Abstinence-contingent wage supplements for adults experiencing homelessness and alcohol use disorder: A randomized clinical trial.

This study evaluated the effectiveness of abstinence-contingent wage supplements in promoting alcohol abstinence and employment in adults experiencing homelessness and alcohol use disorder. A randomized clinical trial was conducted from 2019 to 2022. After a 1-month Induction period, 119 participants were randomly assigned to a Usual Care Control group (n = 57) or an Abstinence-Contingent Wage Supplement group (n = 62). Usual Care participants were offered counseling and referrals to employment and treatment programs. Abstinence-Contingent Wage Supplement participants could earn stipends for working with an employment specialist and wage supplements for working in a community job but had to maintain abstinence from alcohol as determined by transdermal alcohol concentration monitoring devices to maximize pay. Abstinence-Contingent Wage Supplement participants reported significantly higher rates of alcohol abstinence than Usual Care participants during the 6-month intervention (82.8% vs. 60.2% of months, OR = 3.4, 95% CI 1.8 to 6.3, p < .001). Abstinence-Contingent Wage Supplement participants were also significantly more likely to obtain employment (51.3% vs. 31.6% of months, OR = 2.6, 95% CI 1.5 to 4.4, p < .001) and live out of poverty (38.2% vs. 16.7% of months, OR = 3.7, 95% CI 2.0 to 7.1, p < .001) than Usual Care participants. These findings suggest that Abstinence-Contingent Wage Supplements can promote alcohol abstinence and employment in adults experiencing homelessness and alcohol use disorder. ClinicalTrials.gov Identifier: NCT03519009.

Preventing alcohol use post-bariatric surgery: patient perspectives on a technology-based approach.

BACKGROUND: Nearly two-thirds of patients engage in alcohol use after bariatric surgery, while a substantial number meet criteria for alcohol use disorder after their procedure. Given that pre-surgical education may not be sufficient, alternative methods of preventing post-surgical drinking are needed. We sought feedback on a proposed technology-based intervention to reduce alcohol use for individuals who have undergone bariatric surgery. METHODS: Twenty patients who consumed alcohol post-surgery completed qualitative interviews where they provided opinions on sample intervention content, delivery method, timing, and other aspects of a two-session web-based intervention followed by tailored text messaging for 6 months. Interviews were recorded, transcribed, and coded using thematic analysis principles. RESULTS: Participants strongly endorsed using technology to deliver an alcohol intervention, citing the interactivity and personal tailoring available in the proposed software. Education about the effects of post-surgical drinking and learning new coping strategies for social situations were the two most salient themes to emerge from questions about intervention content. Throughout the interviews, participants strongly highlighted the importance of measuring patient readiness to change alcohol use and matching intervention content to such motivation levels. Respondents felt that text messages could extend what they had learned, but also requested additional non-alcohol content (e.g., recipes, exercise tips). Most participants agreed that an online forum consisting of peers and professionals with whom they could ask questions and interact would be useful. CONCLUSION: Web- and text message-based interventions may be an acceptable approach to prevent alcohol use post-bariatric surgery.

Patient perceptions regarding alcohol use after bariatric surgery.

INTRODUCTION: Patients who have undergone bariatric surgery are at increased risk of an alcohol use disorder. Though patients understand this risk, the majority engage in post-surgical alcohol use. This suggests that education alone is not sufficient to reduce post-surgical drinking. To prevent development of post-surgical alcohol use disorders, we need better understanding of the reasons patients use alcohol following surgery. The purpose of this study was to identify factors associated with post-surgical alcohol use. METHOD: Patients (N = 20) who were 1-3 years post-bariatric surgery and were consuming alcohol at least twice monthly participated in a 60-min interview. Participants responded about their knowledge regarding risk of post-surgical alcohol use and reasons why patients may start drinking. Deductive and inductive coding were completed by two independent raters. RESULTS: Although nearly all participants were aware of the risks associated with post-surgical alcohol use, most believed that lifelong abstinence from alcohol was unrealistic. Common reasons identified for using alcohol after bariatric surgery included social gatherings, resuming pre-surgical use, and addiction transfer. Inductive coding identified three themes: participants consumed alcohol in different ways compared to prior to surgery; the effect of alcohol was substantially stronger than pre-surgery; and beliefs about why patients develop problematic alcohol use following surgery. CONCLUSION: Patients consume alcohol after bariatric surgery for a variety of reasons and they do not believe recommending abstinence is useful. Understanding patient perceptions can inform interventions to minimize alcohol use after bariatric surgery. Modifications to traditional alcohol relapse prevention strategies may provide a more robust solution to decreasing negative outcomes experienced by individuals undergoing bariatric surgery.

Multi-level influences on increased overdose risk behaviors during the COVID-19 pandemic among people who use drugs in Rhode Island: a qualitative investigation.

BACKGROUND: The ongoing COVID-19 pandemic has disproportionately affected structurally vulnerable populations including people who use drugs (PWUD). Increased overdose risk behaviors among PWUD during the pandemic have been documented, with research underscoring the role of influencing factors such as isolation and job loss in these behaviors. Here, we use qualitative methods to examine the impact of the COVID-19 pandemic and pandemic-related response measures on drug use behaviors in a sample of PWUD in Rhode Island. Using a social-ecological framework, we highlight the nested, interactive levels of the pandemic's influence on increased overdose risk behaviors. METHODS: From July to October 2021, semi-structured interviews were conducted with 18 PWUD who self-reported any increase in behaviors associated with overdose risk (e.g., increased use, change in drug type and/or more solitary drug use) relative to before the pandemic. Thematic analysis was conducted using a codebook with salient themes identified from interview guides and those that emerged through close reading of transcribed interviews. Guided by a social-ecological framework, themes were grouped into individual, network, institutional, and policy-level influences of the pandemic on drug use behaviors. RESULTS: Individual-level influences on increased overdose risk behaviors included self-reported anxiety and depression, isolation and loneliness, and boredom. Network-level influences included changes in local drug supply and changes in social network composition specific to housing. At the institutional level, drug use patterns were influenced by reduced access to harm reduction or treatment services. At the policy level, increased overdose risk behaviors were related to financial changes, job loss, and business closures. All participants identified factors influencing overdose risk behaviors that corresponded to several nested social-ecological levels. CONCLUSIONS: Participants identified multi-level influences of the COVID-19 pandemic and pandemic-related response measures on their drug use behavior patterns and overdose risk. These findings suggest that effective harm reduction during large-scale crises, such as the COVID-19 pandemic, must address several levels of influence concurrently.

Social Network Composition, Relationship Type, and Alcohol Use Among Young Adults Not in Four-Year College.

Background: The drinking of social network members has been consistently associated with personal drinking. However, less attention has been paid to emerging adult populations outside of four-year college students and to potential moderators of this relationship. In a sample of emerging adults who never attended four-year college, this research examined: 1) the compositional characteristics of the social networks, 2) the association between the drinking of network members and personal drinking, and 3) how the association between network and personal drinking was moderated by relationship type (e.g., friend, parents, significant other). Methods: Data was provided by a sample of 525 emerging adults who participated in Qualtrics Panels. Results: In this noncollege sample, the composition of the social network was diverse, with roughly one-third of network members being friends and a little less than half being family members. Parents tended to consume alcohol more frequently than friends and significant others, but participants consumed alcohol more frequently with friends and significant others. Furthermore, drinking among friends and significant others tended to have stronger associations with personal alcohol use than drinking among parents. However, relationship type did not moderate the association between drinking with network members and personal alcohol use. Conclusions: Because of this, interventions need to be delivered to drinking groups.

The association between social network members sharing alcohol-related social media content and alcohol outcomes among college student drinkers.

BACKGROUND: College-aged young adults (e.g., 18 to 29-year-olds) use social media more than any other age group. An emerging body of literature shows that higher exposure to alcohol-related social media content is associated with greater alcohol consumption among college students. However, most studies assess exposure to peer drinking on social media using global measures, rather than measuring the exposure to alcohol-related posts of identified specific close peers. We examined whether having a higher proportion of important peers (i.e., social network members) who post alcohol-related social media content is associated with greater alcohol consumption and alcohol-related consequences. We also investigated the extent to which the qualities of network members who share alcohol-related content are associated with participants' alcohol outcomes. METHODS: Participants were 130 college students (86.2% female, 56.9% White) with an average age of 23.39 years (SD = 5.63) who had consumed at least one alcoholic drink in the past week. Participants completed measures of their social media use, alcohol consumption, alcohol-related consequences, and characteristics of important peers in their social network, including their alcohol-related social media posting. RESULTS: Having a higher proportion of social network members who post alcohol-related social media content was positively related to participants' drinks per week and peak number of drinks. Higher network proportions of drinking buddies posting alcohol-related content were also associated with a greater frequency of alcohol use. Having a higher proportion of friends who post alcohol content and from whom the participants seek advice was linked to more alcohol-related consequences. CONCLUSIONS: Having more important peers who post alcohol-related content on social media is associated with alcohol outcomes among college students. Harm-reduction focused alcohol interventions delivered on college campuses that incorporate information about the influence of viewing and sharing alcohol-related content could help to reduce alcohol consumption and alcohol-related consequences among students.

Modeling reciprocal relations between emotion dysregulation and alcohol use using dynamic structural equation modeling: A micro-longitudinal study.

BACKGROUND: Research examining emotion dysregulation and alcohol use has increased exponentially over the past decade. However, these studies have been limited by their use of cross-sectional designs and narrow definitions of emotion dysregulation. To address these significant gaps in the extant literature, this study utilized state-of-the-art methodology (i.e., experience sampling) and statistics (i.e., dynamic structural equation modeling) to examine potential reciprocal associations between negative and positive emotion dysregulation and alcohol use at the momentary level. METHODS: Participants were 145 community women (mean age = 40.56, 40.3% white) experiencing intimate partner violence (IPV) and using substances. Surveys assessing negative and positive emotion dysregulation and alcohol use (i.e., number of standard drinks) were administered three times a day for 30 days using phone-based interactive voice recording. RESULTS: Significant contemporaneous effects indicated that negative and positive emotion dysregulation both co-occurred with alcohol use. However, levels of negative and positive emotion dysregulation did not predict later alcohol use, nor did alcohol use predict later levels of negative or positive emotion dysregulation. There was significant variability among participants in cross-lagged effects. CONCLUSIONS: Findings showed that negative and positive emotion dysregulation co-occurred with alcohol use and that there was significant interindividual variability in the cross-lagged associations between negative and positive emotion dysregulation and alcohol use. Research using idiographic approaches may identify women experiencing IPV for whom negative and positive emotion dysregulation drive alcohol use and alcohol use drives negative and positive emotion dysregulation.

Sensitivity, specificity, and tolerability of the BACTrack Skyn compared to other alcohol monitoring approaches among young adults in a field-based setting.

BACKGROUND: There is a need for novel alcohol biosensors that are accurate, able to detect alcohol concentration close in time to consumption, and feasible and acceptable for many clinical and research applications. We evaluated the field accuracy and tolerability of novel (BACTrack Skyn) and established (Alcohol Monitoring Systems SCRAM CAM) alcohol biosensors. METHODS: The sensor and diary data were collected in a larger study of a biofeedback intervention and compared observationally in the present sub-study. Participants (high-risk drinkers, 40% female; median age 21) wore both Skyn and SCRAM CAM sensors for 1-6 days and were instructed to drink as usual. Data from the first cohort of participants (N = 27; 101 person-days) were used to find threshold values of transdermal alcohol that classified each day as meeting or not meeting defined levels of drinking (heavy, above-moderate, any). These values were used to develop scoring metrics that were subsequently tested using the second cohort (N = 20; 57 person-days). Data from both biosensors were compared to mobile diary self-report to evaluate sensitivity and specificity in relation to a priori standards established in the literature. RESULTS: Skyn classification rules for Cohort #1 within 3 months of device shipment showed excellent sensitivity for heavy drinking (94%) and exceeded expectations for above-moderate and any drinking (78% and 69%, respectively), while specificity met expectations (91%). However, classification worsened when Cohort #1 devices ≥3 months from shipment were tested (area under curve for receiver operator characteristic 0.87 vs. 0.79) and the derived classification threshold when applied to Cohort #2 was inadequately specific (70%). Skyn tolerability metrics were excellent and exceeded the SCRAM CAM (p ≤ 0.001). CONCLUSIONS: Skyn tolerability was favorable and accuracy rules were internally derivable but did not yield useful scoring metrics going forward across device lots and months of usage.

Trajectories of early alcohol use milestones: Interrelations among initiation and progression.

BACKGROUND: Alcohol use shows age-graded patterning, with normative use progressing through characteristic milestones of escalating use or severity. Despite some knowledge about the timing of milestone attainment and sequencing across milestones, there is a gap in our understanding of the earliest stages of use. This study characterizes the timing, sequencing, and speed of progression through milestones beginning with the first sip of alcohol. METHODS: Sixth through eighth graders (N = 1023; 52% female; 76% White; M = 12.23 years old) completed web surveys through the end of high school. Participants reported on alcohol experiences including the first sip, full drink, consumption of 3+ drinks/occasion (heavy drinking), being drunk, and experiencing acute consequences, from which milestone age and speed of progression (duration) were calculated. Milestone prevalence, sequencing, and timing were characterized, and associations between age of attainment and speed of progression were examined. We also examined whether milestone timing and progression varied by sex and racial/ethnic group. RESULTS: Overall, milestones followed the expected ordering with the exception of heavy drinking (3+ drinks/occasion) and being drunk, which appear to index similar experiences. An earlier age of attainment was associated with an increased likelihood of attaining each of the milestones. In contrast, once a milestone was achieved, there was reduced risk of initiation of subsequent adjacent milestones for individuals with an earlier first sip and full drink, and earlier initiation was associated with a longer duration to subsequent milestones. Girls were more likely to attain all milestones than boys, but there was no sex difference in the age of attainment. In contrast, Hispanic youth reported earlier ages of initiation than White non-Hispanic youth, but the likelihood of attainment did not vary by race/ethnicity. Rapid progression was observed in females but did not vary by race/ethnicity. DISCUSSION: Risks associated with early drinking are complex, with little support for normative ordering of milestones beyond the first sip. Although early drinking is associated with an increased risk of subsequent drinking, it does not appear to place the drinker on an accelerated course to heavier use. A nuanced understanding of risks associated with milestone timing may inform intervention efforts.

Sociodemographic and clinical factors associated with transdermal alcohol concentration from the SCRAM biosensor among persons living with and without HIV.

BACKGROUND: Transdermal alcohol biosensors can objectively monitor alcohol use by measuring transdermal alcohol concentration (TAC). However, it is unclear how sociodemographic and clinical factors that influence alcohol metabolism are associated with TAC. The main aim of this study was to examine how sociodemographic factors (sex, age, race/ethnicity) and clinical factors (body mass index, liver enzymes: alanine aminotransferase [ALT] and aspartate transaminase [AST]), alcohol use disorder, and HIV status were associated with TAC while controlling for level of alcohol use. METHODS: We analyzed data from a prospective study involving contingency management for alcohol cessation among persons living with and without human immunodeficiency virus (HIV) that used the Secure Continuous Remote Alcohol Monitoring (SCRAM) biosensor. Forty-three participants (Mage  = 56.6 years; 63% male; 58% people living with HIV) yielded 183 SCRAM-detected drinking days. Two indices derived from SCRAM: peak TAC (reflecting level of intoxication) and TAC area under the curve (TAC-AUC; reflecting alcohol volume)-were the main outcomes. Self-reported alcohol use (drinks/drinking day) measured by Timeline Followback was the main predictor. To examine whether factors of interest were associated with TAC, we used individual generalized estimating equations (GEE), followed by a multivariate GEE model to include all significant predictors to examine their associations with TAC beyond the effect of self-reported alcohol use. RESULTS: Number of drinks per drinking day (B = 0.29, p < 0.01) and elevated AST (B = 0.50, p = 0.01) were significant predictors of peak TAC. Positive HIV status, female sex, elevated AST, and number of drinks per drinking day were positively associated with TAC-AUC at the bivariate level, whereas only self-reported alcohol use (B = 0.85, p < 0.0001) and female sex (B = 0.67, p < 0.05) were significant predictors of TAC-AUC at the multivariate level. CONCLUSIONS: HIV status was not independently associated with TAC. Future studies should consider the sex and liver function of the participant when using alcohol biosensors to measure alcohol use.

Ecological Momentary Assessment of Alcohol Consumption and Its Concordance with Transdermal Alcohol Detection and Timeline Follow-Back Self-report Among Adults Experiencing Homelessness.

BACKGROUND: Studies of alcohol use presume valid assessment measures. To evaluate this presumption, we examined the concordance of alcohol use as measured by ecological momentary assessment (EMA) self-reports, transdermal alcohol concentration readings via the Secure Continuous Remote Alcohol Monitor (SCRAM), and retrospective self-reports via the Timeline Follow-Back (TLFB) among adults experiencing homelessness. METHODS: Forty-nine adults who reported alcohol misuse (mean age = 47, SD = 9; 57% Black; 82% men) were recruited from a homeless shelter. For 4 weeks, alcohol use was assessed: (i) 5 times or more per day by EMA, (ii) every 30 minutes by a SCRAM device worn on the ankle, and (iii) by TLFB for the past month at the end of the study period. There were 1,389 days of observations of alcohol use and alcohol use intensity for 49 participants. RESULTS: EMA and SCRAM alcohol use data agreed on 73% of days, with an interrater agreement Kappa = 0.46. A multilevel analysis of concordance of 3 measures for alcohol use yielded statistically significant correlations of 0.40 (day level) and 0.63 (person level) between EMA and SCRAM. Alcohol use was detected on 49, 38, and 33% of days by EMA, SCRAM, and TLFB, respectively. For alcohol use intensity, EMA and SCRAM resulted in statistically significant correlations of 0.46 (day level) and 0.78 (person level). The concordance of TLFB with either EMA or SCRAM was weak, especially at the day level. CONCLUSIONS: This is the first study to examine concordance of alcohol use estimates using EMA, SCRAM, and TLFB methods in adults experiencing homelessness. EMA is a valid approach to quantifying alcohol use, especially given its relatively low cost, low participant burden, and ease of use. Furthermore, any stigma associated with wearing the SCRAM or reporting alcohol use in person may be attenuated by using EMA, which may be appealing for use in studies of stigmatized and underserved populations.

Contextual factors associated with high-intensity drinking events among young adults: A qualitative inquiry.

BACKGROUND: Much of the prior research addressing risky drinking among young adults has focused on heavy episodic drinking (4+/5+ drinks in a single sitting for females/males). However, 1 in 3 young adults engaged in past-year high-intensity drinking (HID, 8+/10+ drinks in a single sitting for females/males). Consuming such large amounts of alcohol is associated with serious acute consequences (e.g., severe injury, overdose) and the development of alcohol use disorder. This qualitative study aimed to gain an in-depth understanding of contextual influences on HID from drinkers' perspectives. METHODS: We conducted individual interviews of 28 young adults (57% female, aged 20 to 25 years old) who engage in HID to assess the role of context in the prediction of HID (relative to non-HID events). Two authors coded each interview following a structured codebook and thematic analysis was used to analyze the qualitative data. RESULTS: Based on identified themes, factors that may increase HID likelihood include being in larger groups or in social contexts where others are drinking heavily, having close relationships with others who are present, on special occasions, when feeling safe, being comfortable in a given situation, and experiencing intense affective states (especially positive ones). Noted deterrents for HID included friends' extreme intoxication, perceptions that heavy drinking is less acceptable in certain contexts (i.e., at work, family events) or among others present, cost/financial constraints, next-day responsibilities, and needing to drive. CONCLUSIONS: Young adults identified a number of social and psychological factors that they perceived influenced their likelihood of engaging in HID. However, they also generated a number of factors that constrained this style of drinking. Understanding the contexts in which HID is most likely to occur will inform interventions that aim to reduce this high-risk behavior.

Mechanisms Underlying Associations between Media Alcohol Exposure, Parenting, and Early Adolescent Drinking: A Moderated Sequential Mediation Model.

Exposure to alcohol content in the media, especially in movies, is a demonstrated risk factor for adolescent alcohol use. This paper examines processes underlying this association and whether parenting mitigates such harms. A mediational model of parental restriction of mature media (W1), alcohol content exposure (W2), alcohol expectancies, peer norms (W3), and alcohol outcomes (W4) was tested using annual assessments from a study of adolescent drinking (N = 879; 52% female; 21% Non-White; 12% Hispanic). When restrictions are not in place, adolescents report greater exposure to alcohol content, leading to higher perceived peer drinking. Parental monitoring did not buffer the link between exposure and peer norms. Parental media restriction and perceptions about peers comprise mechanisms by which alcohol-saturated media influences youth drinking.

Fixed choice design and augmented fixed choice design for network data with missing observations.

The statistical analysis of social networks is increasingly used to understand social processes and patterns. The association between social relationships and individual behaviors is of particular interest to sociologists, psychologists, and public health researchers. Several recent network studies make use of the fixed choice design (FCD), which induces missing edges in the network data. Because of the complex dependence structure inherent in networks, missing data can pose very difficult problems for valid statistical inference. In this article, we introduce novel methods for accounting for the FCD censoring and introduce a new survey design, which we call the augmented fixed choice design (AFCD). The AFCD adds considerable information to analyses without unduly burdening the survey respondent, resulting in improvements over the FCD, and other existing estimators. We demonstrate this new method through simulation studies and an analysis of alcohol use in a network of undergraduate students living in a residence hall.

Identification and Description of Potentially Influential Social Network Members using the Strategic Player Approach.

Background: Diffusion of innovations theory posits that ideas and behaviors can be spread through social network ties. In intervention work, intervening upon certain network members may lead to intervention effects "diffusing" into the network to affect the behavior of network members who did not receive the intervention. The strategic players (SP) method, an extension of Borgatti's Key Players approach, is used to balance the (sometimes) opposing goals of spreading the intervention to as many members of the target group as possible, while preventing the spread of the intervention to others. Objectives: We sought to test whether members of the SP set have network position and non-network differences (such as demographic, attitudinal, or behavioral differences) compared to the remaining members of the target group (non-SPs). Methods: A first-year class at a private residential university (N = 1342) completed network and non-network measures. Analyses were restricted only to heavy drinkers, leading to a final analytic sample of 529. Results: SPs and non-SPs differed on multiple network variables, but did not differ on most demographic, attitudinal, and behavior variables. Conclusions: As designed, the SP program identified participants who were distinguished by their network position. The fact that they did not also differ on other characteristics shows the SPs are not significantly different than heavy drinkers who were not selected.

Feasibility and Acceptability of a Motivational Intervention Combined with Text Messaging for Alcohol and Sex Risk Reduction with Emergency Department Patients: A Pilot Trial.

BACKGROUND: Interventions aimed at reducing co-occurring heavy drinking and risky sexual behavior among Emergency Department (ED) patients require feasibility and acceptability to optimally engage individuals. OBJECTIVES: This pilot study explored the feasibility and acceptability of an interactive text-messaging (TM) supplement to a brief in-person intervention previously found successful in reducing alcohol use and condomless sex. METHODS: Using a mixed-method design, ED patients with past hazardous alcohol use and condomless sex (N= 20) were randomly assigned to receive either a Motivational Intervention + TM or Brief Advice + TM. All participants completed exit interviews at four weeks follow-up, and transcripts were transcribed and coded to identify themes. We evaluated feasibility through quantitative assessment of TM response rates and latency to response, while acceptability was evaluated through thematic analysis of exit interviews. RESULTS: Findings provide support for the delivery of an integrated and personalized MI and TM. Participants engaged positively with the TM intervention and qualitative interviews offered strong support for the acceptability while offering information necessary to enhance the TM component. CONCLUSIONS: Integrating MI with TM is feasible and acceptable to at-risk ED patients and could facilitate behavior changes beyond MI alone.

Exposure to Alcohol Content in Movies and Initiation of Early Drinking Milestones.

BACKGROUND: Exposure to alcohol content in movies has been shown to be associated with adolescent use of alcohol, including earlier onset. This study examined the influence of movie alcohol exposure on subsequent alcohol onset, considering the social context (whether the movie was viewed with a friend or parent). We examined whether media's influence holds across a spectrum of early drinking milestones: sipping (but not consuming a full drink of) alcohol, consuming a full drink of alcohol, and engaging in heavy episodic drinking (HED). METHODS: Data were taken from a sample of 882 middle school youth (52% female; 24% non-White) enrolled in an ongoing study on alcohol initiation and progression. Exposure to alcohol content in films was measured using a method that combines content analysis and random assignment of movie titles to youth surveys. The hazard of initiating alcohol use (sip, full drink, HED) as a function of exposure was estimated using survival analysis. Associations were adjusted for demographic, personality, and social influence factors known to be associated with both movie exposure and alcohol use. RESULTS: Exposure to alcohol content was common. Hours of exposure prospectively predicted earlier onset of alcohol involvement across all outcomes. Viewing movies with friends appeared to augment the media exposure effect, in contrast to viewing movies with parents, which was not a significant predictor of initiation. CONCLUSIONS: Exposure to alcohol in films is involved in the entry into early stages of alcohol involvement. Findings support further investigation into the role of the media in underage drinking, especially in the context of consuming media with friends and peers. Limiting media exposure and/or stronger Federal Trade Commission oversight of movie ratings should be a priority for preventing underage drinking.

Brief Motivational Intervention for Underage Young Adult Drinkers: Results from a Randomized Clinical Trial.

BACKGROUND: While there is a substantial literature on the efficacy of brief motivational intervention (BMI) for college student drinkers, research has focused less on young adults who do not attend a 4-year college, despite their elevated risk for excessive alcohol use and associated harmful consequences. METHODS: This randomized controlled trial (NCT01546025) compared the efficacy of BMI to a time-matched attention control intervention (relaxation training [REL]) for reducing alcohol consumption and related negative consequences in an underage young adult sample. BMI was tailored to the developmental transition out of high school for young adults who were not immediately planning to enroll in a 4-year college. Non-treatment-seeking underage drinkers who reported past-month heavy drinking (N = 167; ages 17 to 20; 42% female; 59% non-Hispanic White) were randomly assigned to receive a single session of BMI or REL. Outcomes were evaluated 6 weeks and 3 months postintervention via in-person assessments. RESULTS: Generalized estimating equation models provided strong support for the efficacy of BMI for reducing harmful drinking in these young adults. Compared to REL, and after controlling for baseline covariates including gender, those who received BMI subsequently reported significantly fewer average drinks per week, percent drinking days, percent heavy drinking days, lower peak and typical estimated blood alcohol concentration on drinking days, and fewer adverse consequences of drinking (all ps < 0.05). These between-group effects did not weaken over the course of the 3-month follow-up period. CONCLUSIONS: These findings demonstrate an efficacious approach to tailoring BMI for non-college-attending young adults. Future research should replicate and extend these findings over a longer follow-up period.

Parent and Adolescent Motivational Enhancement Intervention for Substance-Using, Truant Adolescents: A Pilot Randomized Trial.

The purpose of this article is to present the results of a treatment development study designed to examine the feasibility, acceptability, and preliminary efficacy of motivational enhancement therapy (MET) for substance using, truant adolescents plus the Family Check-Up (FCU) for parents. A randomized controlled trial was used to test the hypothesis that MET plus the FCU (MET/FCU) would lead to greater reductions in alcohol and marijuana use as well as truant behavior compared to a psychoeducation (PE) condition delivered to both adolescents and parents. Participants (n = 69; M age = 15.8 years) were 39% female, 59% White, and 31% Hispanic/Latino. Adolescents were referred from family court, from school truancy courts, from school counselors, or after presentations in high school health classes. Eligible participants reported using marijuana at least 3 times in the prior 90 days and a history of school truancy in the prior school year. The MET/FCU condition was found to be feasible to implement and was acceptable to both adolescents and parents. The PE condition was also found to be an acceptable and credible comparison condition by participants. Results at the 6-month follow-up favored MET/FCU over PE on days of marijuana use and number of times marijuana was smoked per day (medium effect), high volume drinking days and other drug use (small to medium effects), truancy indicators (small effects), parental monitoring (medium to large effects), and parent-teen problem solving (medium to large effects). A larger study to test the efficacy of the MET/FCU appears warranted based on these promising findings.

Strategic Players for Identifying Optimal Social Network Intervention Subjects.

We present a method whereby social network ties are used to identify behavioral leaders who are situated in the network such that these individuals are: 1) able to influence other individuals who are in need of and most receptive to intervention, thereby maximizing the impact of the intervention; and 2) not embedded with ties that are likely to be behaviorally antagonistic to the intervention or that would compromise the optimal evaluation of intervention efficacy. In this study we developed a novel method which we call Strategic Players, which is a solution for identifying a set of players who are close to a target subset of the network (i.e., the targeted group), and far away from the subset we wish to avoid (i.e. the avoidance group). This solution seeks to maximize the diffusion of the behavior to the targeted group while minimizing contact and influence from the avoidance group. We apply this method to two different social networks.