A confirmatory factor analysis of a revised motives for playing drinking games (MPDG-33) scale among university students in the United States.

AIM: Participating in a drinking game (DG) is common practice among university students and can increase students' risk for heavy drinking. Given the theoretical link between motivations to drink and alcohol use, careful consideration should be given to students' motivations to play DGs. In this study, we examined the factor structure, internal consistency, and concurrent validity of a revised version of the motives for playing drinking games (MPDG) scale, the MPDG-33. METHODS: University students (n = 3345, Mage = 19.77 years, SDage = 1.53; 68.8% = women; 59.6% = White) from 12 U.S. universities completed a confidential online self-report survey that included the MPDG-33 and questions regarding their frequency of DG participation and typical drink consumption while playing DGs. RESULTS: Confirmatory factor analysis indicated the 7-factor model fit the data adequately, and all items had statistically significant factor loadings on their predicted factor. All subscales had adequate to excellent internal consistency and were positively correlated with the frequency of DG participation and the typical number of drinks consumed while playing DGs (though the correlations were small). CONCLUSION: Findings suggest that the MPDG-33 can be reliably used in research and clinical settings to assess U.S. university students' motives for playing DGs.

Severity of Prior Coronavirus Disease 2019 is Associated With Postoperative Outcomes After Major Inpatient Surgery.

OBJECTIVE: To determine how the severity of prior history (Hx) of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection influences postoperative outcomes after major elective inpatient surgery. BACKGROUND: Surgical guidelines instituted early in the coronavirus disease 2019 (COVID-19) pandemic recommended a delay in surgery of up to 8 weeks after an acute SARS-CoV-2 infection. This was based on the observation of elevated surgical risk after recovery from COVID-19 early in the pandemic. As the pandemic shifts to an endemic phase, it is unclear whether this association remains, especially for those recovering from asymptomatic or mildly symptomatic COVID-19. METHODS: Utilizing the National COVID Cohort Collaborative, we assessed postoperative outcomes for adults with and without a Hx of COVID-19 who underwent major elective inpatient surgery between January 2020 and February 2023. COVID-19 severity and time from infection to surgery were each used as independent variables in multivariable logistic regression models. RESULTS: This study included 387,030 patients, of whom 37,354 (9.7%) were diagnosed with preoperative COVID-19. Hx of COVID-19 was found to be an independent risk factor for adverse postoperative outcomes even after a 12-week delay for patients with moderate and severe SARS-CoV-2 infection. Patients with mild COVID-19 did not have an increased risk of adverse postoperative outcomes at any time point. Vaccination decreased the odds of respiratory failure. CONCLUSIONS: Impact of COVID-19 on postoperative outcomes is dependent on the severity of illness, with only moderate and severe disease leading to a higher risk of adverse outcomes. Existing perioperative policies should be updated to include consideration of COVID-19 disease severity and vaccination status.

Patterns of Unnecessary Insurer Prior Authorization Denials in a Complex Surgical Oncology Practice.

INTRODUCTION: Insurance prior authorization (PA) is a determination of need, required by a health insurer for an ordered test/procedure. If the test/procedure is denied, a peer-to-peer (P2P) discussion between ordering provider and payer is used to appeal the decision. The objective of this study was to measure the number and patterns of unnecessary PA denials. METHODS: This was a retrospective review at a quaternary cancer center from October 2021 to March 2022. Included were all patients with outpatient imaging orders for surgical planning or surveillance of gastrointestinal, endocrine, or skin cancer. Primary outcome was unnecessary initial denial (UID) defined as an order that required preauthorization, was initially denied by the insurer, and subsequently overturned by P2P. RESULTS: Nine hundred fifty seven orders were placed and 419 required PA (44%). Of tests requiring authorization, 55/419 (13.1%) were denied. Variability in the likelihood of initial denial was seen across insurers, ranging from 0% to 57%. Following P2P, 32/55 were overturned (58.2% UID). The insurers most likely to have a UID were Aetna (100%), Anthem (77.8%), and Cigna (50.0%). UID was most common for gastrointestinal (58.9%) and endocrine (58.3%) cancers. Average P2P was 33.5 min (interquartile range 28-40). CONCLUSIONS: The majority of imaging studies initially denied were overturned after P2P. If all UIDs were eliminated, this would represent 108 less P2P discussions with an estimated time-savings of 60.3 h annually within a high-volume surgical oncology practice. Combined personnel costs to the health systems and stress on patients with cancer due to image-associated PAs and P2P appear hard to justify.

Prediction of Early Recurrence Following CRS/HIPEC in Patients With Disseminated Appendiceal Cancer.

INTRODUCTION: In patients with disseminated appendiceal cancer (dAC) who underwent cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC), characterizing and predicting those who will develop early recurrence could provide a framework for personalizing follow-up. This study aims to: (1) characterize patients with dAC that are at risk for recurrence within 2 y following of CRS ± HIPEC (early recurrence; ER), (2) utilize automated machine learning (AutoML) to predict at-risk patients, and (3) identifying factors that are influential for prediction. METHODS: A 12-institution cohort of patients with dAC treated with CRS ± HIPEC between 2000 and 2017 was used to train predictive models using H2O.ai's AutoML. Patients with early recurrence (ER) were compared to those who did not have recurrence or presented with recurrence after 2 y (control; C). However, 75% of the data was used for training and 25% for validation, and models were 5-fold cross-validated. RESULTS: A total of 949 patients were included, with 337 ER patients (35.5%). Patients with ER had higher markers of inflammation, worse disease burden with poor response, and received greater intraoperative fluids/blood products. The highest performing AutoML model was a Stacked Ensemble (area under the curve = 0.78, area under the curve precision recall = 0.66, positive predictive value = 85%, and negative predictive value = 63%). Prediction was influenced by blood markers, operative course, and factors associated with worse disease burden. CONCLUSIONS: In this multi-institutional cohort of dAC patients that underwent CRS ± HIPEC, AutoML performed well in predicting patients with ER. Variables suggestive of poor tumor biology were the most influential for prediction. Our work provides a framework for identifying patients with ER that might benefit from shorter interval surveillance early after surgery.

Negative but Not Positive Alcohol-Related Consequences Tend to Occur Above the Heavy Episodic Drinking Threshold: A Daily Study of Young Adult Heavy Drinkers.

AIMS: This study used event-level data to identify the threshold (i.e. number of standard alcoholic drinks) at which specific negative and positive alcohol-related consequences are likely to occur. METHODS: Ninety-six college students aged 18-20 reporting weekly heavy episodic drinking (HED) or at least one negative alcohol-related consequence in the past 2 weeks completed ecological momentary assessment over 28 days. Participants reported number of standard drinks consumed and negative (e.g. nausea) and positive (e.g. new friend) alcohol-related consequences on 492 drinking nights. The area under the receiver operating characteristic (AUROC) curve measured the ability of an increasing number of drinks consumed to discriminate between nights with versus without a given consequence. The Youden Index method was used to identify the optimal threshold of drinks for each consequence. Thresholds were examined for each consequence by participants' biological sex and heavy drinking status. RESULTS: Across subgroups, most consequences occurred on nights where participants reported higher consumption levels relative to nights where consequences did not occur. Thresholds for negative consequences ranged between four and nine drinks and thresholds for positive consequences were between three and six drinks. CONCLUSIONS: Many negative consequences are likely to occur following the traditional HED threshold of 4+/5+ drinks (females/males), with more severe consequences occurring at slightly higher thresholds. Positive consequences are likely to occur at lower thresholds. There may be an optimal number of drinks that maximize positive while minimizing negative consequences for heavy drinking college students.

Quantifying heterogeneity in mood-alcohol relationships with idiographic causal models.

BACKGROUND: Ecological momentary assessment (EMA) studies have provided conflicting evidence for the mood regulation tenet that people drink in response to positive and negative moods. The current study examined mood-to-alcohol relationships idiographically to quantify the prevalence and intensity of relationships between positive and negative moods and drinking across individuals. METHOD: We used two EMA samples: 96 heavy drinking college students (sample 1) and 19 young adults completing an ecological momentary intervention (EMI) for drinking to cope (sample 2). Mood and alcohol use were measured multiple times per day for 4-6 weeks. Mood-alcohol relationships were examined using three different analytic approaches: standard multilevel modeling, group causal modeling, and idiographic causal modeling. RESULTS: Both multilevel modeling and group causal modeling showed that participants in both samples drank in response to positive moods only. However, idiographic causal analyses revealed that only 63% and 21% of subjects (in samples 1 and 2, respectively) drank following any positive mood. Many subjects (24% and 58%) did not drink in response to either positive or negative mood in their daily lives, and very few (5% and 16%) drank in response to negative moods throughout the EMA protocol, despite sample 2 being selected specifically because they endorse drinking to cope with negative mood. CONCLUSION: Traditional group-level analyses and corresponding population-wide theories assume relative homogeneity within populations in mood-alcohol relationships, but this nomothetic approach failed to characterize accurately the relationship between mood and alcohol use in approximately half of the subjects in two samples that were demographically and clinically homogeneous. Given inconsistent findings in the mood-alcohol relationships to date, we conclude that idiographic causal analyses can provide a foundation for more accurate theories of mood and alcohol use. In addition, idiographic causal models may also help improve psychosocial treatments through direct use in clinical settings.

Discussion of alcohol consequences during a brief motivational intervention session: Comparing those who do and do not increase readiness to change.

The present study was designed to take an inductive, qualitative approach to understanding how discussion of alcohol-related consequences during brief motivational interventions (BMI) relate to readiness to change (RTC) prior to versus at the end of a session. Participants were thirty-four adults (35% female) recruited from the emergency room and enrolled in a randomized clinical trial of a BMI for risky alcohol use and risky sex. Seventeen participants both began and remained low on RTC over the course of the session. We selected 17 additional participants, matched on demographics, but who increased RTC over the session. Transcripts were qualitatively coded and analyzed separately within groups. Among participants who increased their RTC relative to participants who remained low on RTC by BMI end, evaluation of alcohol consequences as negative was more typical. In both groups, several consequences were neutrally evaluated. Many who remained low on RTC attributed consequences to something other than alcohol and/or minimized consequence severity. Study findings highlight the value for clinicians in eliciting and maximizing the importance of subjectively negative recent consequences to perhaps increase heavy drinkers' readiness to decrease heavy alcohol use.

Changes in Alcohol Use and Drinking Context due to the COVID-19 Pandemic: A Multimethod Study of College Student Drinkers.

BACKGROUND: In spring 2020, U.S. universities closed campuses to limit the transmission of COVID-19, resulting in an abrupt change in residence, reductions in social interaction, and in many cases, movement away from a heavy drinking culture. The present mixed-methods study explores COVID-19-related changes in college student drinking. We characterize concomitant changes in social and location drinking contexts and describe reasons attributed to changes in drinking. METHODS: We conducted two studies of the impact of the COVID-19 pandemic on drinking behavior, drinking context, and reasons for both increases and decreases in consumption among college students. Study 1 (qualitative) included 18 heavy-drinking college students (Mage  = 20.2; 56% female) who completed semi-structured interviews. Study 2 (quantitative) included 312 current and former college students who reported use of alcohol and cannabis (Mage  = 21.3; 62% female) and who completed an online survey. RESULTS: In both studies, COVID-19-related increases in drinking frequency were accompanied by decreases in quantity, heavy drinking, and drunkenness. Yet, in Study 2, although heavier drinkers reduced their drinking, among non-heavy drinkers several indices of consumption increased or remained stable . Both studies also provided evidence of reductions in social drinking with friends and roommates and at parties and increased drinking with family. Participants confirmed that their drinking decreased due to reduced social opportunities and/or settings, limited access to alcohol, and reasons related to health and self-discipline. Increases were attributed to greater opportunity (more time) and boredom and to a lesser extent, lower perceived risk of harm and to cope with distress. CONCLUSION: This study documents COVID-19-related changes in drinking among college student drinkers that were attributable to changes in context, particularly a shift away from heavy drinking with peers to lighter drinking with family. Given the continued threat of COVID-19, it is imperative for researchers, administrators, and parents to understand these trends as they may have lasting effects on college student drinking behaviors.

Associations between alcohol demand and both the experience and subjective evaluation of positive and negative alcohol-related consequences.

BACKGROUND: Considerable variation exists in the extent to which alcohol-related consequences are evaluated as positive or negative. These evaluations, in turn, predict subsequent drinking behavior. Understanding the etiological pathways to positive and negative alcohol-related consequences is essential to the design of interventions aimed at reducing drinking consequences. Behavioral economic models posit that excessive alcohol valuation contributes to problematic use. Elevated alcohol demand (i.e., relative alcohol value) is associated with negative alcohol-related consequences; however, it is unclear whether demand is related to positive consequences or subjective consequence evaluations. METHODS: College student drinkers (n = 114; 74.6% female) completed an online survey. Participants indicated whether they had ever experienced any of 24 negative and 14 positive consequences and subjectively evaluated their most recent experience of each consequence endorsed. An alcohol purchase task assessed hypothetical alcohol consumption across 14 prices and three observed demand indices were calculated: intensity (i.e., consumption at zero cost), Omax (i.e., maximum expenditure), and Pmax (i.e., price associated with maximum expenditure). Bivariate correlations and hierarchical regressions were used to test associations between observed demand indices and the number and subjective evaluations of positive and negative (researcher- and participant-defined) consequences. RESULTS: Intensity and Omax , but not Pmax , were bivariately associated with researcher- and participant-defined negative and positive consequences. However, in hierarchical regression models that controlled for the maximum number of drinks consumed in a single day over the past month, only intensity was significantly associated with more negative and positive consequences. Intensity was associated with positive consequence evaluations in bivariate but not regression models. CONCLUSION: Students with higher intensity reported more prior alcohol consequences (positive and negative), independent of drinking level. However, subjective evaluations of recent consequences did not vary as a function of demand. Results support using behavioral economic models to facilitate identifying etiologic pathways to alcohol consequences and suggest that novel interventions incorporating demand manipulation may reduce drinking consequences.

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

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

Personalized feedback improves cardiovascular risk perception and physical activity levels in persons with HIV: results of a pilot randomized clinical trial.

People with HIV (PWH) have an elevated risk for cardiovascular disease (CVD) compared with the general population. This study examined the feasibility, acceptability and preliminary efficacy of a tailored intervention aimed at increasing CVD risk perception and the adoption of heart-healthy behaviors in PWH. Forty adults were randomized to receive personalized feedback on CVD risk and discussion of risk reduction or health education. Participants were issued pedometers and seen for two treatment sessions. Participants were 60% male and had a mean age of 51.5 years. Ninety percent of participants completed all study sessions indicating good feasibility and acceptability. A medium effect size for the difference between treatment and control groups was found on both the Perceived Risk for Heart Disease (d = .38) and the Rapid Eating and Activity for Patients scales (d = .56) at 12 weeks. Atherosclerotic cardiovascular disease (ASCVD) risk score moderated the effect of treatment, such that at high (but not low) ASCVD risk, active intervention, compared to control, was associated with a greater increase in steps between baseline and both 8 (d = .38) and 12 weeks (d = .55). Findings provide preliminary evidence that tailored interventions delivered by nurses may be effective for primary prevention of CVD in PWH.

"I Still Don't Know What Happened, Complete Blackout": a Content Analysis of Tweets Referencing Alcohol-Induced Amnesia.

OBJECTIVE: We qualitatively examined the content of alcohol-related blackouts posts ("Tweets") on Twitter, focusing on reflections post-drinking that involved clear references to memory loss. METHODS: We examined publically available Tweets that referenced blackouts after an alcohol consumption event (n = 3,574). RESULTS: Twitter represents a relatively unfiltered glimpse at reflections on alcohol-induced amnesia. As hypothesized, most tweets referencing blackouts did not clearly describe amnesia. In the Tweets that clearly reference amnesia, we identified several themes. Tweeters referenced an 'AlterEgo' who was responsible for all the intoxicated behaviors that were inconsistent with the Tweeter's personality. Additionally, the Tweets discussed ways in which the drinker recovered memories (e.g. from friends, from social media), other events that occurred during the amnesia (e.g. loss of items, help from friends, sexual experiences), and regret about having lost memories. Some Tweeters requested assistance from their followers to reconstruct their drinking event. Tweets have the potential to set norms about acceptable behaviors or scripts following a blackout. CONCLUSIONS: Since most blackout Tweets are ambiguous with regards to alcohol-induced amnesia, these Tweets might be leading people to believe that blackouts are passing out or just periods of heavy intoxication. In addition, themes from these Tweets can inform future interventions by using the cognitions surrounding this high-risk behavior.

Dimensions of Athletic Identity and their Associations with Drinking Behaviors among a National Sample of University Athletes in the United States.

Although prior studies have indicated athletic identity plays a role in alcohol use among college athletes, this research has largely drawn on a unidimensional conceptualization. Addressing this gap, the current study utilized a sample of 8,550 university athletes (Mage = 19.70 years, SD = 1.33, 50.8% men) from 203 U.S. post-secondary institutions to examine the associations between athletic identity dimensions (i.e., social identification, negative affectivity, and exclusivity) and alcohol use for athletes across gender, sport type, and division. The results indicated that negative affectivity and social identification were associated with higher levels of alcohol use, whereas exclusivity was associated with lower levels of alcohol use. Further, the association between dimensions of athletic identity and alcohol use varied across competitive level (i.e., Division I, II, and III). The findings implicate the need for (a) future research to approach athletic identity as a multidimensional concept when examining its association with alcohol use outcomes, and (b) post-secondary alcohol prevention professionals to integrate dimensions of athletic identity in alcohol prevention approaches.

A Test of the Theory of Planned Behavior in the Prediction of Alcohol-Induced Blackout Intention and Frequency.

BACKGROUND: This study examined the theory of planned behavior (TPB) as an explanatory model for alcohol-induced blackouts among college students. Blackouts are periods of time wherein individuals continue to function and engage in their social environment but do not remember it as a result of consuming large quantities of alcohol. Social cognitive factors posited within TPB, such as perceived norms and personal attitudes toward alcohol consumption, are reliable predictors of alcohol use and related problems. However, research to date has not examined these theoretical antecedents as predictors of alcohol-induced blackout. METHODS: College students with a history of blackout (N = 384) completed a baseline survey, and a subsample (N = 120) completed a 1-month follow-up survey. Negative binomial mediation models were used to evaluate intentions to blackout as a mediator of the norms, attitudes, and self-efficacy to avoid blackout-blackout frequency association at baseline and 1-month follow-up. RESULTS: Norms, attitudes, and self-efficacy to avoid blackout all significantly predicted blackout intentions at baseline, which in turn predicted more frequent blackouts both at baseline and at 1-month follow-up. Notably, blackout attitudes demonstrated both direct and indirect associations with blackout frequency. CONCLUSIONS: Prospective analyses provided partial support for the TPB, with only attitudes and intentions demonstrating prospective associations with actual blackout frequency. Given the particularly strong association between blackout attitudes and frequency of blackouts, attitudes may represent an important and novel target for prevention and intervention efforts.

Affective and Situational Precipitants of Smoking Lapses Among Adolescents.

INTRODUCTION: Most adolescent smokers report a desire to quit, and many have made several unsuccessful quit attempts; however, when adolescents attempt to quit, they often resume smoking quickly. This ecological study aimed to (1) characterize affective and situational precipitants of smoking lapses among adolescents and (2) explore the moderating influence of nicotine dependence severity on lapse precipitants. METHODS: Adolescent daily smokers (n = 166; ages 14-18 years) completed electronic diaries of cigarettes smoked, craving and affective states, and situational variables on handheld computers in their natural environment for 2 weeks following an unassisted quit attempt. On average, adolescents were moderately nicotine dependent (Modified Fagerström Tolerance Questionnaire [mFTQ] score = 4.9; SD = 1.6). RESULTS: Craving was a significant episodic cue for lapse and stable influence on lapse, relating to 44% and 15% increased odds of lapse, respectively. High-arousal affective states-regardless of valence-were associated with 12%-13% increased odds of lapse. Low-arousal positive affective states were associated with 17% decreased odds of lapse. A 1-unit difference in a teen's mFTQ score related to 27% increased odds of lapse, but dependence severity did not moderate proximal lapse influences. CONCLUSIONS: This report provides some of the first ecological data characterizing adolescent smoking lapses following a quit attempt. As in prior work with teens, lapses were nearly universal and quickly followed the quit attempt. Specific situational and affective contexts of smoking lapses for adolescents were implicated, indicating the need for cessation interventions to address craving and high-arousal affective states as precipitators of lapse in this high-risk group. IMPLICATIONS: This report provides some of the first ecological data characterizing smoking lapses among teens attempting to quit smoking on their own. Like adults, adolescents face many barriers when making quit attempts. The present work provides ecological data to suggest that the experience of heightened arousal in teens' daily lives interferes with their efforts to quit smoking. Thus, this work highlights the importance of affective dysregulation, or amplitude of emotional feelings, for teen smoking lapses. Moment-to-moment fluctuation in craving was also implicated as a dynamic precipitator of smoking lapse in this high-risk group.

Posting Post-Blackout: A Qualitative Examination of the Positive and Negative Valence of Tweets Posted after "Blackout" Drinking.

Alcohol-induced memory loss (i.e., blackout) is a consequence of drinking that is both common and associated with additional negative outcomes. The goal of the present study was to use publicly available Twitter data to better understand cognitions and emotions following blackouts. Tweets containing key terms (e.g., "black out") were collected over 4 days in 2018. Using NVivo software, we coded all post-blackout Tweets for valence (positive, negative, neutral). Within each valence category, we reviewed Tweets to identify themes. Among Tweets coded with a positive valence, themes included pride in blacking out, pride in ability to function despite blackouts, blackouts as a shared social experience, and overall positive views of a drinking experience despite blackouts. Among Tweets coded with a negative valence, themes included the experience of other negative consequences on blackout nights, blackouts as unexpected/unplanned, blackouts as motivator of change, and blackout-related negative emotions. Additionally, Tweeters expressed pride in avoiding blackouts during drinking events. Findings provide insight into why not all individuals describe blackouts negatively, by analyzing specific statements made in a public forum following a blackout. Such insight may inform interventions targeting those who report this risky outcome of drinking, including those that could be delivered via social media.

Low-Carbohydrate and Very-Low-Carbohydrate Diets in Patients With Diabetes.

Low-carbohydrate diets have been advocated as an effective method for promoting weight loss in overweight and obese individuals and preventing and treating type 2 diabetes. This article reviews the differences between various low-carbohydrate eating plans and discusses the benefits and drawbacks of such a diet based on available evidence. It also offers practical pointers for clinicians.

Location-Specific Social Norms and Personal Approval of Alcohol Use are Associated with Drinking Behaviors in College Students.

Background: Prior research on risky alcohol use points to drinking norms as predictors of drinking behavior. Most research to date has only explored global (versus context-specific) drinking norms as they relate to general drinking behavior. To better understand risky drinking behavior in students, how norms may vary across drinking environments should be considered. Objectives: We sought to explore differences in drinking norms (descriptive and injunctive), personal approval, and alcohol use across specific drinking locations and how these location-specific predictors combine to best predict alcohol consumption in home/dorm locations, bars, and parties. Methods: College student drinkers (N = 115, 76% female) participated in an anonymous online cross-sectional survey in 2015-2016 assessing personal and perceived drinking experiences and attitudes across various locations. Results: Alcohol use, descriptive norms of alcohol use, and injunctive norms of alcohol use (but not personal approval) varied across location. In addition, location-specific descriptive norms were associated with alcohol use in each drinking location, whereas location specific personal approval was associated with alcohol use only at home/dorm and bar locations. Furthermore, descriptive norms and personal approval of drinking in a given location predicted alcohol use in that same location, while norms or approval for other locations did not. Conclusion/Importance: Results highlight the importance of specificity of perceived drinking norms and personal approval for predicting location-specific alcohol use. These findings have implications for interventions, which may benefit from discussions of students' preferred drinking locations and providing location-specific normative feedback.

Effect of beta blocker use and type on hypoglycemia risk among hospitalized insulin requiring patients.

BACKGROUND: Although beta blockers could increase the risk of hypoglycemia, the difference between subtypes on hypoglycemia and mortality have not been studied. This study sought to determine the relationship between type of beta blocker and incidence of hypoglycemia and mortality in hospitalized patients. METHODS: We retrospectively identified non-critically ill hospitalized insulin requiring patients who were undergoing bedside glucose monitoring and received either carvedilol or a selective beta blocker (metoprolol or atenolol). Patients receiving other beta blockers were excluded. Hypoglycemia was defined as any glucose < 3.9 mmol/L within 24 h of admission (Hypo1day) or throughout hospitalization (HypoT) and any glucose < 2.2 mmol/L throughout hospitalization (Hyposevere). RESULTS: There were 1020 patients on carvedilol, 886 on selective beta blockers, and 10,216 on no beta blocker at admission. After controlling for other variables, the odds of Hypo1day, HypoT and Hyposevere were higher for carvedilol and selective beta blocker recipients than non-recipients, but only in basal insulin nonusers. The odds of Hypo1day (odds ratio [OR] 1.99, 95% confidence interval [CI] 1.28, 3.09, p = 0.0002) and HypoT (OR 1.38, 95% CI 1.02, 1.86, p = 0.03) but not Hyposevere (OR 1.90, 95% CI 0.90, 4.02, p = 0.09) were greater for selective beta blocker vs. carvedilol recipients in basal insulin nonusers. Hypo1day, HypoT, and Hyposevere were all associated with increased mortality in adjusted models among non-beta blocker and selective beta blocker recipients, but not among carvedilol recipients. CONCLUSIONS: Beta blocker use is associated with increased odds of hypoglycemia among hospitalized patients not requiring basal insulin, and odds are greater for selective beta blockers than for carvedilol. The odds of hypoglycemia-associated mortality are increased with selective beta blocker use or nonusers but not in carvedilol users, warranting further study.

"Can't Wait to Blackout Tonight": An Analysis of the Motives to Drink to Blackout Expressed on Twitter.

BACKGROUND: Alcohol-related blackouts are associated with a range of negative consequences and are common among social drinkers. Discussing alcohol use on social networking platforms (e.g., Twitter) is common and related to higher alcohol consumption levels. Due to the widespread nature of alcohol-related social networking posts and alcohol-related blackouts, we examined the content of alcohol-related blackouts posts/"Tweets" on Twitter, with a focus on intentions to blackout and specific motivations for blacking out. METHODS: A set of Tweets containing "blackout," "blackout," "blacking out," "blacked out," or "blacks out" were collected from April 26, 2018, and April 29, 2018. Using NVivo software, we coded all preblackout Tweets (i.e., before the blackout experience) for intentions and motives to blackout. RESULTS: Most Tweets that we collected expressed an intention to blackout and these intentions ranged in strength (i.e., will blackout vs. might blackout). With respect to specific motives for blacking out, celebration motives were identified. For example, Tweets addressed blacking out to celebrate one's birthday, someone else's birthday, a school or work accomplishment, a sports win, during a vacation, or a holiday. Another endorsed motive for blacking out was loss or coping motives. For example, the Tweets commented on blacking out to deal with stress or a bad day. CONCLUSION: Our findings suggest that Twitter users express intentions to blackout due to celebration or coping reasons. Given the consequences associated with blackout drinking, future research should consider the link between blackout intentions, blackout motives, and alcohol-related harm.