Providing Lesbian, Gay, Bisexual, Transgender, Nonbinary, and Queer Adolescents With Nurturance, Trustworthiness, and Safety: Protocol for Pilot Cluster Randomized Controlled Trial Design.

BACKGROUND: Sexual and gender minority youths (lesbian, gay, bisexual, transgender, nonbinary, and queer individuals) face elevated risks of substance use (eg, alcohol and tobacco) and mental health issues (eg, depressive symptoms and suicidality) compared to their cisgender heterosexual peers. These inequities are hypothesized to be reduced by building supportive high school environments via the training of school staff. An intervention that trains school staff to better understand and support sexual and gender minority youths and engage in positive bystander behaviors that protect them from bullying exposure may reduce disparities in drug and alcohol use among them. Experts, school staff, and sexual and gender minority youths developed Providing LGBTQ+ Adolescents with Nurturance, Trustworthiness, and Safety (PLANTS), a web-based intervention to train school staff on how to support, affirm, and protect sexual and gender minority youths. OBJECTIVE: This paper describes the design of the PLANTS pilot trial primarily aimed at assessing its acceptability, usability, appropriateness, and feasibility. We hypothesize PLANTS will have high acceptability, usability, appropriateness, and feasibility as rated by the school staff. Secondary objectives focus on implementation, safety, and pre-post changes in high school staff outcomes, including self-efficacy and skills (eg, active-empathic listening and bullying intervention). Exploratory objectives focus on the impact of PLANTS on student health outcomes. METHODS: In a 2-arm cluster randomized controlled trial, high schools in Massachusetts are allocated to PLANTS or an active comparator group (publicly available sexual and gender minority youths resources or training). High school staff complete pretest and posttest surveys containing validated scales. Primary outcomes are validated measures of acceptability, usability, appropriateness, and feasibility of the intervention completed by staff during posttest surveys. To test our primary hypotheses for each outcome, we will calculate means and 95% CIs and P values using 1-sample 2-sided t tests against a priori thresholds or benchmarks of success. Secondary outcomes include staff's active-empathetic listening skills, self-efficacy for working with sexual and gender minority youths, bystander intervention behaviors for bullying and cyberbullying, and self-efficacy for PLANTS' change objectives completed during pretest and posttest staff surveys. Staff can also complete a posttest interview guided by the Information-Motivation-Behavior model and Consolidated Framework for Implementation Research. Exploratory outcomes include student-level data collected via the 2021 and 2023 MetroWest Adolescent Health Surveys, a health behavior surveillance system in 30 Massachusetts schools. RESULTS: School enrollment began in May 2023 and participant enrollment began in June 2023. Data collection is expected to be completed by February 2024. CONCLUSIONS: This pilot trial will yield important information about the PLANTS intervention and provide necessary information to conduct a fully powered trial of the efficacy of PLANTS for reducing the deleterious health inequities experienced by sexual and gender minority youths. TRIAL REGISTRATION: ClinicalTrials.gov NCT05897827; https://clinicaltrials.gov/study/NCT05897827. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55210.

Cyberbullying, school bullying, and psychological distress: a regional census of high school students.

OBJECTIVES: Using data from a regional census of high school students, we have documented the prevalence of cyberbullying and school bullying victimization and their associations with psychological distress. METHODS: In the fall of 2008, 20,406 ninth- through twelfth-grade students in MetroWest Massachusetts completed surveys assessing their bullying victimization and psychological distress, including depressive symptoms, self-injury, and suicidality. RESULTS: A total of 15.8% of students reported cyberbullying and 25.9% reported school bullying in the past 12 months. A majority (59.7%) of cyberbullying victims were also school bullying victims; 36.3% of school bullying victims were also cyberbullying victims. Victimization was higher among nonheterosexually identified youths. Victims report lower school performance and school attachment. Controlled analyses indicated that distress was highest among victims of both cyberbullying and school bullying (adjusted odds ratios [AORs] were from 4.38 for depressive symptoms to 5.35 for suicide attempts requiring medical treatment). Victims of either form of bullying alone also reported elevated levels of distress. CONCLUSIONS: Our findings confirm the need for prevention efforts that address both forms of bullying and their relation to school performance and mental health.

Social capital in the college setting: the impact of participation in campus activities on drinking and alcohol-related harms.

OBJECTIVE: The authors aimed to replicate previous findings on social capital and harmful alcohol outcomes in the college setting and to ascertain the protective effects of additional indicators of social capital. METHODS: Over 4 years (2000-2004), the authors conducted annual cross-sectional, random-sample student surveys at 32 US institutions of higher education (N = 15,875) and constructed multilevel models to examine the association between individual- and campus-level participation in campus activities and harmful drinking outcomes. RESULTS: At the individual level, community volunteerism was protective against harmful drinking outcomes. In contrast to past research, campus-level volunteerism was not significantly associated with the outcome measures. At both the individual and campus levels, participation in a religious organization was protective. Greek membership and varsity athletic participation were risk factors at the individual level. CONCLUSIONS: Results did not corroborate previous findings and revealed mixed results for other measures of participation at the campus level. The influence of social capital on college alcohol consumption deserves further attention.

Sociodemographic and psychobehavioral characteristics of US college students who abstain from alcohol.

OBJECTIVE: The authors examined the sociodemographics and psychobehavioral characteristics of undergraduate US college students who abstain from alcohol. PARTICIPANTS: The respondents were 5,210 undergraduates from 32 colleges and universities. METHODS: A survey was mailed to 300 randomly selected students per institution (spring 2000 or 2001). The response rate was 56.2%. RESULTS: Overall, 20.5% of the students abstained. Predictors of abstention included the student's own negative attitude toward alcohol use; perception of friends' alcohol attitudes; male gender; being under age 21; abstaining in high school; non-Greek member or pledge; nonathlete; nonsmoker; non-marijuana user; participant in a religious group; working either 0 or 10+ hours per week for salary; having a mother who abstains; and having a close friend who abstains. CONCLUSION: Additional research on abstainers is warranted. Campus-based prevention programs should be grounded in a better understanding of how motives not to drink are developed and sustained in high school and college.

Support for alcohol-control policies and enforcement strategies among US college students at 4-year institutions.

OBJECTIVE: The authors examined college student support for policies and enforcement strategies to reduce alcohol problems on campus. PARTICIPANTS: A random sample of students from each of 32 four-year colleges and universities participated. METHODS: Students completed an anonymous mail survey. RESULTS: A majority of students supported 5 of the 12 policy proposals. Whatever percentage of students indicated support for a policy, a far smaller percentage reported that other students supported it. The majority at all 32 schools supported using stricter disciplinary sanctions for students who engage in alcohol-related violence and repeatedly violate campus alcohol policy. The majority at more than half of the schools supported applying stricter penalties for the use of false IDs to purchase alcohol illegally and prohibiting kegs on campus. CONCLUSIONS: Higher-education administrators should survey students to learn which policies a majority of their students will endorse.

A multisite randomized trial of social norms marketing campaigns to reduce college student drinking.

OBJECTIVE: An 18-site randomized trial was conducted to determine the effectiveness of social norms marketing (SNM) campaigns in reducing college student drinking. The SNM campaigns are intended to correct misperceptions of subjective drinking norms and thereby drive down alcohol consumption. METHOD: Institutions of higher education were randomly assigned to treatment and control groups. At the treatment group institutions, SNM campaigns delivered school-specific, data-driven messages through a mix of campus media venues. Cross-sectional student surveys were conducted by mail at baseline (n = 2,771) and at posttest 3 years later (n = 2,939). Hierarchical linear modeling was applied to examine multiple drinking outcomes, taking intraclass correlation into account. RESULTS: Controlling for other predictors, having an SNM campaign was significantly associated with lower perceptions of student drinking levels and lower alcohol consumption, as measured by a composite drinking scale, recent maximum consumption, blood alcohol concentration for recent maximum consumption, drinks consumed when partying, and drinks consumed per week. A moderate mediating effect of normative perceptions on student drinking was demonstrated by an attenuation of the Experimental Group x Time interaction, ranging from 16.4% to 39.5% across measures. Additional models that took into account the intensity of SNM campaign activity at the treatment institutions suggested that there was a dose-response relationship. CONCLUSIONS: This study is the most rigorous evaluation of SNM campaigns conducted to date. Analysis revealed that students attending institutions that implemented an SNM campaign had a lower relative risk of alcohol consumption than students attending control group institutions.

Alcohol prevention on college campuses: the moderating effect of the alcohol environment on the effectiveness of social norms marketing campaigns.

OBJECTIVE: Evaluations of social norms marketing campaigns to reduce college student drinking have produced conflicting results. This study examines whether the effectiveness of such campaigns may be moderated by on-premise alcohol outlet density in the surrounding community. METHOD: Multilevel analyses were conducted of student survey responses (N= 19,838) from 32 U.S. colleges that took part in one of two 4-year randomized, controlled trials completed for the Social Norms Marketing Research Project (SNMRP). In the models, students by year were nested within treatment (n = 16) and control group (n = 16) campuses, which were characterized by the on-premise outlet density in their surrounding community. The moderating effect of outlet density was introduced into the models as an interaction between the treatment effect (i.e., the effect of the social norms marketing campaigns over time) and outlet density. The models were also stratified by campus alcohol outlet density (high vs. low) to examine the effect of the intervention in each type of setting. RESULTS: There was a significant interaction between the treatment effect and on-premise alcohol outlet density for one of the drinking outcomes targeted by the SNMRP intervention, the number of drinks when partying, and marginal evidence of interaction effects for two other outcomes, maximum recent consumption and a composite drinking scale. In stratified analyses, an intervention effect was observed for three of the four outcomes among students from campuses with lower on-premise alcohol outlet density, whereas no intervention effect was observed among students from campuses with higher on-premise alcohol outlet density. CONCLUSIONS: The findings suggest that the campus alcohol environment moderates the effect of social norms marketing interventions. Social norms marketing intervention may be less effective on campuses with higher densities of on-sale alcohol outlets.

Pregaming: an exploratory study of strategic drinking by college students in Pennsylvania.

OBJECTIVES: This exploratory study examined pre-event drinking, or pregaming, by US college students. PARTICIPANTS: 112 undergraduates from 10 Pennsylvania colleges participated. METHOD: A focus group, including a written questionnaire, was conducted at each institution. RESULTS: Only 35.7% of the participants had not pregamed during the last 2 weeks. Pregamers consumed an average of 4.9 (SD = 3.1) drinks during their most recent session. Gender, class year, and other demographic variables did not predict pregaming. Heavier drinkers, and those stating that the average student pregamed 3+ times in the last 2 weeks, were more likely to report pregaming in the last 2 weeks. How much students drink when pregaming is influenced by how much they expect to drink later on. CONCLUSION: Pregaming presents a growing challenge for campus officials. Additional research is needed on the nature of the problem and which combination of prevention strategies might best address this behavior.

An ecological analysis of alcohol-outlet density and campus-reported violence at 32 U.S. colleges.

OBJECTIVE: The purpose of this study was to assess the relationships among campus violence, student drinking levels, and the physical availability of alcohol at off-campus outlets in a multisite design. METHOD: An ecological analysis of on-campus violence was conducted at 32 U.S. colleges. Dependent variables included campus-reported rates of rape, robbery, assault, and burglary obtained from a U.S. Department of Education online database for the years 2000-2004. Measures of student alcohol use and demographics were obtained from student surveys conducted for the Social Norms Marketing Research Project from 2000 to 2004. Measures of alcohol-outlet density within 3 miles of each campus were obtained from state alcohol-licensing authorities for 2004. RESULTS: Both on- and off-premise alcohol-outlet densities were associated with the campus rape-offense rate but not with the assault or robbery rates. Student drinking level was associated with both campus rape and assault rates but not with the campus robbery rate. The apparent effect of on-premise outlet density on campus rape-offense rates was reduced when student drinking level was included in the model, suggesting that the effect of on-premise outlet density may be mediated by student drinking level. Separate analyses revealed a similar mediational role for off-premise outlet density. CONCLUSIONS: These findings demonstrate that there is a campus-level association between sexual violence and the campus-community alcohol environment.

A multisite randomized trial of social norms marketing campaigns to reduce college student drinking: a replication failure.

A 14-site randomized trial tested the effectiveness of social norms marketing (SNM) campaigns, which present accurate student survey data in order to correct misperceptions of subjective drinking norms and thereby drive down alcohol use. Cross-sectional student surveys were conducted by mail at baseline and at posttest 3 years later. Hierarchical linear modeling was applied to examine multiple drinking outcomes, taking into account the nonindependence of students grouped in the same college. Controlling for other predictors, having a SNM campaign was not significantly associated with lower perceptions of student drinking levels or lower self-reported alcohol consumption. This study failed to replicate a previous multisite randomized trial of SNM campaigns, which showed that students attending institutions with a SNM campaign had a lower relative risk of alcohol consumption than students attending control group institutions (W. DeJong et al. J Stud Alcohol. 2006;67:868-879). Additional research is needed to explore whether SNM campaigns are less effective in campus communities with relatively high alcohol retail outlet density.

The contextual role of alcohol outlet density in college drinking.

OBJECTIVE: The objective of the study is to examine the relationship between the physical availability of off-campus alcohol and drinking outcomes among college students. METHOD: A multilevel analysis of students (N = 17,051) nested within college campuses (N = 32) was conducted. Four problem-drinking-related outcomes (i.e., average number of drinks when partying, frequency of drunkenness in past 2 weeks, 30-day frequency of drinking, and greatest number of drinks in one sitting) along with individual level covariates of drinking were introduced at the student level. The physical availability of alcohol was assessed as the number of on-premise and off-premise alcohol outlets within 3 miles of campus per 1,000 students enrolled. RESULTS: Higher densities of on-premise alcohol outlets were strongly related to drinking outcomes even after controlling for individual predictors of college drinking. The association indicated that the campus means for the average number of drinks when partying and the number of drinking occasions in the past 30 days were, respectively, 1.13 drinks and 1.32 occasions greater when the outlet density was 2 SDs higher. CONCLUSIONS: Off-campus, on-premise outlet density is strongly associated with college-drinking outcomes. Given the limited number of modifiable factors that affect college drinking, on-premise outlet density represents a potential modifiable means of addressing the problem.

Measuring college student drinking: illustrating the feasibility of a composite drinking scale.

This study explored the feasibility of a Composite Drinking Scale (CDS) designed to capture fully the phenomenon of problem drinking among college students while allowing easy public understanding. A survey conducted at 32 four-year U.S. colleges included four consumption measures: 30-day frequency; average number of drinks per week; number of drinks usually consumed when partying; and greatest number of drinks in one sitting in the past two weeks. Responses were normalized and added to create a continuous distribution, which was then subdivided into quartiles (CDS/Q1-Q4). The CDS is an easily understood scoring system, but compared to the simplistic "binge drinking" measure, it captures a broader range of relative risks and more clearly establishes the quadratic relationship between consumption and alcohol-related problems. Development of the CDS will require further exploring the best set of questions to include, establishing U.S. norms for the general population, and then transforming those scores to a simple measurement yardstick whose meaning can be easily communicated to the public.