College Students' Day-to-Day Maladaptive Drinking Responses to Stress Severity and Stressor-Related Guilt and Anger.

BACKGROUND: Stress is a common part of college students' daily lives that may influence their physical activity (PA) and alcohol use. Understanding features of daily stress processes that predict health behaviors could help identify targets for just-in-time interventions. PURPOSE: This study used intensive longitudinal data to examine whether prior day stress processes predict current day PA or alcohol use. METHODS: Participants (N=58, Mage=20.5, 59% women, 70% White) were 18-to-25-year-old students who engaged in binge drinking at least twice monthly and used cannabis or tobacco in the past year. They wore activity (activPAL4) and alcohol (Secure Continuous Remote Alcohol Monitor) monitors for 11 days to assess daily PA (e.g., step counts) and alcohol use (e.g., drinking day), and completed daily surveys about yesterday's stress, including number of stressors (i.e., frequency), stressor intensity (i.e., severity), and frequency of affective states (e.g., guilt). Multilevel models examined prior day stress predicting current day PA or alcohol use. RESULTS: Participants had higher odds of current day drinking (odds ratio=1.21) and greater area under the curve (B=0.08) when they experienced greater than usual stress severity the prior day. Participants had higher current day peak transdermal alcohol concentration (B=0.12) and area under the curve (B=0.11) when they more frequently experienced guilt due to stressors the prior day. CONCLUSIONS: College students' unhealthy response of increasing alcohol use due to stress could adversely impact health outcomes. There is a critical need for interventions addressing students' ability to effectively manage and respond to the stress-inducing, daily demands of student life.

College students experience stress regularly, which may influence their physical activity (PA) and drinking behaviors. Understanding how daily stress predicts health behaviors could be useful for stress-reduction interventions. This study examined whether prior day stress predicted current day PA or alcohol use. Participants (N = 58) were 18- to 25-year-old college students who binge drank at least twice per month and used cannabis or tobacco in the past year. They wore PA and alcohol sensors for 11 days to assess daily PA and alcohol use, and completed daily surveys about yesterday's stress, including the number of stressors experienced (i.e., frequency), stressor intensity (i.e., severity), and mood responses related to stress (anger, anxiety, guilt, sadness). Participants were 21% more likely to drink and drank at higher intensity when they experienced greater than usual stress severity the prior day. Participants had higher current day alcohol use intensity when they more frequently experienced guilt due to stressors the prior day. College students' unhealthy response of increasing alcohol use due to stress could negatively impact short- and long-term health outcomes. There is a critical need for interventions addressing students' ability to effectively manage and respond to the stress-inducing, daily demands of student life.

Mean affect and affect variability may interact to predict inflammation.

INTRODUCTION: Individuals with greater affect variability (i.e., moment-to-moment fluctuations possibly reflecting emotional dysregulation) are at risk for greater systemic inflammation, which is associated with cardiovascular disease. Some evidence suggests that affect variability is linked with poorer health indicators only among those with higher average levels of affect, particularly for positive affect (PA), and that associations may be non-linear. The present study sought to examine whether links between both PA and negative affect (NA) variability and inflammation are moderated by average level of affect. METHODS: Participants (N = 300, 50 % female, ages 21-70, 60 % non-Hispanic White, 19 % Hispanic, 15 % non-Hispanic Black) completed a lab assessment and provided a blood sample to measure systemic inflammation (i.e., TNF-α, IL-6, CRP). Affect was collected via a two-day ecological momentary assessment protocol where reports were collected about every 45-min during waking hours. Momentary affect ratings were averaged across both days (i.e., iM), separately for PA and NA, for each participant. Affect variability was calculated as the person-specific SD (i.e., iSD) of affect reports, separately for PA and NA. Linear and quadratic interactions were tested. Models included covariates for sex, race, and body mass index. RESULTS: There were significant interactions between NA iM and NA iSD predicting TNF-α (b = 6.54; p < 0.05) and between PA iM and PA iSD predicting IL-6 (b = 0.45; p < 0.05). Specifically, the association between these affect variability indicators and inflammatory markers were suggestive of a positive association among those with higher average affect but a negative association among those with lower average affect. There was no evidence of non-linear associations between affect and inflammation. DISCUSSION: Incorporating interactive effects between affect variability and average affect may be an important consideration in understanding affective-inflammatory associations.

Pubertal timing moderates the same-day coupling between family hassles and negative affect in girls and boys.

This study examined the association between pubertal timing, daily affect, conduct problems, and the exposure to hassles across family, peer, and school contexts. Adolescents (M age = 12.27; 49.7% female; 62.6% White) completed ecological momentary assessments across 14 consecutive days (N = 388). Earlier maturing girls reported lower daily averages of positive affect compared to their same-sex, same-age peers. We did not find evidence for a relationship between pubertal timing and daily negative affect or conduct problems in girls, nor for daily negative and positive affect or conduct problems in boys. However, pubertal timing did moderate the day-level association between average negative affect and family hassles for both girls and boys. When experiencing more family hassles, earlier maturing girls reported greater negative affect relative to later maturing girls who experienced family hassles. In contrast, later maturing boys, relative to earlier maturing boys, reported higher levels of negative affect in the context of family hassles.

Adolescents' perceptions of family social status correlate with health and life chances: A twin difference longitudinal cohort study.

Children from lower-income households are at increased risk for poor health, educational failure, and behavioral problems. This social gradient is one of the most reproduced findings in health and social science. How people view their position in social hierarchies also signals poor health. However, when adolescents' views of their social position begin to independently relate to well-being is currently unknown. A cotwin design was leveraged to test whether adolescents with identical family backgrounds, but who viewed their family's social status as higher than their same-aged and sex sibling, experienced better well-being in early and late adolescence. Participants were members of the Environmental Risk Longitudinal Twin Study, a representative cohort of British twins (n = 2,232) followed across the first 2 decades of life. By late adolescence, perceptions of subjective family social status (SFSS) robustly correlated with multiple indicators of health and well-being, including depression; anxiety; conduct problems; marijuana use; optimism; not in education, employment, or training (NEET) status; and crime. Findings held controlling for objective socioeconomic status both statistically and by cotwin design after accounting for measures of childhood intelligence (IQ), negative affect, and prior mental health risk and when self-report, informant report, and administrative data were used. Little support was found for the biological embedding of adolescents' perceptions of familial social status as indexed by inflammatory biomarkers or cognitive tests in late adolescence or for SFSS in early adolescence as a robust correlate of well-being or predictor of future problems. Future experimental studies are required to test whether altering adolescents' subjective social status will lead to improved well-being and social mobility.

To Drink or Not to Drink: Is That the Question? Examining Correspondence and Predictive Validity of Morning Drinking Intentions for Young Adults' Drinking Behaviors and Consequences.

The Theory of Planned Behavior suggests that intentions are significant and proximal determinants of behavior. The purpose of this study was to test the predictive validity of drinking intentions for subsequent same-day drinking behaviors and negative consequences. Regularly drinking young adults (N = 222, 21-29 years, 84% undergraduates) completed an ecological momentary assessment (EMA) protocol and wore an alcohol monitor for five consecutive 24-h periods spanning 6 days (Wednesday-Monday). Each morning, participants reported their drinking intentions for the day and their previous day's alcohol consumption and the number of negative drinking consequences. Multilevel models showed that, at the within-person level, on days when people reported intending to drink, to get drunk, or to drink more than usual, they had higher odds of drinking, consumed more drinks, and had higher peak transdermal alcohol concentrations later that day. However, drinking occurred on 28% of days without drinking intentions, suggesting intentions were an imperfect signal for future drinking behavior. Morning drinking intentions also predicted experiencing more negative consequences, even after controlling for alcohol consumption. On average, young adults' morning-reported drinking-related intentions predicted increased odds of same-day drinking behavior and alcohol-related consequences. However, drinking frequently occurred on days participants did not intend to drink, suggesting that focusing only on drinking intention days will result in many missed prevention opportunities. Together, these results suggest the need for additional research to increase the predictive value of drinking intention assessments and for prevention interventions aimed at helping individuals follow through on their intentions not to drink.

Peer Network Counseling Effects on Substance Use: an Individual Participant Data Meta-Analysis Integrating Three Randomized Controlled Trials.

The current study describes an individual participant data meta-analysis (IPDMA) testing the efficacy of a peer-network counseling (PNC) intervention for preventing substance use escalation in adolescents and young adults. PNC has shown efficacy in reducing substance use among adolescents and young adults across small-scale randomized controlled trials (RCTs). Identifying expected large-scale effects and moderators is an important next step in guiding use of PNC in practice. To this end, we combine three small-scale RCTs to test PNC intervention effects on substance use change in a combined sample of 421 adolescents and young adults (50% intervention, 55% female, 69% Black/African-American, M age [SD] = 17.3 [2.2] years). Our approach combines latent change score modeling in a structural equation modeling (SEM) framework with study-level fixed effects to obtain (a) a more generalizable PNC effect than we could obtain with each constituent sample and (b) greater power and precision for individual-level moderation of treatment effects. We found that although PNC main effects on substance use outcomes (past 30-day cannabis, alcohol, tobacco, and drug use) were not significant, PNC effects were moderated by individual-level pre-intervention substance use frequency. PNC more strongly reduced drug use at the 1-month follow-up and cannabis use at the 3-month follow-up among participants who showed higher baseline use of these substances. Implications of our approach and findings for prevention researchers are discussed.

Transdermal sensor features correlate with ecological momentary assessment drinking reports and predict alcohol-related consequences in young adults' natural settings.

BACKGROUND: Wearable transdermal alcohol concentration (TAC) sensors allow passive monitoring of alcohol concentration in natural settings and measurement of multiple features from drinking episodes, including peak intoxication level, speed of intoxication (absorption rate) and elimination, and duration. These passively collected features extend commonly used self-reported drink counts and may facilitate the prediction of alcohol-related consequences in natural settings, aiding risk stratification and prevention efforts. METHOD: A total of 222 young adults aged 21-29 (M age = 22.3, 64% female, 79% non-Hispanic white, 84% undergraduates) who regularly drink heavily participated in a 5-day study that included the ecological momentary assessment (EMA) of alcohol consumption (daily morning reports and participant-initiated episodic EMA sequences) and the wearing of TAC sensors (SCRAM-CAM anklets). The analytic sample contained 218 participants and 1274 days (including 554 self-reported drinking days). Five features-area under the curve (AUC), peak TAC, rise rate (rate of absorption), fall rate (rate of elimination), and duration-were extracted from TAC-positive trajectories for each drinking day. Day- and person-level associations of TAC features with drink counts (morning and episodic EMA) and alcohol-related consequences were tested using multilevel modeling. RESULTS: TAC features were strongly associated with morning drink reports (r = 0.6-0.7) but only moderately associated with episodic EMA drink counts (r = 0.3-0.5) at both day and person levels. Higher peaks, larger AUCs, faster rise rates, and faster fall rates were significantly predictive of day-level alcohol-related consequences after adjusting for both morning and episodic EMA drink counts in separate models. Person means of TAC features added little above daily scores to the prediction of alcohol-related consequences. CONCLUSIONS: These results support the utility of TAC sensors in studies of alcohol misuse among young adults in natural settings and outline the specific TAC features that contribute to the day-level prediction of alcohol-related consequences. TAC sensors provide a passive option for obtaining valid and unique information predictive of drinking risk in natural settings.

Daily Physical Activity, Sedentary Behavior and Alcohol Use in At-Risk College Students.

BACKGROUND: The college years present an opportunity to establish health behavior patterns that can track across adulthood. Health behaviors tend to cluster synergistically however, physical activity and alcohol have shown a positive association. PURPOSE: This study applied a multi-method approach to estimate between- and within-person associations between daily physical activity, sedentary behavior and alcohol use among polysubstance-using college students. METHODS: Participants were screened for recent binge drinking and either tobacco or cannabis use. They wore an activPAL4 activity monitor and a Secure Continuous Remote Alcohol Monitor continuously in the field for 11 days, and completed daily online questionnaires at the beginning of each day to report previous day physical activity, sedentary behavior, and alcohol consumption. RESULTS: Participants (N = 58, Mage = 20.5 years, 59% women, 69% White) reported meeting national aerobic physical activity guidelines (75%) and drinking 2-4 times in the past month (72%). On days when participants reported an hour more than usual of daily sedentary behavior, they reported drinking for less time than usual (γ = -.06). On days when participants took 1,000 more steps than usual, the longest episode of continuous transdermal alcohol detection was shorter (γ = -.03). CONCLUSIONS: Daily physical activity and sedentary behavior were negatively associated with time-based measures of alcohol use with the lowest risk on days characterized by both activity and sedentary behavior. Intensive longitudinal monitoring of time-based processes can provide new insights into risk in multiple behavior change and should be prioritized for future work.

Does Adolescent Digital Technology Use Detract from the Parent-Adolescent Relationship?

A population-representative sample of young adolescents (N = 2,104, mean age 12.4) reported on digital technology use and relationships in 2015. A subsample (N = 388) completed a 14-day ecological momentary assessment in 2016-2017 via mobile phone. Across the 2,104 adolescents, those who reported more social networking site engagement were more likely to live in families characterized by more family chaos and to report that their online experiences resulted in problems with their parents. However, when the subsample of adolescents was followed daily, there was little consistent evidence that adolescents' quantity of daily digital technology use detracted from the amount of time they spend interacting with close others (including parents) nor that adolescent daily technology use was associated with more negative or less positive parent-adolescent interactions.

Effectiveness and Utility of Mobile Device Assessment of Subjective Craving during Residential Opioid Dependence Treatment.

Background: Craving is a dynamic state that is both theoretically and empirically linked to relapse in addiction. Static measures cannot adequately capture the dynamic nature of craving, and research has shown that these measures are limited in their capacity to link craving to treatment outcomes. Methods: The current study reports on assessments of craving collected 4x-day across 12 days from 73 patients in residential treatment for opioid dependence. Analyses investigated whether the within-person assessments yielded expected across- and within-day variability, whether levels of craving changed across and within days, and, finally, whether individual differences in craving variability predicted post-residential treatment relapse. Results: Preliminary analyses found acceptable levels of data entry compliance and reliability. Consistent with expectations, craving varied both between (46%) and within persons, with most within-person variance (over 40%) existing within days. Other patterns that emerged indicated that, on average, craving declined across the 12-days of assessment, and was generally strongest at mid-day. Analyses also found that patients' person-level craving variability predicted post-treatment relapse, above and beyond their mean levels of craving. Conclusion: Analyses support the reliability, sensitivity, and potential utility of the 4x-day, 12-day assessment protocol for measuring craving during residential treatment.

Young Adolescents' Digital Technology Use, Perceived Impairments, and Well-Being in a Representative Sample.

OBJECTIVE: To examine the cross-sectional associations between young adolescents' access, use, and perceived impairments related to digital technologies and their academic, psychological, and physical well-being. STUDY DESIGN: There were 2104 adolescents (ages 10-15 years), representative of the North Carolina Public School population, who completed questionnaires in 2015. Administrative educational records were linked with parental consent. RESULTS: Nearly all young adolescents (95%) had Internet access, 67% owned a mobile phone, and 68% had a social media account. Mobile phone ownership was not associated with any indicators of well-being (math and reading test scores, school belonging, psychological distress, conduct problems, or physical health) after controlling for demographic factors. Having a social media account and frequency of social media use were only robustly associated with conduct problems (explaining ∼3% of the variation in conduct problems). Despite the lack of strong associations, 91% of adolescents reported at least 1 perceived technology-related impairment and 29% of adolescents reported online-to-offline spillover of negative experiences. Economically disadvantaged adolescents reported similar access, but greater online-to-offline spillover and stronger associations between social media account ownership and poor psychological well-being compared with their more affluent peers. CONCLUSIONS: At the population level, there was little evidence that digital technology access and use is negatively associated with young adolescents' well-being. Youth from economically disadvantaged families were equally likely to have access to digital technologies, but were more likely than their more affluent peers to report negative online experiences. Closing the digital divide requires prioritizing equity in experiences and opportunities, as well as in access.

Annual Research Review: Ecological momentary assessment studies in child psychology and psychiatry.

BACKGROUND: Enhancements in mobile phone technology allow the study of children and adolescents' everyday lives like never before. Ecological momentary assessment (EMA) uses these advancements to allow in-depth measurements of links between context, behavior, and physiology in youths' everyday lives. FINDINGS: A large and diverse literature now exists on using EMA to study mental and behavioral health among youth. Modern EMA methods are built on a rich tradition of idiographic inquiry focused on the intensive study of individuals. Studies of child and adolescent mental and behavioral health have used EMA to characterize lived experience, document naturalistic within-person processes and individual differences in these processes, measure familiar constructs in novel ways, and examine temporal order and dynamics in youths' everyday lives. CONCLUSIONS: Ecological momentary assessment is feasible and reliable for studying the daily lives of youth. EMA can inform the development and augmentation of traditional and momentary intervention. Continued research and technological development in mobile intervention design and implementation, EMA-sensor integration, and complex real-time data analysis are needed to realize the potential of just-in-time adaptive intervention, which may allow researchers to reach high-risk youth with intervention content when and where it is needed most.

A multimethod approach examining the relative contributions of optimism and pessimism to cardiovascular disease risk markers.

Although dispositional optimism and pessimism are associated with cardiovascular disease (CVD), their relative independence and unique contributions to CVD risk are unclear. This study addressed these issues by using multiple indicators of optimism and pessimism and linking them to objective risk factors for CVD. A diverse sample of adults (N = 300) completed baseline assessments (including global reports of optimism and pessimism), a 2-day/1-night EMA protocol with ambulatory blood pressure (BP) at 45-min intervals, and had inflammatory markers and carotid intima media imaging collected. EMA reports of momentary positive and negative expectations were averaged to form intraindividual (person) means of optimism and pessimism, respectively. Optimism and pessimism were only modestly correlated between- and within-assessment methods. Higher pessimism, regardless of assessment method, predicted both lower odds of whether BP dipping occurred and a smaller degree of dipping, but was unrelated to other biomarkers. Optimism was not uniquely predictive of CVD risk factors. Pessimism thus appears to exhibit stronger relative contribution to risk indicators of CVD than optimism.

Adolescents' Subjective Social Status Predicts Day-to-Day Mental Health and Future Substance Use.

Adolescents' subjective social status (SSS) is associated with mental and behavioral health outcomes, independent of socioeconomic status (SES). Many previous findings, however, come from cross-sectional studies. We report results from a longitudinal study with 151 adolescents identified as at risk for early substance use and behavioral problems sampled from low-SES neighborhoods. We examined whether adolescent's SSS predicted mental health (depression, anxiety, and inattention/impulsivity) measured over 30 days via ecological momentary assessment and risk for substance use at an 18-month follow-up. Results showed that with each perceived step "up" the SSS ladder, adolescents experienced fewer mental health symptoms in daily life and lower future substance use risk after adjusting for objective SES and previous psychopathology. Implications of these findings are discussed.

College Expectations Promote College Attendance: Evidence From a Quasiexperimental Sibling Study.

When adolescents are asked how likely they think it is that they will go to college, does their answer influence what they will actually do? Typically, it is difficult to determine whether college expectations promote academic achievement or just reflect a reasonable forecast of what is likely to happen to them. We used a sample of siblings from the National Longitudinal Study of Adolescent to Adult Health (N = 1,766) to test whether associations between college expectations and educational attainment remained after accounting for unobserved family factors that may shape both educational expectations and attainment. Compared with their siblings, adolescents with higher college expectations were also 43% more likely to attend college, even when analyses controlled for grades and IQ. The effect of college expectations on college attendance was strongest among youths living in higher-socioeconomic-status families.

Evaluating the Use of Commercially Available Wearable Wristbands to Capture Adolescents' Daily Sleep Duration.

Commercially available wearable devices are marketed as a means of objectively capturing daily sleep easily and inexpensively outside of the laboratory. Two ecological momentary assessment studies-with 120 older adolescents (aged 18-19) and 395 younger adolescents (aged 10-16)-captured nightly self-reported and wearable (Jawbone) recorded sleep duration. Self-reported and wearable recorded daily sleep duration were moderately correlated (r ~ .50), associations which were stronger on weekdays and among young adolescent boys. Older adolescents self-reported sleep duration closely corresponded with estimates from the wearable device, but younger adolescents reported having an hour more of sleep, on average, compared to device estimates. Self-reported, but not wearable-recorded, sleep duration and quality were consistently associated with daily well-being measures. Suggestions for the integration of commercially available wearable devices into future daily research with adolescents are provided.

Is Alcohol and Other Substance Use Reduced When College Students Attend Alcohol-Free Programs? Evidence from a Measurement Burst Design Before and After Legal Drinking Age.

College drinking and its negative consequences remain a major public health concern. Yet, many prevention efforts targeting college drinkers are expensive, are difficult to implement, use indicated approaches targeting only high-risk drinkers, and/or are only marginally effective. An alternative strategy taken explicitly or implicitly by many colleges is campus-led alcohol-free programming which provides students with attractive leisure alternatives to drinking on weekend nights. This study aimed to extend work by Patrick et al. (Prevention Science, 11, 155-162, 2010), who found that students drank less on weekend nights they attended LateNight Penn State (LNPS) activities during their first semester of college. Here, daily diary and longitudinal data on college students' daily lives and risk behaviors were collected from 730 students on 19,506 person-days across seven semesters at a large university in the Northeastern United States. Generalized linear mixed models were used to estimate alcohol and illegal substance use on weekend days as a function of LNPS attendance, gender, legal drinking status (≥ 21 years), and day of the weekend. Across college, students who attended LNPS used alcohol and illegal substances less in general and less on days they participated compared to themselves on days they did not participate. Legal drinking status moderated the association between LNPS attendance and alcohol and illegal substance use such that levels of use were lowest for students under 21 years old on weekend days they attended LNPS. Our findings provide support for campus-led alcohol-free programming as a potential harm reduction strategy on college campuses.

Romantic Partner Alcohol Misuse Interacts with GABRA2 Genotype to Predict Frequency of Drunkenness in Young Adulthood.

Previous research has identified the importance of romantic partners-including spouses, significant others, and dating partners-for influencing the engagement in health-risking behaviors, such as alcohol misuse during emerging adulthood. Although genetic factors are known to play a role in the development of young adult alcohol misuse, little research has examined whether genetic factors affect young adults' susceptibility to their romantic partners' alcohol misusing behaviors. The current study tests whether a single nucleotide polymorphism in the GABRA2 gene (rs279845) moderates the relationship between romantic partner alcohol misuse and frequency of drunkenness in young adulthood. Results revealed differential risk associated with romantic partner alcohol misuse and young adult drunk behavior according to GABRA2 genotype, such that individuals with the TT genotype displayed an elevated risk for frequency of drunkenness when romantic partner alcohol misuse was also high (IRR = 1.06, p ≤ 0.05). The findings demonstrate the potential for genetic factors to moderate the influence of romantic partners' alcohol misuse on drunk behavior during the transition to young adulthood.

Concurrent and Subsequent Associations Between Daily Digital Technology Use and High-Risk Adolescents' Mental Health Symptoms.

Adolescents are spending an unprecedented amount of time using digital technologies (especially mobile technologies), and there are concerns that adolescents' constant connectivity is associated with poor mental health, particularly among at-risk adolescents. Participants included 151 adolescents at risk for mental health problems (Mage  = 13.1) who completed a baseline assessment, 30-day ecological momentary assessment, and 18 month follow-up assessment. Results from multilevel regression models showed that daily reports of both time spent using digital technologies and the number of text messages sent were associated with increased same-day attention deficit hyperactivity disorder (ADHD) and conduct disorder (CD) symptoms. Adolescents' reported digital technology usage and text messaging across the ecological momentary assessment (EMA) period was also associated with poorer self-regulation and increases in conduct problem symptoms between the baseline and follow-up assessments.

PROSPER Intervention Effects on Adolescents' Alcohol Misuse Vary by GABRA2 Genotype and Age.

Preventive intervention effects on adolescent alcohol misuse may differ based on genotypes in gene-by-intervention (G x I) interactions, and these G x I interactions may vary as a function of age. The current study uses a novel statistical method, time-varying effect modeling (TVEM), to test an age-varying interaction between a single nucleotide polymorphism in the GABRA2 gene (rs279845) and a preventive intervention in predicting alcohol misuse in a longitudinal study of adolescents (ages 11-20). The preventive intervention was PROSPER, a community-based system for delivery of family and school programs selected from a menu of evidence-based interventions. TVEM results revealed a significant age-varying GABRA2 x intervention interaction from ages 12 to 18, with the peak effect size seen around age 13 (IRR = 0.50). The intervention significantly reduced alcohol misuse for adolescents with the GABRA2 TT genotype from ages 12.5 to 17 but did not reduce alcohol use for adolescents with the GABRA2 A allele at any age. Differences in intervention effects by GABRA2 genotype were most pronounced from ages 13 to 16-a period when drinking is associated with increased risk for alcohol use disorder. Our findings provide additional evidence that intervention effects on adolescent alcohol misuse may differ by genotype, and provide novel evidence that the interaction between GABRA2 and intervention effects on alcohol use may vary with age. Implications for interventions targeting adolescent alcohol misuse are discussed.