Wellbeing in Addiction Recovery: Does It Differ across Addictions?

Limited research has been conducted on the experiences of individuals in long-term recovery from addiction, and addictions are usually studied in isolation. However, no theories of addiction differentiate between addictions or assume that individuals will experience only one addiction. This study aimed to compare affect between individuals with addictions to drugs and alcohol and to explore how QoL changes in long-term recovery from addiction. Individuals in recovery from addiction (n = 115; 52.2% male) were recruited via snowball sampling on social media signposted by an addiction rehabilitation charity. Participants completed questionnaires about QoL (WHOQOL-Bref) and positive and negative affect (PANAS-X). The main primary addictions were drugs (76.5%) and alcohol (21.7%), with 69.7% reporting multiple addictions including food, sex, internet, and gambling. Affect and coping strategies did not differ by addiction. QoL appeared to improve with time in recovery. The high percentage of multiple addictions and greater similarities than differences between individuals with drug and alcohol addictions suggest that addictions should not be studied in isolation when studying psychological health during long-term recovery.

Corrigendum: Utilising online eye-tracking to discern the impacts of cultural backgrounds on fake and real news decision-making.

[This corrects the article DOI: 10.3389/fpsyg.2022.999780.].

Social norms and goal-setting interventions to promote responsible gambling in low-to-moderate online gamblers: protocol for a four-arm randomised controlled feasibility study.

INTRODUCTION: Gambling is increasingly recognised as an important public health issue. Problem gambling is associated with highly negative impacts on physical, psychological and social well-being, not only for those who gamble but also for those around them. There has been a rapid expansion of internet gambling and attributes such as continuous play and instant rewards, and enhanced privacy may lead to a greater likelihood of gambling-related harms. In this randomised controlled feasibility study, we are testing (1) the acceptability and feasibility of three online responsible gambling interventions targeting people with low-to-moderate risk of online problem gambling and (2) the feasibility of a future full-scale randomised controlled trial (RCT) to test their effectiveness and cost-effectiveness. METHODS AND ANALYSIS: Four-arm randomised controlled feasibility study with qualitative substudy. One-hundred and forty UK residents with low-to-moderate risk of online gambling recruited via gambling operators and social media will be randomised (1:1:1:1) to either (1) goal setting, (2) descriptive norms messages (challenge perceptions of peer behaviours), (3) injunctive norms messages (challenge perceptions of peer attitudes) and (4) control (delayed intervention). Interventions will be delivered over 6 weeks and individually tailored. Outcomes, administered online, will be measured at baseline, 7 weeks, and 3 and 6 months post randomisation (including gambling risk behaviours and cognitions, anxiety and depression, quality of life, health use and productivity). Analyses will be descriptive, focusing on feasibility and acceptability of the interventions and study procedures. Telephone/online interviews, with a subsample of approximately 30 participants, will elicit experiences of participating in the study. Prespecified progression criteria will guide decisions around whether to progress to a definitive RCT. ETHICS AND DISSEMINATION: Ethical approval obtained from Bournemouth University Research Ethics Committee (reference number 33247). Participants will be given a participant information sheet plus a 'Key Facts' summary and will provide informed online consent. Findings will be published in peer-reviewed journals and presented at conferences and public engagement events. TRIAL REGISTRATION NUMBER: ISRCTN37874344.

Utilising online eye-tracking to discern the impacts of cultural backgrounds on fake and real news decision-making.

Introduction: Online eye-tracking has been used in this study to assess the impacts of different cultural backgrounds on information discernment. An online platform called RealEye allowed participants to engage in the eye-tracking study from their personal computer webcams, allowing for higher ecological validity and a closer replication of social media interaction. Methods: The study consisted of two parts with a total of five visuals of social media posts mimicking news posts on Twitter, Instagram, and Facebook. Participants were asked to view examples of real and fake news taken from a news fact-checking website, Snopes, and their eye movements were recorded during the process. Participants were recruited through Prolific and SONA; the total sample size for study 1.1 was 29 participants, and the total for study 1.2 was 25 participants, after removing poor eye-tracking data. A total of five visual images comprising true and false news were shown to the participant, study 1.1 had three examples and study 1.2 had two examples. There were two main cultural backgrounds in focus: participants born in China or the United Kingdom. Results: Results suggested that participants follow a similar visual pattern of attention to Areas of Interest (AOIs) on the posts, which leads us to believe that due to the global standardisation of popular social media platforms, a bias might have occurred during information discernment. Discussion: It is suggested that regardless of country background, users may have similar eye-tracking results while viewing a social media post because social media platform formats are standardised globally. Further research would recommend looking at language and linguistic traits when seeking differences between country backgrounds during online information discernment.

Problematic internet usage: the impact of objectively Recorded and categorized usage time, emotional intelligence components and subjective happiness about usage.

Most research on Problematic Internet Usage (PIU) relied on self-report data when measuring the time spent on the internet. Self-reporting of use, typically done through a survey, showed discrepancies from the actual amount of use. Studies exploring the association between trait emotional intelligence (EI) components and the subjective feeling on technology usage and PIU are also limited. The current cross-sectional study aims to examine whether the objectively recorded technology usage, taking smartphone usage as a representative, components of trait EI (sociability, emotionality, well-being, self-control), and happiness with phone use can predict PIU and its components (obsession, neglect, and control disorder). A total of 268 participants (Female: 61.6%) reported their demographic and completed a questionnaire that included Problematic Internet Usage Questionnaire short form (PIUQ-SF-6), Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF), level of happiness with the amount and frequency of smartphone use, and living conditions (whether alone or with others). Their smartphone usage was objectively recorded through a dedicated app. A series of one-way ANOVA revealed no significant difference in PIU for different living conditions and a significant difference in the subjective level of happiness with phone usage (F (3, 264) = 7.55, p < .001), as well as of the frequency of usage where the unhappy group had higher PIU (F (3, 264) = 6.85, p < .001). Multiple linear regression analysis showed that happiness with phone usage (ß = -.17), the actual usage of communication (ß = .17), social media (ß = .19) and gaming apps (ß = .13), and trait EI component of self-control (ß = -.28) were all significant predictors of PIU. Moreover, gender, age, and happiness with the frequency of phone usage were not significant predictors of PIU. The whole model accounted for the total variance of PIU by 32.5% (Adjusted R2 = .287). Our study contributes to the literature by being among the few to rely on objectively recorded smartphone usage data and utilizing components of trait EI as predictors.

Did Usage of Mental Health Apps Change during COVID-19? A Comparative Study Based on an Objective Recording of Usage Data and Demographics.

This paper aims to objectively compare the use of mental health apps between the pre-COVID-19 and during COVID-19 periods and to study differences amongst the users of these apps based on age and gender. The study utilizes a dataset collected through a smartphone app that objectively records the users' sessions. The dataset was analyzed to identify users of mental health apps (38 users of mental health apps pre-COVID-19 and 81 users during COVID-19) and to calculate the following usage metrics; the daily average use time, the average session time, the average number of launches, and the number of usage days. The mental health apps were classified into two categories: guidance-based and tracking-based apps. The results include the increased number of users of mental health apps during the COVID-19 period as compared to pre-COVID-19. Adults (aged 24 and above), compared to emerging adults (aged 15-24 years), were found to have a higher usage of overall mental health apps and guidance-based mental health apps. Furthermore, during the COVID-19 pandemic, males were found to be more likely to launch overall mental health apps and guidance-based mental health apps compared to females. The findings from this paper suggest that despite the increased usage of mental health apps amongst males and adults, user engagement with mental health apps remained minimal. This suggests the need for these apps to work towards improved user engagement and retention.

What's in the box? Exploring UK players' experiences of loot boxes in games; the conceptualisation and parallels with gambling.

Loot boxes are a popular mechanic within many video games, but it remains unclear if some forms of loot boxes can be seen of as gambling. However, the perspectives of players are often neglected, such as whether they see them as 'fair' game elements and how closely they feel this aligns with gambling. In this paper, we synthesise a conceptualisation for loot boxes through players' actual experience and explore if there are any parallels with gambling. Twenty-one participants who played video games took part in the research through either an interview or online survey. Thematic analysis suggested that six themes were core to exploring loot boxes: Random Chance Effects, Attitudes Towards Content, Implementation, Parallels with Gambling, Game Design, and The Player. The results suggested both indirect and direct parallels with gambling from the players experiences. Implications of game design and classifying loot boxes as gambling are discussed in relation to game design and risk factors of gambling and purchasing behaviour.

Negative Consequences of Substance Use in European University Students: Results from Project SNIPE.

BACKGROUND: University students are a risk group for heavy substance use and the experience of various potentially severe negative substance use consequences which may impact on their health, social, and academic functioning. Whilst the experience of negative consequences of substance use is well understood in North American student samples, there is little data on these experiences in European students. In order to develop effective harm prevention and reduction interventions for students' substance use, there needs to be an understanding of the types of consequences experienced in European student samples. OBJECTIVES: The aim of the study was to investigate the prevalence and predictors of the experience of negative substance use-related consequences amongst university students in 7 European countries. METHODS: University students (n = 4,482) in Belgium, Denmark, Germany, the Slovak Republic, Spain, Turkey, and the UK completed an online survey of their substance use behaviours and the experience of associated negative consequences. RESULTS: European students reported that experiencing a hangover or illness, missing class, being short of money, and experiencing memory loss were the most commonly experienced negative consequences of substance use. Not living with other students and using alcohol, cannabis, sedatives, and cocaine were also associated with higher odds of experiencing these negative consequences. CONCLUSIONS: In contrast to North American data, European university students tended to experience consequences that are associated with lower level health risks rather than more severe consequences (e.g., drink-driving and physical injury). Harm prevention and reduction interventions for students should be targeted towards those consequences that are most salient to the target group to ensure feedback is relevant and potentially more effective in changing students' substance use behaviours.

Managing Procrastination on Social Networking Sites: The D-Crastinate Method.

Procrastination refers to the voluntary avoidance or postponement of action that needs to be taken, that results in negative consequences such as low academic performance, anxiety, and low self-esteem. Previous work has demonstrated the role of social networking site (SNS) design in users' procrastination and revealed several types of procrastination on SNS. In this work, we propose a method to combat procrastination on SNS (D-Crastinate). We present the theories and approaches that informed the design of D-Crastinate method and its stages. The method is meant to help users to identify the type of procrastination they experience and the SNS features that contribute to that procrastination. Then, based on the results of this phase, a set of customised countermeasures are suggested for each user with guidelines on how to apply them. To evaluate our D-Crastinate method, we utilised a mixed-method approach that included a focus group, diary study and survey. We evaluate the method in terms of its clarity, coverage, efficiency, acceptance and whether it helps to increase users' consciousness and management of their own procrastination. The evaluation study involved participants who self-declared that they frequently procrastinate on SNS. The results showed a positive impact of D-Crastinate in increasing participants' awareness and control over their procrastination and, hence, enhancing their digital wellbeing.

Understanding Phishing Email Processing and Perceived Trustworthiness Through Eye Tracking.

Social engineering attacks in the form of phishing emails represent one of the biggest risks to cybersecurity. There is a lack of research on how the common elements of phishing emails, such as the presence of misspellings and the use of urgency and threatening language, influences how the email is processed and judged by individuals. Eye tracking technology may provide insight into this. In this exploratory study a sample of 22 participants viewed a series of emails with or without indicators associated with phishing emails, whilst their eye movements were recorded using a SMI RED 500 eye-tracker. Participants were also asked to give a numerical rating of how trustworthy they deemed each email to be. Overall, it was found that participants looked more frequently at the indicators associated with phishing than would be expected by chance but spent less overall time viewing these elements than would be expected by chance. The emails that included indicators associated with phishing were rated as less trustworthy on average, with the presence of misspellings or threatening language being associated with the lowest trustworthiness ratings. In addition, it was noted that phishing indicators relating to threatening language or urgency were viewed before misspellings. However, there was no significant interaction between the trustworthiness ratings of the emails and the amount of scanning time for phishing indicators within the emails. These results suggest that there is a complex relationship between the presence of indicators associated with phishing within an email and how trustworthy that email is judged to be. This study also demonstrates that eye tracking technology is a feasible method with which to identify and record how phishing emails are processed visually by individuals, which may contribute toward the design of future mitigation approaches.

Combating Fear of Missing Out (FoMO) on Social Media: The FoMO-R Method.

Background: The fear of missing out (FoMO) on social media refers to the apprehension that online content and interactions from others are unseen and reacted to in a timely fashion. FoMO can become problematic, leading to anxiety, interrupted sleep, lack of concentration and dependence on social media to generate gratification. The literature has mainly focused on understanding the FoMO experience, factors contributing to it and its consequences. Method: In this paper, we build on previous research and develop a FoMO Reduction (FoMO-R) approach that embraces technical elements such as autoreply, filtering, status, education on how FoMO occurs and skills on how to deal with it; e.g., self-talk and checklists. We evaluate the method through focus groups and a diary study involving 30 participants who self-declared to experience FoMO regularly. Results: The results show that the method was accepted by the participants and helped them to manage their FoMO. They also show that a set of extra functionalities in social media design is needed so that users can manage FoMO more effectively. Conclusion: FoMO can be reduced through socio-technical approaches, joining both social and technical skills, and literacy on how social media are designed and how social interactions should happen on them.

Is It Still Double Edged? Not for University Students' Development of Moral Reasoning and Video Game Play.

Previous research with video game play and moral development with adolescents, found both positive and negative relationships. This study aimed to extend this research to explore moral development and video game play with university students. One hundred and thirty-five undergraduate students (M = 20.29, SD = 2.70) took part in an online survey. The results suggested higher moral reasoning for participants who described themselves as gamers and those which do not play, compared those who play but do not identify as gamers. It was suggested that males had higher moral scores and more mature reasoning than females. The results of a regression analysis suggested that there were no significant predictors for moral development from either game play or the demographic variables. The findings suggest that moral development could be less influenced by sex, age, and video game play factors such as video game content and amount of game play, than was previously thought for this age group.

Interdisciplinary Lessons Learned While Researching Fake News.

The misleading and propagandistic tendencies in American news reporting have been a part of public discussion from its earliest days as a republic (Innis, 2007; Sheppard, 2007). "Fake news" is hardly new (McKernon, 1925), and the term has been applied to a variety of distinct phenomenon ranging from satire to news, which one may find disagreeable (Jankowski, 2018; Tandoc et al., 2018). However, this problem has become increasingly acute in recent years with the Macquarie Dictionary declaring "fake news" the word of the year in 2016 (Lavoipierre, 2017). The international recognition of fake news as a problem (Pomerantsev and Weiss, 2014; Applebaum and Lucas, 2016) has led to a number of initiatives to mitigate perceived causes, with varying levels of success (Flanagin and Metzger, 2014; Horne and Adali, 2017; Sample et al., 2018). The inability to create a holistic solution continues to stymie researchers and vested parties. A significant contributor to the problem is the interdisciplinary nature of digital deception. While technology enables the rapid and wide dissemination of digitally deceptive data, the design and consumption of data rely on a mixture of psychology, sociology, political science, economics, linguistics, marketing, and fine arts. The authors for this effort discuss deception's history, both old and new, from an interdisciplinary viewpoint and then proceed to discuss how various disciplines contribute to aiding in the detection and countering of fake news narratives. A discussion of various fake news types (printed, staged events, altered photographs, and deep fakes) ensues with the various technologies being used to identify these; the shortcomings of those technologies and finally the insights offered by the other disciplines can be incorporated to improve outcomes. A three-point evaluation model that focuses on contextual data evaluation, pattern spread, and archival analysis of both the author and publication archives is introduced. While the model put forth cannot determine fact from fiction, the ability to measure distance from fact across various domains provides a starting point for evaluating the veracity of a new story.

It's Double Edged: The Positive and Negative Relationships Between the Development of Moral Reasoning and Video Game Play Among Adolescents.

Due to the concerns over the effects of video game play, this study investigated adolescents' moral development and their video game play. 166 adolescents aged 11-18 years (M = 13.08, SD = 1.91) attending an English school completed an online survey, which included a measure of moral development and questions regarding video game play. In contrast to previous research, male participants were found to have significantly (p = 0.02) higher moral reasoning scores than females. The results also suggested a transition in moral development, which takes place between the ages of 12-14. The results of moral development and video game played suggested both positive and negative relationships. Regression analysis suggested that there was a significant positive relationship between the more types of game genres played and higher moral scores. Although not significant, the results suggested a trend for the following variables; years playing video games, mature content, engagement, moral narrative, Grand Theft Auto, Call of Duty, and length of time playing video games which all had a negative relationship with moral scores. The implications of these results are discussed with regards to moral education and the variables involved in video game play, including the role of video game content.

A Critical Appraisal of the Social Norms Approach as an Interventional Strategy for Health-Related Behavior and Attitude Change.

The Social Norms Approach is a widely used intervention strategy for promoting positive health-related behaviors. The Approach operates on the premise that individuals misperceive their peers' behaviors and attitudes, with evidence of under- and over-estimations of behaviors and peer approval for a range of positive and negative behaviors respectively. The greater these misperceptions, the more likely an individual is to engage in negative behaviors such as consuming heavier amounts of alcohol and other substances and reduce positive behaviors such as eating healthily and using sun protection. However, there are many complexities associated with the use of social norms feedback in interventions and empirical studies. Many social norms interventions do not attempt to change misperceptions of social norms or measure changes in normative perceptions pre- and post-intervention. This has led to a conflation of generic social norms interventions with those that are explicitly testing the Approach's assumptions that it is misperceptions of peer norms which drive behavior. The aim of the present review was to provide a critical appraisal of the use of the Social Norms Approach as an intervention strategy for health-related behaviors, identify the current issues with its evidence base, highlight key opportunities and challenges facing the approach, and make recommendations for good practice when using the approach. There are three core challenges and areas for improved practice when using the Social Norms Approach. Firstly, improvements in the methodological rigor and clarity of reporting of 'social norms' research, ensuring that studies are testing the approach's assumption of the role of misperceptions on behaviors are differentiated from studies investigating other forms of 'social norms.' Secondly, the need for a more explicit, unified and testable theoretical model outlining the development of normative misperceptions which can be translated into interventional studies. Finally, a need for a more robust evaluation of social norms interventions in addition to randomized controlled trials, such as the inclusion of process evaluations, qualitative studies of participant experiences of social norms feedback, and alternative study designs better suited for real-world public health settings. Such improvements are required to ensure that the Social Norms Approach is adequately tested and evaluated.

Personal and perceived peer use and attitudes towards use of non-prescribed prescription sedatives and sleeping pills among university students in seven European countries.

INTRODUCTION: The use of non-prescribed prescription sedatives and sleeping pills (NPPSSP) among university students has been described as an important public health issue. However, the impact of perceived social norms on students' use and attitudes towards use of NPPSSP is still unclear. Our aim was to investigate whether perceptions of peer use and approval of use are associated with students' personal use and approval of NPPSSP use. METHODS: Cross-sectional data from the Social Norms Intervention for the prevention of Polydrug Use (SNIPE) project containing 4482 university students from seven European countries were analyzed to investigate self-other discrepancies regarding personal use and attitudes towards NPPSSP use. Associations between personal and perceived peer use and between personal and perceived approval of use were examined using multivariable logistic regression. RESULTS: The majority (51.0%) of students perceived their peers' NPPSSP use to be higher than their personal use. 92.6% of students perceived their peers' approval of NPPSSP use to be identical or higher than their personal approval. Students perceiving that the majority of peers had used NPPSSP at least once displayed higher odds for personal lifetime use (OR: 1.95, 95% CI: 1.49-2.55). Perceived peer approval of NPPSSP use was associated with higher odds for personal approval (OR: 5.49, 95% CI: 4.63-6.51). CONCLUSIONS: Among European university students, perceiving NPPSSP use and approval of use to be the norm was positively associated with students' personal NPPSSP use and approval of use, respectively. Interventions addressing perceived social norms may prevent or reduce NPPSSP use among university students. Final trial registration number: DRKS00004375 on the 'German Clinical Trials Register'.

The Social Norms of Suicidal and Self-Harming Behaviours in Scottish Adolescents.

Although the suicidal and self-harming behaviour of individuals is often associated with similar behaviours in people they know, little is known about the impact of perceived social norms on those behaviours. In a range of other behavioural domains (e.g., alcohol consumption, smoking, eating behaviours) perceived social norms have been found to strongly predict individuals' engagement in those behaviours, although discrepancies often exist between perceived and reported norms. Interventions which align perceived norms more closely with reported norms have been effective in reducing damaging behaviours. The current study aimed to explore whether the Social Norms Approach is applicable to suicidal and self-harming behaviours in adolescents. Participants were 456 pupils from five Scottish high-schools (53% female, mean age = 14.98 years), who completed anonymous, cross-sectional surveys examining reported and perceived norms around suicidal and self-harming behaviour. Friedman's ANOVA with post-hoc Wilcoxen signed-ranks tests indicated that proximal groups were perceived as less likely to engage in or be permissive of suicidal and self-harming behaviours than participants' reported themselves, whilst distal groups tended towards being perceived as more likely to do so. Binary logistic regression analyses identified a number of perceived norms associated with reported norms, with close friends' norms positively associated with all outcome variables. The Social Norms Approach may be applicable to suicidal and self-harming behaviour, but associations between perceived and reported norms and predictors of reported norms differ to those found in other behavioural domains. Theoretical and practical implications of the findings are considered.

The Associations Between Children's and Adolescents' Suicidal and Self-Harming Behaviors, and Related Behaviors Within Their Social Networks: A Systematic Review.

Social influences-including the suicidal and self-harming behaviors of others-have been highlighted as a risk factor for suicidal and self-harming behavior in young people, but synthesis of the evidence is lacking. A systematic review of 86 relevant papers was conducted. Considerable published evidence was obtained for positive associations between young people's suicidal and self-harming behavior and that of people they know, with those reporting knowing people who had engaged in suicidal or self-harming behaviors more likely to report engaging in similar behaviors themselves. Findings are discussed in relation to a number of methodological and measurement issues-including the role of normative perceptions-and implications for the prevention of suicidal and self-harming behavior are considered.

Normative Perceptions of Cannabis Use Among European University Students: Associations of Perceived Peer Use and Peer Attitudes With Personal Use and Attitudes.

OBJECTIVE: Perceptions of peer behavior and attitudes exert considerable social pressure on young adults to use substances. This study investigated whether European students perceive their peers' cannabis use and approval of cannabis use to be higher than their own personal behaviors and attitudes, and whether estimations of peer use and attitudes are associated with personal use and attitudes. METHOD: University students (n = 4,131) from Belgium, Denmark, Germany, the Slovak Republic, Spain, Turkey, and the United Kingdom completed an online survey as part of the Social Norms Intervention for Polysubstance usE in students (SNIPE) Project, a feasibility study of a web-based normative feedback intervention for substance use. The survey assessed students' (a) personal substance use and attitudes and (b) perceptions of their peers' cannabis use (descriptive norms) and attitudes (injunctive norms). RESULTS: Although most respondents (92%) did not personally use cannabis in the past 2 months, the majority of students thought that the majority of their peers were using cannabis and that their peers had more permissive attitudes toward cannabis than they did. When we controlled for students' age, sex, study year, and religious beliefs, perceived peer descriptive norms were associated with personal cannabis use (odds ratio [OR] = 1.42; 95% CI [1.22, 1.64]) and perceived injunctive norms were associated with personal attitudes toward cannabis use (OR = 1.46; 95% CI [1.09, 1.94]). CONCLUSIONS: European students appear to possess similar discrepancies between personal and perceived peer norms for cannabis use and attitudes as found in North American students. Interventions that address such discrepancies may be effective in reducing cannabis use.

Perception of High Alcohol Use of Peers Is Associated With High Personal Alcohol Use in First-Year University Students in Three Central and Eastern European Countries.

OBJECTIVES: The objectives of this study were to assess discrepancies between estimated peer and personal drinking behavior and to determine associations between perceptions of peer and personal drinking behavior among university students from Hungary (HU), Lithuania (LT), and the Slovak Republic (SK). METHODS: 2,554 freshman university students completed an online questionnaire on the frequency of their personal alcohol use, the number of heavy drinking occasions and on their perception concerning the corresponding drinking behavior of a typical student. Associations between perceived peer and personal use were analyzed by means of logistic regression, adjusting for sex. RESULTS: The majority of students across all countries thought their peers drink more frequently and are more often involved in heavy drinking occasions than themselves. Students who perceived the frequency of peer alcohol use to be higher were more likely to drink alcohol twice a week or more often (SR: OR = 3.81, 95% CI = 2.51-5.79; LT: OR = 3.16, 95% CI = 2.11-4.75; HU: OR = 2.10, 95% CI = 1.53-2.87) compared with students who drink alcohol monthly or less. Those who perceived the number of peer heavy drinking occasions as high were more likely to report heavy drinking weekly or more often (SR: OR = 3.16, 95% CI = 1.92-5.20; LT:OR = 3.56, 95% CI = 2.14-5.94; HU:OR = 1.41, 95% CI = 0.79-2.51) compared with students who report heavy drinking less than monthly. CONCLUSIONS/IMPORTANCE: University students perceived peer alcohol use to be higher than their personal use. Given the association between perceptions and personal alcohol use, future research should investigate if targeting perceptions in the surveyed countries may have an impact on alcohol use.