A synthesis of evidence for policy from behavioural science during COVID-19.

Scientific evidence regularly guides policy decisions1, with behavioural science increasingly part of this process2. In April 2020, an influential paper3 proposed 19 policy recommendations ('claims') detailing how evidence from behavioural science could contribute to efforts to reduce impacts and end the COVID-19 pandemic. Here we assess 747 pandemic-related research articles that empirically investigated those claims. We report the scale of evidence and whether evidence supports them to indicate applicability for policymaking. Two independent teams, involving 72 reviewers, found evidence for 18 of 19 claims, with both teams finding evidence supporting 16 (89%) of those 18 claims. The strongest evidence supported claims that anticipated culture, polarization and misinformation would be associated with policy effectiveness. Claims suggesting trusted leaders and positive social norms increased adherence to behavioural interventions also had strong empirical support, as did appealing to social consensus or bipartisan agreement. Targeted language in messaging yielded mixed effects and there were no effects for highlighting individual benefits or protecting others. No available evidence existed to assess any distinct differences in effects between using the terms 'physical distancing' and 'social distancing'. Analysis of 463 papers containing data showed generally large samples; 418 involved human participants with a mean of 16,848 (median of 1,699). That statistical power underscored improved suitability of behavioural science research for informing policy decisions. Furthermore, by implementing a standardized approach to evidence selection and synthesis, we amplify broader implications for advancing scientific evidence in policy formulation and prioritization.

Looking out for You and Me: College students' Strategies for Preventing Sexual Assault in Drinking Contexts.

Background: Sexual assault and heavy alcohol use are prevalent and interrelated public health concerns on university campuses. Surprisingly, however, few alcohol harm reduction interventions address this intersection to help students reduce both personal and community risks for sexual assault in college drinking contexts. Objectives: In the current study, students (ages 18-24) shared strategies they use to protect themselves and others from sexual assault in college drinking contexts, as well as challenges to implementing these strategies. A series of six focus groups were conducted across two universities in the U.S. (N = 35). Participants responded to open-ended questions focused on drinking and sexual assault (e.g., What are some of the things students might do to avoid or address situations where they feel pressured of coerced to hook up or have sex when they do not want to?). Results: Thematic analyses demonstrated students' awareness of protective behavioral and bystander intervention strategies that could help reduce vulnerability to experience sexual assault for themselves or others in drinking contexts. Perceived barriers to using bystander intervention strategies included student's own and friends' heavy drinking (decreased inhibitions, loss of autonomy), ambiguity in deciphering risk (lack of familiarity, minimization, diffusion of responsibility), and gender (gender norms, power imbalances). Conclusions: This study informs the development of interventions that help students identify strategies and overcome barriers to reduce risks for sexual assault in college drinking contexts.

Is marijuana identity associated with marijuana use and consequences? An examination of direct and interactive associations.

BACKGROUND: There is relatively little research examining the relationship between identity and marijuana-related outcomes (e.g., marijuana use and consequences). Identity may both directly help shape marijuana use behaviors and moderate the influence of other risk factors on marijuana outcomes. OBJECTIVES: The current study examines the relationship between marijuana identity and marijuana-related outcomes among emerging adults and explores whether identity moderates the relationships between nonidentity correlates (e.g., perceived norms and negative affect) of marijuana-related outcomes. METHODS: College students who reported marijuana use in the past 12 months completed measures of marijuana identity, perceived norms, negative affect, frequency of marijuana use, and marijuana consequences. Conclusions/Importance: The results indicated that marijuana identity is associated with marijuana use frequency and moderates the relationship between perceived norms and marijuana consequences. The findings have implications for both identity-based and social norms-based interventions targeting problematic marijuana use among emerging adults.

Does reactivation trigger episodic memory change? A meta-analysis.

According to the reconsolidation hypothesis, long-term memories return to a plastic state upon their reactivation, leaving them vulnerable to interference effects and requiring re-storage processes or else these memories might be permanently lost. The present study used a meta-analytic approach to critically evaluate the evidence for reactivation-induced changes in human episodic memory. Results indicated that reactivation makes episodic memories susceptible to physiological and behavioral interference. When applied shortly after reactivation, interference manipulations altered the amount of information that could be retrieved from the original learning event. This effect was more pronounced for remote memories and memories of narrative structure. Additionally, new learning following reactivation reliably increased the number of intrusions from new information into the original memory. These findings support a dynamic view of long-term memory by showing that memories can be changed long after they were acquired.

Being Blunt About Marijuana: Parent Communication About Marijuana with Their Emerging Adult Children.

While research suggests that parents continue to influence students' marijuana use after matriculation to college, there is limited data examining how parents communicate about marijuana use and what impact parent marijuana communication has on college student outcomes. The aim of the current study is to investigate the types of parent marijuana messages that college students receive and the relationship between parent communication and students' marijuana attitudes and behaviors. Students (N = 506) completed a survey assessing marijuana approval, use, negative consequences, and parent communication. A factor analysis of parent communication items yielded three factors: risk communication, permissive communication, and marijuana use communication. Risk communication was the most common form of communication. In multivariate models, risk communication was associated with increased odds of a student remaining abstinent but not with frequency of marijuana use or negative consequences. Greater permissive communication was associated with more approving student attitudes, greater odds of non-abstinence, more frequent use in the past year, and more negative consequences. These findings highlight the need to consider the different types of messages parents deliver when designing interventions aimed at engaging parents in marijuana prevention efforts.

Perceived parent and peer marijuana norms: the moderating effect of parental monitoring during college.

This study examined descriptive and injunctive normative influences exerted by parents and peers on college student marijuana approval and use. It further evaluated the extent to which parental monitoring moderated the relationship between marijuana norms and student marijuana outcomes. A sample of 414 parent-child dyads from a midsize American university completed online surveys. A series of paired and one-sample t tests revealed that students' actual marijuana use was significantly greater than parents' perception of their child's use, while students' perception of their parents' approval were fairly accurate. The results of a hierarchical multiple regression indicated that perceived injunctive parent and student norms, and parental monitoring all uniquely contributed to the prediction of student marijuana approval. Furthermore, parental monitoring moderated the effects of perceived norms. For example, at low but not high levels of parental monitoring, perceptions of other students' marijuana use were associated with students' own marijuana approval. Results from a zero-inflated negative binomial regression showed that students who reported higher descriptive peer norms, higher injunctive parental norms, and reported lower parental monitoring were likely to report more frequent marijuana use. A significant Parental Monitoring × Injunctive Parental norms interaction effect indicated that parental approval only influenced marijuana use for students who reported that their parents monitored their behavior closely. These findings have intervention implications for future work aimed at reducing marijuana approval and use among American college students.

The efficacy of a standalone protective behavioral strategies intervention for students accessing mental health services.

Students with poor mental health are at increased risk for problematic alcohol use. These students also tend to underutilize alcohol-related protective behavioral strategies (PBS). Cross-sectional studies indicate that PBS use may be particularly useful for students with mental health challenges; however, it is unclear whether training these students to use PBS is an effective approach for reducing alcohol use and consequences. The current study evaluated the efficacy of a standalone PBS skills training and personalized feedback (PBS-STPF) intervention among students accessing mental health services. Participants (N = 251) were randomly assigned to either an individual facilitator-led PBS-STPF intervention or a health-related control condition. Participants completed online follow-up surveys 1 and 6 months post-intervention which included measures of alcohol use, negative consequences, and a composite measure of PBS use. Relative to control participants, students in the PBS-STPF condition reported significantly greater PBS use but no differences in alcohol use or consequences. Participants in both conditions reported decreases in drinking outcomes over time. Tests of mediation indicated that the intervention indirectly led to reduction in drinking outcomes at 6 months through increased PBS use. Although the intervention resulted in changes in PBS use that were maintained for up to 6 months post-intervention, the effects of the intervention on drinking and consequences were limited. A brief standalone PBS training may need augmentation in order to promote effective use of PBS for substantial decreases in alcohol consequences.

Combining self-affirmation with the extended parallel process model: the consequences for motivation to eat more fruit and vegetables.

There is potential for fruitful integration of research using the Extended Parallel Process Model (EPPM) with research using Self-affirmation Theory. However, to date no studies have attempted to do this. This article reports an experiment that tests whether (a) the effects of a self-affirmation manipulation add to those of EPPM variables in predicting intentions to improve a health behavior and (b) self-affirmation moderates the relationship between EPPM variables and intentions. Participants (N = 80) were randomized to either a self-affirmation or control condition prior to receiving personally relevant health information about the risks of not eating at least five portions of fruit and vegetables per day. A hierarchical regression model revealed that efficacy, threat × efficacy, self-affirmation, and self-affirmation × efficacy all uniquely contributed to the prediction of intentions to eat at least five portions per day. Self-affirmed participants and those with higher efficacy reported greater motivation to change. Threat predicted intentions at low levels of efficacy, but not at high levels. Efficacy had a stronger relationship with intentions in the nonaffirmed condition than in the self-affirmed condition. The findings indicate that self-affirmation processes can moderate the impact of variables in the EPPM and also add to the variance explained. We argue that there is potential for integration of the two traditions of research, to the benefit of both.

Social anxiety and drinking refusal self-efficacy moderate the relationship between drinking game participation and alcohol-related consequences.

BACKGROUND: Participation in drinking games is associated with excessive drinking and alcohol risks. Despite the growing literature documenting the ubiquity and consequences of drinking games, limited research has examined the influence of psychosocial factors on the experience of negative consequences as the result of drinking game participation. OBJECTIVES: The current event-level study examined the relationships among drinking game participation, social anxiety, drinking refusal self-efficacy (DRSE) and alcohol-related consequences in a sample of college students. METHODS: Participants (n = 976) reported on their most recent drinking occasion in the past month in which they did not preparty. RESULTS: After controlling for sex, age, and typical drinking, higher levels of social anxiety, lower levels of DRSE, and playing drinking games predicted greater alcohol-related consequences. Moreover, two-way interactions (Social Anxiety × Drinking Games, DRSE × Drinking Games) demonstrated that social anxiety and DRSE each moderated the relationship between drinking game participation and alcohol-related consequences. Participation in drinking games resulted in more alcohol problems for students with high social anxiety, but not low social anxiety. Students with low DRSE experienced high levels of consequences regardless of whether they participated in drinking games; however, drinking game participation was associated with more consequences for students confident in their ability to resist drinking. CONCLUSION: Findings highlight the important role that social anxiety and DRSE play in drinking game-related risk, and hence provide valuable implications for screening at-risk students and designing targeted harm reduction interventions that address social anxiety and drink refusal in the context of drinking games.

Utility of the Theory of Planned Behaviour for predicting parents' intentions to vaccinate their children against COVID-19.

Vaccination is a crucial form of primary prevention, and it is important to understand the factors that influence parents' decisions to vaccinate their children. The current study examines the utility of the Theory of Planned Behaviour (TPB) and anticipated affect for explaining parents' intentions to vaccinate their children against COVID-19. Parents (N = 843) living in the United States completed an online survey. The TPB variables explained 65% of the variability in parents' intentions. In addition to all three of the TPB antecedents predicting vaccine intentions, both anticipated regret of not vaccinating and anticipated positive emotions of vaccinating were associated with parent intentions. Contrary to predictions, subjective norms were a stronger predictor of intentions when perceived behavioural control was lower compared to higher. These findings help further our understanding of parent-for-child vaccine decisions in the context of novel health threats and inform intervention efforts aimed at encouraging this behaviour.

Pornography Use, Perceived Peer Norms, and Attitudes Toward Women: A Study of College Men.

Men's negative attitudes toward women is a known risk factor for sexual aggression perpetration. Sexual aggression is a widespread public health concern, especially among emerging adults, and is associated with a multitude of negative consequences. The current study evaluated whether pornography-related perceived peer norms, own approval, and self-reported use are associated with negative attitudes towards women in a sample of college men. Types of pornography examined included: pornography (in general), pornography that included portrayals of bondage, whipping, and spanking but without explicit dissent (i.e., pornography that depicted bondage/physical aggression), as well as pornography consisting of sexually explicit rape depictions in which force is used. Self-report measures assessing the frequency of pornography exposure, self-acceptance of pornography use, and perceived peer norms were collected from 283 college men. A multiple linear regression model revealed that only perceived peer norms for acceptance of pornography that depicted rape was positively associated with negative attitudes toward women. Findings highlight the importance of better understanding and addressing perceived peer norms in sexual assault prevention programs for college men.

College students' perceptions of positive and negative drinking-related sexual experiences.

Objective: During young adulthood, drinking and sexual behaviors are both normative and inextricably linked. While this association is well documented, little is known about how students define positive and negative drinking-related sexual experiences. Methods: Thirty-five undergraduates participated in a focus group about sexual experiences in the context of drinking. Thematic analysis was utilized to identify themes in the data. Results: Students' descriptions of positive drinking-related sexual encounters included having a good time, feeling safe, maintaining control over alcohol, as well as feeling safe in drinking contexts where sexual partners are located. Students' perceptions of negative experiences included specific consequences such as a damaged reputation, loss of control due to alcohol, and concern of engagement in sex when they or a partner was too intoxicated to consent. Conclusion: Gaining a better understanding of how college students view positive and negative drinking-related sexual experiences could inform interventions aimed at promoting student well-being.

Assessing the feasibility, acceptability, and initial efficacy of a multiple behavior change intervention addressing alcohol use, sexual risk taking, and bystander intervention.

OBJECTIVE: Prevention programs that address the intersecting health problems of risky alcohol use, unsafe sexual behaviors, and sexual violence are needed. This pilot project assessed the feasibility, acceptability, and preliminary efficacy of a two-session group-based intervention, Sex Positive Lifestyles: Addressing Alcohol & Sexual Health (SPLASH), targeting these highly interconnected risks for college students across genders. METHOD: A total of 217 participants (51.6% male, ages 18-24) took part in the SPLASH intervention or a nutrition/exercise control condition. SPLASH included three approaches aimed at reducing the incidence of alcohol problems, unsafe sex, and sexual victimization: normative feedback to modify misperceptions around peers' drinking, sexual behaviors, and support of bystander intervention; drinking and sexual-related protective behavioral strategy training to enhance safer drinking and sex-risk behaviors; and bystander intervention skills training to promote bystander efficacy and engagement. Participants completed baseline and follow-up (1-month and 6-month) online assessments. RESULTS: SPLASH demonstrated high acceptability and feasibility, as well as preliminary efficacy. SPLASH participants reported strong acceptability of the intervention, particularly its integrated content and interactive, in-person group format. Successful enrollment (70% randomized) and retainment point to the feasibility of recruiting students to this two-session in-person intervention. Results showed sustained trends toward more accurate perceived sex-related norms and indications of increasing bystander norms among intervention but not control participants. CONCLUSIONS: Results demonstrate the potential for SPLASH to effectively address the interrelated health risks of risky alcohol use, unsafe sex, and sexual violence on college campuses and point to the need for larger-scale studies.

(Mis)Perceptions of bystander behaviors and approval: The role of gender-specific perceived norms.

Objective: The current study examines college students' perceptions of same-gender and opposite gender peer norms for bystander behaviors in drinking contexts, as well as the association between perceived norms and participants' willingness to intervene and actual behavior. Method: Participants completed an online survey assessing bystander-related perceived norms, willingness, and behavior. A subset of participants also completed a measure of bystander behavior 4-months later. Results: The results indicated a divergent pattern of normative misperceptions for descriptive and injunctive norms, in which participants overestimated descriptive norms and underestimated injunctive norms. Further, participants who perceived greater perceived injunctive norms reported greater willingness to intervene in the future. While those who perceived that their peers intervened more frequently were more likely to have engaged in bystander behavior at baseline and the four-month follow-up. Conclusions: Results also suggest that the role of gender-specific norms is complex and dependent on participants' own gender. The results indicate the potential value of developing norms-based interventions addressing bystander behaviors and implications for the types of normative misperceptions to target.

Capturing connections during COVID-19: Using photography to assess US college students' sense of belonging.

Past research has highlighted a range of factors that impact college students' sense of belonging. It is less clear how the COVID-19 pandemic has shaped college students' experience of belonging. The current study used a reflective photography approach to examine US college students' experience of belonging to their institution during the COVID-19 pandemic. Student responses included themes of: Physical Space, Community, Adaptation/Continuity, Identity, and Negative Affect. Physical space emerged as the most common theme. Regardless of whether students were studying on campus or remotely, students described the role of the natural and built environment in finding a sense of connection and belonging. In comparisons based on students' class year, first-year students talked more about the role of structured groups and other cohorts highlighted the role of past shared experiences. The findings have implications for interventions aimed at promoting student belonging.

"Let's Not Talk About It": Parents' Reasons for Not Discussing Alcohol Use With Emerging Adult Children.

PURPOSE: It is unclear why parents avoid discussing alcohol use with their emerging adult (EA) children. Understanding parents' reasons for not communicating could inform parent-based interventions (PBIs) aimed at encouraging constructive discussions. The current study adds to the literature by examining common reasons parents avoid discussing alcohol use with their EA children. METHODS: Parents of EAs completed a web-based survey that included items assessing reasons for not communicating about alcohol, as well as measures of alcohol communication intentions, parenting self-efficacy, relationship quality, and interest in participating in an alcohol PBI. RESULTS: Results from the Exploratory Factor Analysis revealed five core reasons why parents do not communicate about alcohol: (1) they lack the skills or resources to communicate; (2) they believe their child is a nondrinker; (3) they believe their child is an independent, trustworthy decision maker; (4) they can teach their child how to drink through modeling; (5) they believe communication is futile. Believing that an EA could and should make their own alcohol decisions was the most common reason for not communicating. In multivariate analyses, this reason for not communicating was associated with greater levels of parental self-efficacy and perceiving a child to drink less alcohol. Further, this reason for not communicating was associated with lower intentions to communicate about drinking and less interest in taking part in a PBI. DISCUSSION: Most parents reported barriers to communication. Understanding why parents are reluctant to discuss alcohol use could inform PBI efforts.

Development and Application of a Comprehensive Measure of Access to Health Services to Examine COVID-19 Health Disparities.

Research on access to health services during the COVID-19 pandemic is limited, and the conceptualization of access has not typically included access to community resources. We developed and tested an access-to-health-services measure and examined disparities in access among individuals in the U.S. during the pandemic. Data are from a U.S. sample of 1491 respondents who completed an online survey in August 2021. Linear regression models assessed the relationships between the access-to-health-services-measure components, including impact on access to medicine and medical equipment, impact on access to healthcare visits, and confidence in accessing community resources, and predictor variables, including sociodemographic- and health-related factors. Disparities in access to healthcare during the pandemic were associated with sociodemographic characteristics (i.e., race, gender, and age) and health-related characteristics (i.e., chronic illness, mental health condition, and disability). Factors such as race, gender, income, and age were associated with individuals' degree of confidence in accessing community services. Our study presents a new access-to-health-services measure, sheds light on which populations may be most vulnerable to experiencing reduced access to health services, and informs the development of programmatic interventions to address the salient needs of these populations.

What pandemic? A multisite study of drinking motives and drinking games participation among college students during a pandemic (COVID-19) academic year.

A drinking game (DG) is a widely practiced social activity that tends to encourage rapid alcohol consumption. While social restrictions during the pandemic (COVID-19) academic year were implemented as a health measure across many colleges/universities, the extent to which college student drinkers continued to play DGs in-person is not well understood. Because theory and research suggest that drinking motives are proximal correlates of drinking behaviors, we examined which drinking motives increased the likelihood of playing DGs in-person, and playing DGs in-person in a group of 10 + people during the 2020-21 pandemic academic year. College students (past-year drinkers) from 12 universities completed an online survey (N = 900; Mage = 19.42, Range = 18-25; SDage = 1.45, White = 73.1%, 69.2% female). Of the students surveyed, 590 students played DGs, with 460 students only playing DGs in-person. Of the students who played DGs in-person, 274 students reported that the maximum number of people they played DGs with in-person exceeded the CDC's recommended guidelines (10 + people). Accounting for demographics, general alcohol use, and perceived COVID-19 threat, social drinking motives were positively associated with an increased likelihood of playing DGs in-person; the inverse was found for coping motives. Drinking motives were not associated with the likelihood of playing DGs with 10 + people but greater alcohol use and lower perceived threat of COVID-19 were. Given that the pandemic did not deter many student drinkers from playing DGs in-person, further investment in targeted intervention and public health initiatives aimed at substance-free alternatives promoting engagement and enhancement of social activities may be needed.

Development of the perceived risk of HIV scale.

Past studies have used various methods to assess perceived risk of HIV infection; however, few have included multiple items covering different dimensions of risk perception or have examined the characteristics of individual items. This study describes the use of Item Response Theory (IRT) to develop a short measure of perceived risk of HIV infection scale (PRHS). An item pool was administered by trained interviewers to 771 participants. Participants also completed the risk behavior assessment (RBA) which includes items measuring risky sexual behaviors, and 652 participants completed HIV testing. The final measure consisted of 8 items, including items assessing likelihood estimates, intuitive judgments and salience of risk. Higher scores on the PRHS were positively associated with a greater number of sex partners, episodes of unprotected sex and having sex while high. Participants who tested positive for HIV reported higher perceived risk. The PRHS demonstrated good reliability and concurrent criterion-related validity. Compared to single item measures of risk perception, the PRHS is more robust by examining multiple dimensions of perceived risk. Possible uses of the measure and directions for future research are discussed.

Substance use patterns among high-risk American Indians/Alaska Natives in Los Angeles County.

BACKGROUND: Substance abuse among American Indians/Alaska Natives (AI/ANs) is a significant and long-standing health problem in the U.S. Two-thirds of American AIs/ANs reside in the urban setting. However, studies analyzing substance use characteristics among urban AI/ANs are very limited. METHODS: Substance use patterns among a sample of AI/ANs (n = 77) and other ethnic/racial groups in Los Angeles County at high risk of substance abuse were analyzed utilizing three datasets from programs targeting individuals at high risk for substance abuse and risky sexual behaviors. RESULTS: Compared to all other ethnic/racial groups, AI/ANs demonstrated significantly younger age of onset of alcohol, marijuana, methamphetamine, and "other" drug use, higher correlations of age of first use of amphetamine with a measure of the drug's reinforcement, and higher mean number of illicit drug injections in the 30 days before being interviewed. CONCLUSIONS: Results from this study highlight a critical need for furthering our understanding of substance abuse problems among urban AI/ANs.