Trends in Driving Under the Influence of Alcohol and Cannabis Among Young Adults in Washington State From Before to During the COVID-19 Pandemic.

Objectives. To examine trends in young adult self-reported driving under the influence of alcohol (DUI-A), cannabis (DUI-C), and simultaneous alcohol and cannabis use (DUI-AC) in a state with legalized nonmedical cannabis use from before to during the COVID-19 pandemic. Methods. We used logistic regression and annual statewide data from the Washington Young Adult Health Survey to assess DUI behaviors from 2016 to 2021. Results. Both prepandemic yearly changes in prevalence and deviations from those trends during the pandemic years were small and not statistically significant. However, prevalence estimates were alarming: 12.0% of participants reported DUI-A, 12.5% reported DUI-C, and 2.7% reported DUI-AC. Exploratory moderation analyses indicated a relative increase in DUI-A during 2020 among 4-year college students relative to young adults not attending 4-year colleges. Conclusions. Young adults in Washington State continued to engage in risky DUI behaviors during the pandemic. College students may have increased their likelihood of DUI-A during COVID-19. Public Health Implications. Young adults, for whom vehicle crashes remain a leading cause of death, showed little change in DUI behaviors during the COVID-19 pandemic. There is continued need for young adult DUI prevention efforts. (Am J Public Health. 2024;114(S8):S698-S701. https://doi.org/10.2105/AJPH.2024.307767).

Discovering what young adults want in electronic interventions aimed at reducing alcohol-related consequences.

BACKGROUND: Despite intervention efforts, negative alcohol-related consequences continue to impact young adults. Most alcohol interventions focus on reducing alcohol consumption; however, previous research indicates that focusing solely on alcohol use may not decrease consequences. Additionally, many alcohol interventions have diminishing engagement, and few are designed with young adults involved in the development process. Drawing on user-centered design, this study sought to understand young adult perceptions, preferences, and needs for electronic interventions specifically aimed at reducing alcohol consequences. METHODS: Using semi-structured qualitative interviews, 21 young adult drinkers (ages 18-24; 57.1% female) shared their opinions regarding the need for electronic interventions (i.e., mobile or web-delivered) to reduce alcohol consequences as well as their preferences for content, features, and ways to increase engagement. Interviews were coded and analyzed using a multi-step thematic analysis approach. RESULTS: As part of our discovery phase of intervention development, content coding revealed four main themes. Participants perceived several benefits of interventions focused on alcohol consequences, such as promoting mindful alcohol use and reducing alcohol-related harms. Participants also discussed perceived limitations of such programs, including believing consequences from drinking are unavoidable, necessary for learning, and associated with peer pressure. Preferences for features included real-time tracking, personalized feedback, and psychoeducation along with preferences for design including non-judgmental framing, interactive content, and a user-friendly platform. CONCLUSIONS: Engaging end users early in the development process is a valuable approach to increase intervention relevancy with the target population. This can also inform intervention content and design to maximize engagement and satisfaction (e.g., framing, features, and interactivity) while also reducing barriers identified early on (e.g., peer pressure).

General and Domain-Specific Perceived Risk Demonstrate Unique Associations with Cannabis Use, Negative Outcomes, and Motivation to Change among Undergraduate Students.

College student cannabis use is at an all-time high. Although frequent heavy cannabis use is related to cannabis problems, perceived risk of cannabis use is rapidly decreasing. Yet, it is unknown whether specific domains of risk perceptions (general and domain-specific risk, risk to others and personal risk) are related to more cannabis use or related problems. Thus, among 130 undergraduates who reported past-month cannabis use, the present study conducted secondary analyses to test whether, for both perceived risk to others and perceived personal risk: (1) general perceived risk was associated with cannabis-related outcomes (i.e., use, negative consequences, cannabis use disorder (CUD) symptoms, motivation to change), (2) seven specific domains of perceived risk were related to cannabis outcomes, and (3) domain-specific perceived risk was related to cannabis use frequency. General perceived risk to others was negatively associated with cannabis use frequency whereas general perceived personal risk was positively associated with cannabis-related negative consequences, CUD symptoms, and importance and readiness to change. Greater legal and withdrawal/dependence risks were uniquely related to several outcomes (e.g., CUD symptoms). Participants who used cannabis frequently perceived more personal risk in most risk domains and less general risk to others than those who used infrequently. Findings suggest personal risk is an important component to consider when assessing perceived risk of cannabis use and focusing on both general and domain-specific risks may provide valuable insight for future prevention and intervention efforts.

Young Adult Alcohol and Cannabis Impaired Driving After the Opening of Cannabis Retail Stores in Washington State.

Motor vehicle crashes are a leading cause of death for young adults (YA) in the USA, and driving under the influence of alcohol (DUIA), cannabis (DUIC), and simultaneous use of both substances (DUIAC) are prominent risk factors. Trends in YA impaired driving behaviors after opening of cannabis retail stores have been understudied. We examined YA trends in DUIA, DUIC, and DUIAC from immediately prior through 5 years following the opening of cannabis retail outlets in Washington State (2014-2019). Differences in trends were assessed across age, sex, and urbanicity. Weighted logistic regressions assessed yearly change in prevalence of DUIA, DUIC, and DUIAC from 2014 to 2019, using annual statewide data from the Washington Young Adult Health Survey (n = 12,963; ages 18-25). Moderation of trends by age, sex, and urbanicity was assessed. Prevalence of DUIA decreased overall (AOR = 0.93, 95% CI 0.90, 0.97) and among drinkers (AOR = 0.95, 95% CI 0.91, 0.99) but remained at concerning levels in 2019 (10% overall; 16% among drinkers). Overall DUIC did not change significantly (AOR = 0.99, 95% CI 0.96, 1.03; 11% by 2019) but decreased among those who used cannabis (AOR = 0.91, 95% CI 0.86, 0.96; 33% by 2019). DUIAC decreased but not significantly (overall: AOR = 0.89, 95% CI 0.78, 1.01; those who used alcohol and cannabis: AOR = 0.84, 95% CI 0.74, 1.04). Prevalence of YA DUI remained concerning. Trends may reflect some success in reducing DUI, but additional detection and prevention are needed.

Longitudinal examination of alcohol use motives, item-level protective behavioral strategies, and alcohol-related consequences.

BACKGROUND: Alcohol misuse among college students is a public health concern. Protective behavioral strategies (PBS) can be used before, during, after, or instead of drinking to reduce alcohol use and negative consequences, but findings on their utility at the aggregate level are mixed. Although recent work has provided important information on the performance of individual PBS items, it is limited by research designs that are cross-sectional, do not examine consequences, or do not examine other important correlates, such as drinking motives. This study examines both the association between item-level PBS and alcohol-related negative consequences and the moderating effect of drinking motives longitudinally. METHODS: College students from two universities (n = 200, 62.5% female, Mage = 20.16) completed the Drinking Motives Questionnaire-Revised, Protective Behavioral Strategies Survey, the Rutgers Alcohol Problem Index, and a measure of the quantity of alcohol use at baseline and 3-month follow-up. Generalized linear models were conducted to assess direct effects of item-level PBS on alcohol-related consequences and the moderating effects of drinking motives. RESULTS: Two PBS items were associated with fewer alcohol-related consequences at follow-up, and two items were associated with greater alcohol-related consequences at follow-up. Drinking motives differentially moderated associations between item-level PBS and alcohol-related consequences for a proportion in the sample. Enhancement motives moderated the greatest number of associations, followed by coping, conformity, and social motives. Certain PBS (e.g., drink slowly, rather than gulp or chug) were moderated by several drinking motives, whereas other PBS items were not moderated by any motives. CONCLUSION: Consistent with previous research, some item-level PBS were associated longitudinally with increased negative consequences, and some were associated with decreased negative consequences. Drinking motives, particularly enhancement, moderated several item-level PBS and consequence associations, suggesting that reasons for drinking may be important for understanding the associations between PBS strategies and alcohol-related consequences.

Changes in Cannabis Use From 2014 to 2019 Among Young Adults in Washington State.

INTRODUCTION: Understanding changes in cannabis use in the legalized nonmedical cannabis context is critical. Washington State, one the earliest states to implement legalization, presents a unique opportunity to examine how cannabis use and its consequences changed after the implementation of legalization for adults. With a focus on Washington State young adults, this study conducted in 2022-2023 examined changes in (1) cannabis use by sex and age, (2) preferred mode of use, and (3) cannabis use disorder symptoms. METHODS: Using repeated cross-sectional data on young adults aged 18-25 years in Washington State from 2014 (premarket opening) to 2019 (N=12,945), logistic regression models assessed trends over time in the prevalence of any and frequent (20+ days) past-month cannabis use. Among individuals reporting use, multinomial logistic regressions estimated trends over time in the preferred mode of use and negative binomial regressions examined trends in the count of cannabis use disorder symptoms. RESULTS: From 2014 to 2019, the prevalence of cannabis use converged by sex, with females being equally likely as males to report both any and frequent use by 2019. Among young adults reporting past-month use, smoking as the preferred mode of use decreased relative to other modes. Number of cannabis use disorder symptoms reported increased, which was not accounted for by changes in preferred mode of use. CONCLUSIONS: During the 5-year period following the implementation of legalization, patterns of young adult cannabis use shifted, including particularly sharp increases among females and increases in cannabis use disorder symptoms. Future studies should investigate underlying causes for these important changes.

Whose Approval Matters Most? Examining Discrepancies in Self- and Other- Perceptions of Drinking.

BACKGROUND: Research demonstrates that perceptions of others' attitudes toward drinking behaviors (injunctive norms) are strong predictors of alcohol consumption and problems. Personalized normative feedback (PNF) aims to reduce the discrepancy between one's perception of others' attitudes toward drinking and others' actual attitudes toward drinking. An implicit assumption of PNF is that self and (perceived) other attitudes toward drinking are aligned (thus, shifting one's perceptions of others' attitudes shifts one's own attitudes). However, there is minimal research on the extent to which alignment (or discrepancy) in self-other attitudes toward drinking is associated with alcohol-related outcomes. METHODS: College students (N = 1,494; Mage = 20.11, 61.0% female, 66.4% White) who endorsed past-month heavy episodic drinking reported injunctive norms toward drinking on weekends, drinking daily, drinking to black out, and drinking and driving. Participants reported their perceptions of attitudes toward these drinking behaviors for three reference groups: close friends, typical university-affiliated peers, and parents. Outcomes included weekly drinking, alcohol problems, and alcohol-related risk. RESULTS: Response surface analyses indicated that alignment in approval (versus alignment in disapproval) of drinking demonstrated a linear association with alcohol-related outcomes. Discrepancies in self-peer and self-parent attitudes were associated with alcohol-related outcomes and one's own attitudes (versus one's ratings of others' attitudes) of drinking were more strongly associated with outcomes. CONCLUSIONS: Results provide evidence of how self-other discrepancies in attitudes toward drinking are associated with alcohol-related outcomes. Future work is needed to test whether self-other discrepancies in attitudes toward drinking impacts response to norms-based interventions.

A Cross-Cultural Comparison of Negative Alcohol-Related Consequences in the United States and Sweden: Measurement Invariance of the Rutgers Alcohol Problem Index.

Commensurate measures of alcohol-related consequences across countries and cultures are critical for addressing the global burden of hazardous alcohol use. The Rutgers Alcohol Problem Index (RAPI), developed and validated in the United States, is a popular measure of alcohol problems. This study examined measurement invariance of the RAPI across samples of U.S. and Swedish high school seniors. Latent mean differences in alcohol problems across countries and differences in associations between alcohol problems with alcohol use and protective behavioral strategies (PBS) were also examined. The RAPI was scalar invariant. Swedish students reported fewer problems than U.S. students (latent mean difference = -0.19, p = .047). In both samples, the RAPI was positively correlated with alcohol use frequency and quantity (ps < .001), and negatively correlated with PBS use (ps < .05). Overall, the RAPI demonstrated measurement invariance, and we found evidence for its validity across samples of U.S. and Swedish high school seniors.

Do brief motivational interventions increase motivation for change in drinking among college students? A two-step meta-analysis of individual participant data.

BACKGROUND: Brief motivational interventions (BMIs) are one of the most effective individually focused alcohol intervention strategies for college students. Despite the central theoretical role of motivation for change in BMIs, it is unclear whether BMIs increase motivation to change drinking behavior. We conducted a two-step meta-analysis of individual participant data (IPD) to examine whether BMIs increase motivation for change. N = 5903;59% women, 72% White) from Project INTEGRATE. The BMIs included individually delivered motivational interviewing with personalized feedback (MI + PF), stand-alone personalized feedback (PF), and group-based motivational interviewing (GMI). METHODS: We included 15 trials of BMI (N = 5903;59% women, 72% White) from Project INTEGRATE. The BMIs included individually-delivered motivational interviewing with personalized feedback (MI + PF), stand-alone personalized feedback (PF), and group-based motivational interviewing (GMI). Different measures and responses used in the original trials were harmonized. Effect size estimates were derived from a model that adjusted for baseline motivation and demographic variables for each trial (step 1) and subsequently combined in a random-effects meta-analysis (step 2). RESULTS: The overall intervention effect of BMIs on motivation for change was not statistically significant (standard mean difference [SMD]: 0.026, 95% CI: [-0.001, 0.053], p = 0.06, k = 19 comparisons). Of the three subtypes of BMIs, GMI, which tended to provide motivation-targeted content, had a statistically significant intervention effect on motivation, compared with controls (SMD: 0.055, 95% CI: [0.007, 0.103], p = 0.025, k = 5). By contrast, there was no evidence that MI + PF (SMD = 0.04, 95% CI: [-0.02, 0.10], k = 6, p = 0.20) nor PF increased motivation (SMD = 0.005, 95% CI: [-0.028, 0.039], k = 8, p = 0.75), compared with controls. Post hoc meta-regression analysis suggested that motivation sharply decreased each month within the first 3 months postintervention (b = -0.050, z = -2.80, p = 0.005 for k = 14). CONCLUSIONS: Although BMIs provide motivational content and normative feedback and are assumed to motivate behavior change, the results do not wholly support the hypothesis that BMIs improve motivation for change. Changing motivation is difficult to assess during and following interventions, but it is still a theoretically important clinical endpoint. Further, the evidence cautiously suggests that changing motivation may be achievable, especially if motivation-targeted content components are provided.

Injunctive Norms and Driving Under the Influence and Riding With an Impaired Driver Among Young Adults in Washington State.

PURPOSE: Alcohol- and cannabis-impaired driving behaviors remain a public health concern especially among young adults (i.e., ages 18-25). Limited updates to prevention efforts for these behaviors may be due, in part, to limited understanding of malleable psychosocial predictors. The current study assessed associations between perceived injunctive norms (i.e., acceptability) of driving under the influence of alcohol (DUI-A) and cannabis (DUI-C), and riding with a driver under the influence of alcohol (RWI-A) and cannabis (RWI-C) in Washington State young adults. METHODS: Participants included 1,941 young adults from the 2019 cohort of the Washington Young Adult Health Survey. Weighted logistic regressions assessed the associations between peer injunctive norms and impaired driving-related behaviors. RESULTS: A weighted total of 11.5% reported DUI-A, 12.4% DUI-C, 10.9% RWI-A, and 20.9% RWI-C at least once in the past 30 days. Overlap between the outcomes was observed, indicating some young adults had engaged in multiple impaired driving-related behaviors. After controlling for substance use frequency, weighted logistic regressions indicated more positive perceived injunctive norms were associated with nearly 2 ½ times higher odds of DUI-A, 8 times higher odds of DUI-C, 4 times higher odds of RWI-A and six and a half times higher odds of RWI-C. DISCUSSION: Results increase the understanding of how injunctive norms-a potentially malleable psychosocial factor-are associated with four impaired driving-related outcomes. Prevention programs that focus on assessing and addressing the norms of these outcomes individually and collectively, such as normative feedback interventions and media campaigns, may be helpful in reducing these behaviors.

Self-report methodology for quantifying standardized cannabis consumption in milligrams delta-9-tetrahydrocannabinol.

Background: There is currently no format-independent method to determine delta-9-tetrahydrocannabinol (THC) in milligrams for self-report studies.Objectives: Validate self-report method for quantifying mg THC from commercially available cannabis products using product labeling, which includes both net weight and product potency.Methods: 53 adult cannabis users (24 M, 29F), 21-39 years of age (M = 28.38, SD = 4.15), were instructed to report daily use via a weekly survey for two consecutive weeks, provide product label photographs, abstain from use for 24 h, submit a urine sample and complete the Cannabis Use Disorder Identification Test - Revised (CUDIT-R) and the Marijuana Craving Questionnaire - Short Form (MCQ-SF). Milligrams of THC were determined by multiplying quantity of product used by its THC concentration. Urine was analyzed for the urine metabolite 11-nor-carboxy-THC (THC-COOH) via liquid chromatography mass spectroscopy. THC and THC-COOH values were log10 transformed prior to correlational analyses.Results: Median daily THC consumption was 102.53 mg (M = 203.68, SD = 268.13). Thirty-three (62%) of the 53 participants reported using two or more formats over the 2-week period. There was a significant positive correlation between log10 THC-COOH and log10 THC mg (r(41) = .59, p < .001), log10 THC mg and MCQ-SF score (r(41) = .59, p < .001), and log10 THC mg dose and CUDIT-R score, (r(41) = .39, p = .010).Conclusion: Our label-based methodology provides consumption information across all modalities of cannabis use in standard units that can be combined across products for calculation of dose. It is a viable and valid method for quantifying mg of THC consumed and can be utilized in any region where cannabis is legal, and labeling is regulated.

Daily-level relationships between negative affect, negative emotion differentiation, and cannabis behaviors among a high-risk sample of young adults.

Prior research suggests that higher trait negative emotion differentiation (NED; one's ability to make subtle distinctions between different negative emotional states) is associated with consuming less alcohol when experiencing high negative affect (NA) in daily life. Yet, whether these findings extend to cannabis use behaviors is unclear. The present study used intensive daily data to test whether NED moderated the relationship between NA and cannabis behaviors. A community sample of 409 young adults who used alcohol and cannabis completed a baseline survey and five 2-week bursts of online surveys across two years. Multilevel models tested cross-level interactions between trait NED (person-level) and daily NA (daily-level) predicting cannabis use, hours high, negative consequences, craving, and coping motives. In contrast to expectations, on days with higher reported NA, people with higher NED (compared to those with lower NED) had a greater likelihood of experiencing any cannabis craving, experienced more intense craving, and reported higher cannabis coping motives. NED x NA interaction was not significant for likelihood of cannabis use, hours high, or negative consequences. Post-hoc descriptive analyses suggest notable person-specific heterogeneity in these findings. Individuals with higher ability to differentiate between negative emotions reported higher coping motives and craving when experiencing higher NA. However, these associations were variable for individuals within the sample. It may be that high NED individuals crave and purposefully use cannabis to reduce NA states. Findings are inconsistent with the alcohol literature and have important implications for intervention efforts aimed at reducing coping-motivated cannabis use among young adults.

The association between cannabis use and risk of non-medical pain reliever misuse onset among young adults in a legal cannabis context.

BACKGROUND: Little is known about the prospective relationship between cannabis use and pain reliever misuse. This study examined associations of non-medical and medical cannabis use with onset of non-medical pain reliever misuse among young adults in Washington State (WA), where non-medical cannabis is legal. METHODS: Data were from a cohort-sequential study of adults 18-25 residing in WA. Four annual surveys were used from cohorts recruited in 2014, 2015, and 2016. Participants who had not reported non-medical pain reliever misuse at baseline were included in discrete time survival analyses (N = 4,236). Odds ratios (ORs) were estimated for new onset of non-medical pain reliever misuse in any given follow-up year over the course of three years according to baseline non-medical and medical cannabis use. RESULTS: When included separately in models, non-medical and medical cannabis use at baseline were associated with increased risk of non-medical pain reliever misuse adjusting for demographic characteristics as well as past year cigarette use and alcohol use (non-medical OR = 5.27; 95 % CI: 3.28, 8.48; medical OR = 2.21; 95 % CI: 1.39, 3.52). Including both forms of use in the model, associations of non-medical and medical cannabis use with non-medical pain reliever misuse onset remained (non-medical OR = 4.64; 95 % CI: 2.88, 7.49; medical OR = 1.65; 95 % CI: 1.04, 2.62). CONCLUSIONS: Despite claims that cannabis use may reduce opioid use and related harms, findings suggest that cannabis use, including medical use, may not be protective, but instead may increase risk for non-medical pain reliever misuse.

The Relationship Between Alcohol and Drug Use, Compulsive Sexual Behavior, and Condomless Anal Sex in Men Who have Sex with Men: Analysis of Retrospectively-Reported Sexual Behavior.

Men who have sex with men (MSM) are disproportionately impacted by HIV in the United States, and substance use and compulsive sexual behavior (CSB) are contributors to HIV risk behavior. This study sought to examine the direct and interactive effects of concurrent substance use and CSB on condomless anal sex (CAS) in a community sample of MSM (N = 200) utilizing a 90-day timeline follow-back assessment. Results indicated CSB did not directly increase risk for CAS when controlling for substance use and age. There was limited evidence for a direct effect of concurrent alcohol use on CAS, and no evidence for an interaction effect with CSB. The relationship between concurrent drug use and CAS was moderated by CSB, such that concurrent drug use was positively associated with CAS for those who screened positive for CSB, while the association was non-significant for those who screened negative. Implications and limitations of these findings are discussed.

RESUMEN: En los Estados Unidos, los hombres que tienen sexo con hombres (HSH) se ven afectados de manera desproporcionada, por el VIH, el uso de sustancias y el comportamiento sexual compulsivo (CSB), lo que contribuye al comportamiento de riesgo del VIH. Este estudio buscó examinar los efectos directos e interactivos del uso simultáneo de sustancias y el CSB sobre el sexo anal sin condón (CAS) en una muestra comunitaria de HSH (N = 200) utilizando una evaluación de retrospectiva de 90 días. Los resultados indicaron que CSB no aumentó directamente el riesgo de CAS al controlar el uso de sustancias y la edad. Se encontró evidencia limitada de un efecto directo del consumo concurrente de alcohol sobre CAS y no se encontró evidencia de efecto de interacción con la CSB. La relación entre el uso concurrente de drogas y CAS fue moderada por CSB, de modo que el uso concurrente de drogas se asoció positivamente con CAS para aquellos que dieron positivo para CSB, mientras que la asociación no fue significativa para aquellos que dieron negativo. Se discuten las implicaciones y limitaciones de estos hallazgos.

Injunctive and descriptive normative feedback for college drinking prevention: Is the whole greater than the sum of its parts?

OBJECTIVE: Single-component personalized normative feedback (PNF) interventions and multicomponent personalized feedback interventions (PFI) have been shown to reduce alcohol consumption among college students. The present study compared the efficacy of PNF interventions targeting descriptive norms alone (descriptive PNF), injunctive norms alone (injunctive PNF), or their combination (combined PNF), against a multicomponent PFI and an attention control condition. METHOD: Undergraduates (N = 1,137) across two universities who reported a minimum of one past-month episode of heavy episodic drinking (i.e., 4 +/5 + drinks on a single occasion for females/males) completed assessments at baseline and 3, 6, and 12 months postintervention. RESULTS: Relative to the attention control, participants in each of the four intervention conditions showed greater reductions in perceived descriptive/injunctive norms, total drinks per week, and alcohol-related consequences. Peak estimated blood alcohol concentration was also reduced in the injunctive PNF, combined PNF, and multicomponent PFI conditions, with the latter two conditions showing an advantage for duration of effects. The multicomponent PFI condition also evidenced greater reductions than the injunctive PNF in descriptive norms at 3-month and injunctive norms at 6- and 12-month follow-ups. No other group comparisons on any outcome were significant. CONCLUSIONS: Each intervention has merit for use in college student harm reduction efforts. Single-component or combined PNF could be considered a potential starting point, as PNF is less burdensome than a multicomponent PFI when considering ease and length of delivery. Results can inform optimization of norms-based interventions and guide recommendations on efficacious components for reducing alcohol use and harms on college campuses. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Using Alcohol and Cannabis as Sleep Aids: Associations with Descriptive Norms Among College Students.

PURPOSE: Young adults may use alcohol and cannabis as sleep aids, a risky behavior that can worsen sleep health over time and lead to substance dependence. Perceived norms for such risky behaviors are often overestimated and related to one's own use. This cross-sectional study examined: (a) the extent to which college students overestimated the prevalence of alcohol and cannabis use as sleep aids (i.e., perceived descriptive norms), and (b) the extent to which perceived descriptive norms were associated with students' own use of alcohol and cannabis as sleep aids. METHODS: 2,642 undergraduate college students (Mage = 18.84 years) reported past 30-day use of alcohol and cannabis as sleep aids. Participants also estimated the percent of college students who use alcohol and cannabis as sleep aids (i.e., perceived descriptive norms). RESULTS: One-sample t-tests revealed participants, on average, overestimated the norms for using alcohol and cannabis as sleep aids. Participants who endorsed past 30-day use of these substances as sleep aids overestimated these norms to an even greater extent. Count regression models showed perceived descriptive norms were associated with students' use of alcohol and of cannabis as sleeps aids, in respective models, even when controlling for sleep difficulties. CONCLUSIONS: College students may overestimate the prevalence of using alcohol and cannabis as sleep aids, and students who believe these behaviors are more normative report more frequent use of these substances as sleep aids. Taken together, findings may highlight the potential for norm-correcting strategies as a prudent approach to reducing/preventing the use of alcohol and cannabis as sleep aids.

Prom, graduation and parties: Alcohol use and normative perceptions among high school seniors during specific events.

BACKGROUND: Previous research has shown that a majority of adolescents in the United States initiate and drink alcohol prior to graduating high school and nearly twenty percent of high school seniors engage in heavy episodic drinking. Despite anecdotal evidence and media portrayals of alcohol use during high school events (e.g., prom), little is understood about alcohol use surrounding specific events that may be identified as "high-risk" events and addressed in specific interventions. Similarly, normative perceptions exert powerful influence on behaviors but little is understood about normative perceptions of alcohol use at high school events. OBJECTIVES: The purpose of the present study was to understand whether high school alcohol use is associated with specific events by describing behaviors and normative perceptions. METHODS: Participants were 386 U.S. college students age 18 to 19 (60.4 % female, mean age = 18.4) who provided retrospective accounts of their alcohol use surrounding senior year high school events (either before, which is relevant to pregaming addressed in this special issue, during, or after). RESULTS: Most students did not drink surrounding high school events but nearly all reported that they perceived that the typical high school senior did. Those who did drink alcohol tended to drink heavily, particularly during prom. Alcohol use was associated with other high school events ranging from the beginning of senior year (e.g., Homecoming) though the end (e.g., graduation parties) CONCLUSIONS: Results indicate the importance of future research efforts tailoring intervention efforts around specific events and the applicability of personalized normative feedback approaches.

A Tutorial on Cognitive Diagnosis Modeling for Characterizing Mental Health Symptom Profiles Using Existing Item Responses.

In research applications, mental health problems such as alcohol-related problems and depression are commonly assessed and evaluated using scale scores or latent trait scores derived from factor analysis or item response theory models. This tutorial paper demonstrates the use of cognitive diagnosis models (CDMs) as an alternative approach to characterizing mental health problems of young adults when item-level data are available. Existing measurement approaches focus on estimating the general severity of a given mental health problem at the scale level as a unidimensional construct without accounting for other symptoms of related mental health problems. The prevailing approaches may ignore clinically meaningful presentations of related symptoms at the item level. The current study illustrates CDMs using item-level data from college students (40 items from 719 respondents; 34.6% men, 83.9% White, and 16.3% first-year students). Specifically, we evaluated the constellation of four postulated domains (i.e., alcohol-related problems, anxiety, hostility, and depression) as a set of attribute profiles using CDMs. After accounting for the impact of each attribute (i.e., postulated domain) on the estimates of attribute profiles, the results demonstrated that when items or attributes have limited information, CDMs can utilize item-level information in the associated attributes to generate potentially meaningful estimates and profiles, compared to analyzing each attribute independently. We introduce a novel visual inspection aid, the lens plot, for quantifying this gain. CDMs may be a useful analytical tool to capture respondents' risk and resilience for prevention research.

Brief Alcohol Interventions are Effective through 6 Months: Findings from Marginalized Zero-inflated Poisson and Negative Binomial Models in a Two-step IPD Meta-analysis.

To evaluate and optimize brief alcohol interventions (BAIs), it is critical to have a credible overall effect size estimate as a benchmark. Estimating such an effect size has been challenging because alcohol outcomes often represent responses from a mixture of individuals: those at high risk for alcohol misuse, occasional nondrinkers, and abstainers. Moreover, some BAIs exclusively focus on heavy drinkers, whereas others take a universal prevention approach. Depending on sample characteristics, the outcome distribution might have many zeros or very few zeros and overdispersion; consequently, the most appropriate statistical model may differ across studies. We synthesized individual participant data (IPD) from 19 studies in Project INTEGRATE (Mun et al., 2015b) that randomly allocated participants to intervention and control groups (N = 7,704 participants, 38.4% men, 74.7% White, 58.5% first-year students). We sequentially estimated marginalized zero-inflated Poisson (Long et al., 2014) or negative binomial regression models to obtain covariate-adjusted, study-specific intervention effect estimates in the first step, which were subsequently combined in a random-effects meta-analysis model in the second step. BAIs produced a statistically significant 8% advantage in the mean number of drinks at both 1-3 months (RR = 0.92, 95% CI = [0.85, 0.98]) and 6 months (RR = 0.92, 95% CI = [0.85, 0.99]) compared to controls. At 9-12 months, there was no statistically significant difference in the mean number of drinks between BAIs and controls. In conclusion, BAIs are effective at reducing the mean number of drinks through at least 6 months post intervention. IPD can play a critical role in deriving findings that could not be obtained in original individual studies or standard aggregate data meta-analyses.

Posttraumatic stress symptoms and substance use among college students: Exploring interactions with sleep quality and assigned sex.

Substance use is widely recognized as a negative outcome following traumatic events and is tied to symptoms of posttraumatic stress (PTS). Sleep quality may influence the PTS and substance use association, particularly among college students who are at risk for poor sleep. The purpose of the present study was to examine the moderating effect of sleep quality on the relationship between PTS and substance use in a cohort of college students, with an exploratory aim of examining potential differences by assigned sex. A screening survey was completed by 2,767 students enrolled in a larger RCT examining various brief college student alcohol reduction strategies. Results found a significant two-way interaction between PTS symptoms and subjective sleep quality on weekly number of drinks and peak drinking occasion, where the significant positive association between PTS symptoms to weekly drinks and peak drinking occasion was only found for those who reported poor sleep quality. A similar pattern emerged for the significant two-way interaction between PTS symptoms and subjective sleep quality on cannabis use frequency. A significant three-way interaction (i.e., PTS Symptoms × Poor Subjective Sleep Quality × Assigned Sex) indicated the two-way interaction between PTS symptoms and sleep quality for both weekly drinks and cannabis use frequency was stronger among male compared to female participants. Study findings suggest sleep quality is an important factor contributing to the relation between PTS symptom severity and substance use among college students. Strategies for assessing and improving sleep quality and PTS symptoms can be incorporated into prevention and intervention efforts targeting substance use related harm for college students.