The Effects of Personalized Boosters for a Computerized Intervention Targeting College Student Drinking

Heavy episodic alcohol use within the college student population is both widespread and problematic (Benton et al., 2004; Core Institute, 2006; Hingson, Zha, & Weitzman, 2009; O\u27Malley & Johnston, 2002; Perkins, 2002; Singleton, 2007). More than 40% of college students report at least one symptom of alcohol abuse or dependence (Knight et al., 2002). Computerized interventions are widely used because of their advantages over in-person interventions. They are more cost-effective and can quickly deliver tailored individual feedback to more students. Computerized interventions can be administered to large groups of students (e.g., incoming students, athletes, fraternities/sororities). However, a (2007) meta-analysis by Carey and colleagues found that in-person interventions are generally more efficacious than interventions delivered via other mediums. The current study is a prospective examination of intervention efficacy, the ability of personalized feedback to boost efficacy, and protective behavioral strategies (PBS) as a possible mediator for these relationships. The intervention for the current study, Alcohol 101 Plus™ (Century Council, 2003), incorporates a number of intervention components, including alcohol education, college student drinking norms, skills training, and personalized feedback. The current study sought to improve the efficacy of the online intervention with personalized feedback via email boosters. Content was created based on a comparison of 2-week data to baseline. Boosters provided personalized feedback based on reported alcohol consumption, alcohol-related problems, and PBS use. They included normative data and emphasized PBS. Data were collected from N = 233 college students. Eligibility criteria included drinking 4+ alcoholic drinks within two weeks of the assessment and being between the ages of 18 and 24. Participants were randomized into one of three conditions: 1) control, 2) intervention only, or 3) intervention plus booster. Participants were assessed at baseline (pre-intervention), 2 weeks post, and 4 weeks post. The intervention was administered during the baseline procedure, immediately following assessment. After the 2-week assessment, participants in the intervention-plus-booster condition were sent a booster email. Piecewise latent growth models revealed no intervention effect among alcohol use indicators or alcohol-related problems. However, knowledge about alcohol and related consequences was significantly increased after the intervention. Interestingly, a significantly indirect effect was found, such that intervention receipt significantly increased growth trajectories for PBS, which in turn was associated with reduced trajectories for alcohol use and related problems. Additionally, the booster emails with personalized feedback had a significant effect. All alcohol use indicators and alcohol-related problems were significantly reduced for those in the experimental booster group. There was limited support for PBS as a mediator of both intervention and booster effects. The implications of these findings are far-reaching, given the prevalence of online interventions targeting college student drinking and the ability of easily-disseminated, cost-effective emails to boost efficacy

The Impact of Time Perspective Latent Profiles on College Drinking: A Multidimensional Approach

Background- Zimbardo and Boyd\u27s1 time perspective, or the temporal framework individuals use to process information, has been shown to predict health behaviors such as alcohol use. Previous studies supported the predictive validity of individual dimensions of time perspective, with some dimensions acting as protective factors and others as risk factors. However, some studies produced findings contrary to the general body of literature. In addition, time perspective is a multidimensional construct, and the combination of perspectives may be more predictive than individual dimensions in isolation; consequently, multidimensional profiles are a more accurate measure of individual differences and more appropriate for predicting health behaviors. Objectives- The current study identified naturally occurring profiles of time perspective and examined their association with risky alcohol use. Methods- Data were collected from a college student sample (n = 431, mean age = 20.41 years) using an online survey. Time perspective profiles were identified using latent profile analysis. Results-Boot-strapped regression models identified a protective class that engaged in significantly less overall drinking (β= -0.254) as well as engaging in significantly less episodic high risk drinking (β = -0.274). There was also emerging evidence of a high risk time perspective profile that was linked to more overall drinking (β = 0.198) and engaging in more high risk drinking (β = 0.245), though these differences were not significant. Conclusions/Importance- These findings support examining time perspective in a multidimensional framework rather than individual dimensions in isolation. Implications include identifying students most in need of interventions, and tailoring interventions to target temporal framing in decision-making

Personalized Boosters For a Computerized Intervention Targeting College Drinking: The Influence of Protective Behavioral Strategies

Objective: Computerized interventions are cost-effective and can quickly deliver individual feedback to many students. However, in-person interventions are more efficacious. The current study sought to improve the efficacy of a popular online intervention via e-mailed boosters with personalized feedback. Participants: Participants were 213 student drinkers at a southeastern public university, ages 18-24. Methods: Students were randomized into (1) intervention only, or (2) intervention plus booster. Alcohol consumption and related problems were assessed at baseline, 2weeks post, and 4weeks post. Results: Boosters yielded reductions in drinking, but not alcohol-related problems. Boosters were associated with significant reductions for drinking frequency, heavy drinking days, peak drinks, and associated blood alcohol concentration (BAC). Protective behavioral strategies (PBS) moderated this effect, with significant reductions for students low in PBS, but not students already highly engaged in PBS use. Conclusions: Easy dissemination and low cost make e-mailed boosters a very efficient way to promote student health

Clarifying Observed Relationships Between Protective Behavioral Strategies and Alcohol Outcomes: The Importance of Response Options

Protective behavioral strategies (PBS), or harm-reduction behaviors that can potentially reduce alcohol consumption or associated problems, have been assessed in varied ways throughout the literature. Existing scales vary in focus (i.e., broad vs. narrow), and importantly, in response options (i.e., absolute frequency vs. contingent frequency). Absolute frequency conflates PBS use with number of drinking occasions, resulting in inconsistencies in the relationship between PBS use and alcohol outcomes, whereas contingent frequency is less precise, which could reduce power. The current study proposes the use of absolute frequencies to maximize precision, with an adjustment for number of drinking days to extricate PBS use from drinking occasions, resulting in a contingent score. Study 1 examined the associations between PBS subscales using the Strategy Questionnaire (Sugarman & Carey, 2007) and alcohol outcomes, finding that in raw score form the association between PBS and typical alcohol outcomes varied greatly from significantly positive to significantly negative, but adjusted score relationships were all consistent with harm reduction perspectives. In addition, curvilinear relationships with typical alcohol use were eliminated using the score adjustment, resulting in linear associations. Study 2 confirmed the findings from Study 1 with a more precise timeframe, additional alcohol assessments, and heavier college drinkers. The relationships between alcohol outcomes and PBS in raw score form were again varied, but became consistently negative using the score adjustment. Researchers examining PBS and related constructs should consider modifying current scales to include a precise frequency response scale that is adjusted to account for number of drinking occasions

Exploring the Intersection of Sexual Identity and Route of Administration in Relation to Cannabis Use Among Young Adult Females

Background and Objective: Rates of cannabis use continue to increase with sexual minority women (SMW) reporting greater use than heterosexual women. Along with these increasing trends, the routes of administration (ROA) for cannabis are evolving. The current study examined associations between cannabis ROA and frequency of use, as well as differences across sexual identity (heterosexual vs. SMW). Methods: Participants were 949 young adult (18–25 years old) women (29.8% SMW) who reported past month cannabis use and were recruited through Amazon Mechanical Turk. Number of cannabis use days and each ROA used (joint, pipe, blunt, bong, vape, edible, and ointment) in the past 30 days were measured. Analysis of covariance models examined if sexual identity moderated the association between each ROA and cannabis use frequency. Results: Among the full sample, joints were the most common ROA (78.6%); cannabis vaping was the most common noncombustible ROA (25.9%). SMW were more likely than heterosexual women to use each ROA except for joints. SMW who used pipes or edibles reported greater cannabis use frequency, compared to those who did not; there were no differences in frequency of use across ROA for heterosexual women. Discussion and Conclusions: SMW may use a greater variety of ROA, potentially increasing the harms associated with cannabis. Marketing strategies targeting the sexual minority community may increase the likelihood of using various cannabis ROA and subsequent use. Scientific Significance: Findings further our knowledge about how young adult women are using cannabis, and highlight how ROA may contribute to the disparities observed among SMW

Identifying Patterns of Situational Antecedents to Heavy Drinking Among College Students

Background- Emerging adults have the highest prevalence of heavy drinking as compared to all other age groups. Given the negative consequences associated with such drinking, additional research efforts focused on at-risk consumption are warranted. The current study sought to identify patterns of situational antecedents to drinking and to examine their associations with drinking motivations, alcohol involvement, and mental health functioning in a sample of heavy drinking college students. Method- Participants were 549 (65.8% women) college student drinkers. Results- Latent profile analysis identified three classes based on likelihood of heavy drinking across eight situational precipitants. The High Situational Endorsement\u27 group reported the greatest likelihood of heavy drinking in most situations assessed. This class experienced the greatest level of alcohol-related harms as compared to the Low Situational Endorsement\u27 and Moderate Situational Endorsement\u27 groups. The Low Situational Endorsement class was characterized by the lowest likelihood of heavy drinking across all situational antecedents and they experienced the fewest alcohol-related harms, relative to the other classes. Class membership was related to drinking motivations with the High Situational Endorsement\u27 class endorsing the highest coping- and conformity-motivated drinking. The High Situational Endorsement\u27 class also reported experiencing more mental health symptoms than other groups. Conclusions- The current study contributed to the larger drinking literature by identifying profiles that may signify a particularly risky drinking style. Findings may help guide intervention work with college heavy drinkers

A Latent Profile Analysis of Drinking Patterns Among Nonstudent Emerging Adults

Research indicates that nonstudent emerging adults, as compared to their college-attending peers, are at higher risk for experiencing alcohol-related problems, including alcohol use disorders. The present study sought to extend the limited research on nonstudent drinking by (1) identifying sub-groups of nonstudent drinkers based on their drinking patterns and (2) determining the extent to which social-cognitive between-person factors related to drinking (i.e., social expectancies, perceived drinking norms, social drinking motivations) distinguish these sub-groups. Participants were 195 (65.1% men) nonstudent emerging adult heavy episodic drinkers recruited from the community. Mean age was 21.88 (SD = 2.08) years and 45.4% were unemployed. Latent profile analysis identified two classes based on drinking across 30 days. The moderate drinkers group (n = 143; 73.3%) reported consuming 10-11 drinks weekly and drinking two to three times per week, on average. The heavy drinkers class (n = 52; 26.7%) reported consuming 42-43 drinks weekly and drinking six to seven days per week. Both groups exhibited a cyclic pattern of drinking whereby weekday drinking was lower, with increases on the weekend; the heavy drinkers class had stronger weekend increases starting earlier. Heavy drinkers reported greater volume, frequency, and problematic drinking behaviors, as compared to the moderate drinkers. The heavy drinkers class also endorsed stronger social motives and perceived their peers to drink more. The present study offered unique insights into nonstudent emerging adult drinking patterns by identifying sub-populations of drinkers based on their past 30-day use. Knowledge gained from this study could aide in tailoring existing alcohol interventions to nonstudents to reduce alcohol-related harms

Differences in Weekday Versus Weekend Drinking Among Nonstudent Emerging Adults

In the current investigation, we sought to examine day-of-the-week drinking of an at-risk sample of nonstudent emerging adults and whether specific factors are associated with differential drinking patterns. Our study aims were to (a) identify differences in weekday versus weekend drinking, and (b) examine specific expectancies (i.e., sociability, tension reduction) and demographic factors (e.g., age, sex) relating to weekend versus weekday drinking after controlling for harmful drinking and holiday drinking. Participants were heavy-drinking noncollege attenders recruited from the community (N = 238; 63.4% men, 35.7% women; M age = 21.92 years). They reported daily drinking for the previous 30 days and completed measures of harmful drinking, alcohol expectancies, and demographic information. Results showed that more drinks were consumed on the weekends (i.e., Thursday to Saturday) than weekdays, with 63% of drinks consumed on weekends. Multilevel modeling analyses indicated that weekday drinking was associated with tension-reduction expectancies, social expectancies, sex, and age. Weekend-drinking increases were related to social expectancies, but not tension-reduction expectancies. Our final model indicated that, after controlling for the effect of holiday drinking, the within-person weekday-weekend distinction explained 18% of the total variance. In general, our findings highlight the importance of alcohol expectancies and drinking contexts in understanding the drinking behaviors of nonstudents. The differential role of tension-reduction and social-facilitation expectancies on drinking throughout the week imply that different cognitive pathways are involved in weekday versus weekend drinking, and both types of expected alcohol effects should be targets of risk-reduction efforts with nonstudent drinkers