. Findings suggest that intervention efforts to prevent problem drinking would benefit from being gender-specific. The study's limitations are noted.
doi:10.1080/10826080802490659
PMCID: PMC3682922  PMID: 19938937
expectancies; college students; alcohol–related negative consequences; gender; problem drinking
14.  “Man-ing” up and Getting Drunk: The Role of Masculine Norms, Alcohol Intoxication and Alcohol-Related Problems among College Men 
Addictive behaviors  2011;36(9):906-911.
Compared to college women, college men face elevated risks for problematic drinking and negative alcohol-related consequences. These risks highlight the critical need to investigate gender issues and risk factors contributing to intoxication and related problems among men. Theoretical models suggest that conforming to masculine norms or the beliefs and expectations of what it means to be a man, may help explain patterns of problematic drinking among men. The current study advances the literature by investigating the association between masculine norms, drinking to intoxication, and alcohol-related consequences among 776 undergraduate males after taking into account the importance of fraternity status and perceived peer norms. Results indicate that fraternity status and higher perceived peer norms regarding drinking increased the risks of getting drunk and experiencing alcohol-related consequences. Specifically, the masculine norms of being a “playboy”, risk-taking, and winning were risk factors of drinking to intoxication; while, being a “playboy”, risk-taking, and self-reliance increased the risks of alcohol-related problems. Primacy of work and heterosexual presentation were two masculine norms that were protective of drinking to intoxication. Our findings contribute to important future considerations for prevention, clinical interventions, and public-health implications in college settings.
doi:10.1016/j.addbeh.2011.04.005
PMCID: PMC3118921  PMID: 21620570
alcohol; men; masculinity; intoxication; alcohol problems; college
15.  Current drinking and health-risk behaviors among male high school students in central Thailand 
BMC Public Health  2011;11:233.
Background
Alcohol drinking is frequently related to behavioral problems, which lead to a number of negative consequences. This study was to evaluate the characteristics of male high school students who drink, the drinking patterns among them, and the associations between current drinking and other health risk behaviors which focused on personal safety, violence-related behaviors, suicide and sexual behaviors.
Method
A cross-sectional study was conducted to explore current alcohol drinking and health-risk behaviors among male high school students in central Thailand. Five thousand one hundred and eighty four male students were classified into 2 groups according to drinking in the previous 30 days (yes = 631, no = 4,553). Data were collected by self-administered, anonymous questionnaire which consisted of 3 parts: socio-demographic factors, health-risk behaviors and alcohol drinking behavior during the past year from December 2007 to February 2008.
Results
The results showed that the percent of current drinking was 12.17. Most of them were 15-17 years (50.21%). Socio-demographic factors such as age, educational level, residence, cohabitants, grade point average (GPA), having a part time job and having family members with alcohol/drug problems were significantly associated with alcohol drinking (p < 0.05). Multiple logistic regression analysis, after adjusting for socio-demographic factors, revealed that health-risk behavioral factors were associated with current alcohol consumption: often drove after drinking alcohol (OR = 3.10, 95% CI = 1.88-5.12), often carried a weapon (OR = 3.51, 95% CI = 2.27-5.42), often got into a physical fight without injury (OR = 3.06, 95% CI = 1.99-4.70), dating violence (OR = 2.58, 95% CI = 1.79-3.71), seriously thought about suicide (OR = 2.07, 95% CI = 1.38-3.11), made a suicide plan (OR = 2.10, 95% CI = 1.43-3.08), ever had sexual intercourse (OR = 5.62, 95% CI = 4.33-7.29), alcohol or drug use before last sexual intercourse (OR = 2.55, 95% CI = 1.44-4.53), and got someone pregnant (OR = 3.99, 95% CI = 1.73-9.25).
Conclusions
An increased risk of health-risk behaviors, including driving vehicles after drinking, violence-related behaviors, sad feelings and attempted suicide, and sexual behaviors was higher among drinking students that led to significant health problems. Effective intervention strategies (such as a campaign mentioning the adverse health effects and social consequences to the risk groups, and encouraging parental and community efforts to prevent drinking) among adolescents should be implemented to prevent underage drinking and adverse consequences.
doi:10.1186/1471-2458-11-233
PMCID: PMC3090349  PMID: 21492419
16.  Changes in Protective Behavioral Strategies and Alcohol Use among College Students* 
Drug and alcohol dependence  2011;118(2-3):504-507.
Background
Protective behavioral strategies (PBS) are specific cognitive-behavioral strategies designed to reduce alcohol consumption and resulting negative consequences. A host of studies have examined the cross-sectional relationship between such strategies and alcohol use in the high-risk population of United States college students, but prospective studies on the construct are lacking. The primary purposes of this study were to determine if PBS use prospectively predicted subsequent alcohol use/alcohol-related problems and if changes in PBS use were associated with less alcohol use and fewer problems.
Methods
Data were examined from 521 heavy drinking college students (60% male, 84% White, mean age = 18.9 years). Participants completed questionnaires assessing alcohol use, alcohol-related problems, and PBS use at baseline, 6-month, and 12-month follow-ups.
Results
Analysis of residualized change scores indicated that increases in some PBS across time were associated with less alcohol use and fewer alcohol-related problems at follow-up. Findings regarding the prospective relationship between PBS use and subsequent alcohol use/problems were equivocal.
Discussion
Results from the study suggest that PBS may have value in alcohol-related interventions among college students. Clinicians who help clients increase their use of PBS may help those clients increase the probability of drinking less and experiencing fewer alcohol-related problems in the future.
doi:10.1016/j.drugalcdep.2011.04.020
PMCID: PMC3176975  PMID: 21612879
Alcohol; College Student; Protective Behavioral Strategies
17.  Do Research Assessments Make College Students More Reactive to Alcohol Events? 
Psychology of Addictive Behaviors  2011;26(2):338-344.
This study examines possible synergistic effects of alcohol-related events and post-event assessments on changes in college student readiness to change alcohol use, frequency of alcohol use, and negative consequences. Students were participants in a longitudinal study of drinking behavior. A portion of those reporting negative alcohol events/consequences (e.g., injury, vomiting, memory loss) during the parent study were randomly selected to participate in the present study (n = 492) and randomized to a post-event assessment (n = 296) or a no-assessment control (n = 196). Participants in the post-event assessment group were interviewed soon after their event, and participants in both conditions were interviewed three months after their event. Linear regression models showed higher 3-month readiness to change alcohol use in participants who received a post-event assessment than those who did not. There were reductions in drinking days, heavy drinking days, and further consequences post-event, but no differences by assessment group. However, female participants showed greater reductions in drinking days and heavy drinking days if they were assigned to assessment compared to control. There also was greater post-event reduction in drinking days among assessment group participants with high pre-college alcohol severity compared to low pre-college alcohol severity. Conversely, participants who reported high aversiveness of their event and were in the control group showed greater reduction in heavy drinking days than those assigned to the assessment group. Findings suggest that college student heavy drinking is reactive to alcohol events, whereas reactivity to post-event assessments may depend on gender, alcohol severity, and event aversiveness. This work highlights the importance of considering possible interactions among extra-therapeutic factors in clinical outcome research.
doi:10.1037/a0025571
PMCID: PMC3257404  PMID: 21928871
Alcohol Abuse; Alcohol Consequences; Assessment Reactivity; College Student Drinking; Readiness to Change; Research Reactivity
18.  Compulsive use of alcohol among college students 
Psychiatry research  2012;205(0):95-102.
Among college students alcohol consumption is associated with other high-risk behaviors that can lead to short- and long-term negative health consequences. Identification of college students consuming alcohol who are at high risk for problems may have important public health implications. This study examines the ability of the CHQ compulsive use of alcohol item to detect high-risk behaviors relative to other screening measures and its association with different dimensions of compulsive drinking. Three hundred thirty-two college students completed measures on compulsive drinking and hazardous behaviors. Results showed that among male students the CHQ compulsive use of alcohol item was not sensitive to detect hazardous alcohol consumption but co-occurred with the use of illicit drugs. Among female students it was sensitive to detect heavy drinking but not alcohol or drug problems. Among college students compulsive use of alcohol corresponds to an urge to consume alcohol that may be associated with use of illicit drugs in male students, with heavy drinking in female students and with substance use problems. This study suggest that the CHQ compulsive use of alcohol item should not be used as a stand-alone screening for alcohol or drug problems but it could be considered a marker for at-risk behaviors.
doi:10.1016/j.psychres.2012.08.012
PMCID: PMC3791317  PMID: 22951374
College students; Compulsive drinking; Risky behaviors; Alcohol; Drug use
19.  Delineating Potential Mechanisms of Implicit Alcohol Cognitions: Drinking Restraint, Negative Affect, and their Relationship with Approach Alcohol Associations 
Problem drinkers may use alcohol to avoid negative mood states and may develop implicit cognitive associations between negative emotional states and reinforcing properties of drinking. Ironically, attempts to control drinking, such as among those high in drinking restraint, may inadvertently increase desire to drink and subsequent alcohol consumption, and this may be exaggerated under times of emotional distress when urges to drink are high. We examined whether individuals who are high on drinking restraint would demonstrate stronger alcohol-related thoughts elicited by stimuli that represent the desire to use alcohol, in response to stronger versus weaker negative mood arousal. Seventy hazardous drinkers completed measurements of drinking restraint, alcohol consumption, and consequences of use. After being randomized to view negative or positive pictures sets, participants completed an Implicit Association Task (IAT) to test differences in the strength of the association between desire to approach or avoid alcohol or water cues, and then a measurement of subjective craving following the IAT. Regression analyses showed that trait restriction, but not temptation, was positively related to IAT scores, after controlling for relevant covariates and explained 7% of the total variance. Trait temptation, but not IAT, predicted subjective craving. Negative affect was unrelated to IAT scores, singly or in conjunction with measures of drinking restraint, contrary to predictions. In sum, implicit alcohol cognitions are related to attempts to restrict drinking, but not temptation to drink, and are less strongly influenced by mood state.
doi:10.1037/a0027281
PMCID: PMC3927785  PMID: 22369223
Implicit cognitions; drinking restraint; urges; alcohol consumption
20.  Use of Protective Behavioral Strategies and their Association to 21st Birthday Alcohol Consumption and Related Negative Consequences: A Between- and Within-person Evaluation 
Psychology of Addictive Behaviors  2011;26(2):179-186.
The purpose of the present study was to examine between- and within-person relationships among protective behavioral strategies (PBS), alcohol consumption, and related negative consequences during the 21st birthday week. Participants for the present study included undergraduate college students (N = 1,028) who turned 21 during three academic quarters at a large public northwestern university in the U.S. Students completed a Web-based survey that was comprised of measures of 21st birthday PBS, alcohol consumption, and alcohol-related negative consequences. Between-person findings indicated that participants who employed more manner of drinking PBS and fewer serious harm reduction PBS consumed fewer drinks and reached lower BACs. Results also showed that participants who employed a greater number of limiting/stopping PBS and who used more manner of drinking PBS experienced fewer negative consequences. Within-person findings demonstrated that on days when participants used more limiting/stopping PBS, fewer manner of drinking PBS, and more serious harm reduction PBS than average they also consumed more drinks and reached higher BACs. When examining negative consequences, within-person results showed that on days when participants used more limiting/stopping PBS, fewer manner of drinking PBS, and more serious harm reduction PBS than usual they experienced more negative consequences. Discussion focuses on clarification of the association between PBS and drinking and implications for preventive interventions.
doi:10.1037/a0023797
PMCID: PMC3191316  PMID: 21553945
21st birthday drinking; alcohol use; alcohol-related consequences; within-person analysis; event-specific drinking; protective behavioral strategies
21.  Are All Negative Consequences Truly Negative? Assessing Variations Among College Students’ Perceptions of Alcohol Related Consequences 
Addictive behaviors  2008;33(10):1375-1381.
Brief feedback sessions have been shown to reduce alcohol consumption in college student samples. However, these feedback sessions show mixed results in reducing negative consequences of alcohol consumption. Because the discussion of alcohol consequences is a component of feedback sessions, it was seen as important to evaluate the degree to which college students perceive these consequences as negative. The present study assessed college students’ perceptions of positivity-negativity of alcohol-related consequences they experienced during the past year. The findings revealed college students’ perceptions of positivity-negativity varied depending on the consequence that was assessed. Most consequences were considered negative by greater than 50% of the sample. There were six consequences that were not considered negative by the majority of the sample and of these, all were considered positive or neutral by greater than at least 50% of the sample. Finally, perceived positivity of the consequences were associated with higher weekly drinking patterns for vomiting, blackouts, regretted sex, late to work/class, skipping an evening meal, and being hungover. Results are discussed in reference to improving brief alcohol interventions for college students.
doi:10.1016/j.addbeh.2008.06.014
PMCID: PMC2566513  PMID: 18639384
College Drinking; Alcohol; Perceptions of Consequences
22.  Treatment Completion in a Brief Motivational Intervention in the Emergency Department: The Effect of Multiple Interventions and Therapists’ Behavior 
Background
The aim of this study was to identify therapist behaviors during a brief motivational intervention (BMI) given to injured emergency department patients that predicted participant return for a second BMI session and 12-month alcohol-related outcomes.
Method
This was a secondary data analysis of a randomized controlled trial (n = 539) previously demonstrating that random assignment to a BMI and booster session resulted in a significant reduction of 12-month postintervention alcohol-related injuries and negative consequences relative to standard care.
Results
Participants who actually received 2 BMI sessions had significantly less alcohol-related negative consequences than those who received only 1 BMI session. Therapists who reported a higher focus on emotional support and low focus on participant drinking behaviors during the initial BMI session were more likely to have assigned participants return for the second BMI session.
Conclusion
The results of these secondary analyses show that compliance with a 2-session therapeutic intervention (BIB) predicted fewer negative alcohol-related consequences, and that therapists’ supportive emotional emphasis during the first BMI session was important in predicting participants returning for the second MI session.
doi:10.1111/j.1530-0277.2007.00498.x
PMCID: PMC2728218  PMID: 17880351
Treatment Completion; Brief Motivational Intervention
23.  The Social Norms of Alcohol-Related Negative Consequences 
Social norms for alcohol use are important influences on individual college student drinking. The present study extends social norms research by examining alcohol-related consequences and, in particular, whether similar misperceptions exist regarding the frequency and evaluation of these consequences over time. The associations between social norms and alcohol-related consequences are examined in the context of projection and conformity models. College student drinkers (N=624) participating in a longitudinal study completed web-based surveys assessing alcohol use and related consequences, as well as their beliefs about frequency and evaluation of consequences for the typical college student. Findings suggest that students overestimated how often typical college students experience negative consequences and underestimated how negative other students evaluated those consequences. Finally, results support a bidirectional model for alcohol-related consequences, possibly indicating a reciprocal, mutually influential feed-forward loop of norms and consequences that promotes maintenance of college student drinking and consequences.
doi:10.1037/a0018020
PMCID: PMC2902870  PMID: 20565160
alcohol-related problems; evaluations; descriptive and injunctive norms; conformity; projection; drinking consequences
24.  Event Specific Drinking Among College Students 
College represents a period of risk for heavy drinking and experiencing unwanted consequences associated with drinking. Previous research has identified specific events including holidays (e.g., New Years), school breaks (e.g., Spring Break) and personally relevant events (e.g., 21st birthdays) that are associated with elevated risk of heavy drinking and negative alcohol-related consequences. The systematic evaluation of relative risk offers insights into event specific drinking and an empirical basis upon which to consider allocation of limited prevention resources. Thus, the purpose of the present study was to provide a comparative index of drinking across a wide range of holidays and compare holiday drinking to 21st birthday drinking. Participants were 1,124 students (55% female) who had turned 21 within the previous three weeks in 2008 and provided 90-day retrospective reports of their drinking using the Timeline Follow-back. Results based on a hurdle mixed model for blood alcohol content (BAC) revealed several holidays that stand out for elevated drinking, including New Year’s Eve and July 4th, whereas other holidays appear more similar to weekend drinking, such as Spring Break (approximately last week of March) and graduation (mid-June). Drinking on holidays or special days was substantially lower than drinking on 21st birthdays. Results are discussed in terms of practical applications for targeted intervention efforts on college campuses toward specific events where elevated drinking is known to occur.
doi:10.1037/a0024051
PMCID: PMC3192907  PMID: 21639597
event-specific drinking; 21st birthday drinking; timeline follow-back
25.  Brief Intervention for Hazardous and Harmful Drinkers in the Emergency Department 
Annals of emergency medicine  2008;51(6):742-750.e2.
Study Objective
To determine efficacy of emergency practitioner performed brief intervention for hazardous/harmful drinkers in reducing alcohol consumption and negative consequences in an Emergency Department (ED) setting.
Methods
A randomized clinical trial (Project ED Health) was conducted in an urban ED from 5/2002 to 11/2003 for hazardous/harmful drinkers. Patients ≥ 18 who screened above National Institute for Alcohol Abuse and Alcoholism guidelines for “low risk” drinking or presented with an injury in the setting of alcohol ingestion were eligible. The mean number of drinks per week and binge drinking episodes over the past 30 days were collected at 6 and 12-months; negative consequences and use of treatment services at 12-months. A Brief Negotiation Interview (BNI) performed by emergency practitioners was compared to scripted discharge instructions (DI).
Results
A total of 494 hazardous/harmful drinkers were studied. The two groups were similar with respect to baseline characteristics. In the BNI group the mean number of drinks per week at 12 months was 3.8 less than the 13.6 reported at baseline. The DI group decreased 2.6 from 12.4 at baseline. Likewise, binge drinking episodes per month decreased by 2.0 from a baseline of 6.0 in the BNI group and 1.5 from 5.4 in the DI group. For each outcome the time effect was significant and the treatment effect was not. Conclusion: Among ED patients with hazardous/harmful drinking, we did not detect a difference in efficacy between emergency practitioner-performed BNI and DI. Further studies to test the efficacy of brief intervention in the ED are needed.
doi:10.1016/j.annemergmed.2007.11.028
PMCID: PMC2819119  PMID: 18436340

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